Myelom-Gruppe Rhein-Main

Last modified: 12 January 2013

Treatment with bisphosphonates

Patient Guide for Myeloma Bone Disease and Bisphosphonates

This brochure aims to

  • Help you understand more about myeloma bone disease
  • Help you understand more about bisphosphonate treatment
  • Provide answers to questions you may have about myeloma bone disease
  • Help you make informed treatment decisions

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One of the most frequent symptoms encountered by patients that ultimately leads to the diagnosis of multiple myeloma patients, is the occurrence of bone pain, in particular in the spinal column and ribs. The pain is caused by the destruction of bone material, in turn brought about by the myeloma cells. Bisphosphonates are part of the standard therapy for multiple myeloma. They can slow down the bone-destroying process.

Myeloma cells produce factors which stimulate the activity of the cells regulating the bone destruction activity (osteoclasts) and lead to increased bone resorption. It is thought that local factors play a role, which means that bone resorption is most pronounced in areas where myeloma cells are found. This mainly affects the whole spinal column, the pelvis and the pelvic girdle, but also the cranial bones, shoulders and the bony thorax. The aim of treatment with bisphosphonates is to suppress the excessive activity of the osteoclasts. Patients treated often experienced a considerable reduction in their bone pain.

Bisphosphonates are a relatively safe form of medicine. However, they can lead to influenza-like symptoms and, when used for the first time, can even cause a temporary increase in the bone pains. All bisphosphonates can cause kidney problems if infused (introduced) too quickly. Despite the absence of any long-term studies in this respect, life-long treatment with bisphosphonates is recommended for myeloma patients, whereby the kidney function must be monitored on a regular basis.

Bisphosphonates probably prevent the further destruction of bone but do not, however, lead to any regression of existing damage. Although there are no studies on this, some doctors treat their patients with bisphoshonates even in the early stages of myeloma as a precautionary measure. Laboratory studies have shown that bisphosphonates can destroy myeloma cells.

Symptoms of so-called osteonecrosis can occur from time to time with patients treated with bisphosphonates. This is bone destruction in the jaw. The results can be pain, loose teeth, sharp edges of free-lying bone tissue and the breaking off of small parts of bone. The initial symptoms are frequently swelling, a sense of numbness and pain. With oral surgery operations, the healing process can be seriously impaired. Thus far it is not known whether the type of bisphosphonate plays a role and whether other factors (for example radiation, other medicine, dental pre-treatment) have any influence.

Until such time as these questions are clarified, myeloma patients are advised to inform the dentist of their treatment with bisphosphonates if applicable. In the event of the problems outlined occurring, the treatment should be interrupted for two to four months. The use of antibiotics is recommended for treating infections in the jaw area.