Bone disease in Multiple Myeloma

Dr.Srinivasan Narayanan

Consultant Haematologist

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Contact 956622253/ [email protected]

Myeloma is a type of cancer, usually arising in the bone marrow plasma cells producing abnormal proteins. It can affect the bones in up to 80% of the patients with this condition, causing bone pain and weak bones that can lead to fractures. The backbone, ribs, hips, long bones on the arms and legs are the commonly affected areas in this condition.

The most common symptoms of myeloma are unusual tiredness due to anaemia, recurrent infections, high calcium levels, kidney damage, bone pain and fracture of the bone.

Cancerous plasma cells produce abnormal substances, which lead to bone destruction by releasing the bone strengthening minerals and preventing new bone formation. This can eventually cause a “Pathological” fracture.

Some diseases such as Myeloma, other cancers, infections can weaken the bones, which lead to a fracture of the bone spontaneously or with trivial injury only.

If Multiple myeloma is suspected, blood test to check full blood count, renal functions, calcium and immunoglobulins (abnormal proteins in blood and urine) will be helpful to determine if this is a possibility.

If any of these tests are abnormal, bone marrow biopsy and X-rays (sometimes MRI scans) are done to look for abnormal plasma cells in the marrow and bone diseases respectively, to confirm the diagnosis.

Chemo/radiotherapy: If bones are affected with myeloma, it suggest active disease requiring treatment with chemotherapy, and this will help to reduce further bone damage. Low dose radiotherapy to the most affected bone is given, which helps to reduce pain.

Bisphosphonates: Bone strengthening medications called ‘Bisphosphonates’ are routinely used to reduce bone pain, prevent further breakdown of the bone and reduces the risk of bone fractures.

Surgery: Long bone fractures or bones ‘at risk’ of fracture should be fixed with surgery and the type of surgery required will depend on the type of fracture, proximity to the joints and the extent of bone disease.

Vertebral fracture causes loss of height and can compromise mobility. Minimally invasive procedures such as “Vertebroplasty” or “Kyphoplasty” are used to regain the lost height, reduce bone pain and maintain the normal bone alignment.

Vertebroplasty is done under radiological guidance by spinal surgeons. A type of bone cement is injected into the spine to strengthen and stabilise the bone. This helps to reduce bone pain and improve mobility.

Kyphoplasty is similar to Vertebroplasty, but involves inserting and inflating a balloon in the vertebral bone and then the bone cement is injected.  This also helps to regain the height and the shape of the collapsed vertebrae.