Multiple Myeloma: Support for Bone-Related Problems

As multiple myeloma progresses, it can weaken your bones and increase your risk of fractures and bone pain. Myeloma cells can form tumors within the bone marrow, eventually spreading beyond the marrow space to damage the bone tissue. In addition, myeloma cells can induce bone marrow cells to remove calcium from the bone, which causes soft spots called osteolytic lesions.

If you experience bone fractures, our surgeons can use metal rods and plates to provide support to weight-bearing bones. Our doctors may also suggest you wear a back brace or a neck brace to support bones and relieve pain.

Slowing Bone Loss with Bisphosphonates

Over the past 15 years, our physicians have used a group of drugs called bisphosphonates in myeloma patients to slow bone loss. Bisphosphonates are commonly used to treat osteoporosis, the thinning of bone tissue and loss of bone density associated with aging. At higher doses, bisphosphonates can halt the progression of bone destruction in myeloma and other cancers. By preventing bone destruction, these agents also provide pain relief.

Bisphosphonate therapy for myeloma is given intravenously (through the vein) on a monthly basis. Unlike pain relievers, which start working immediately, bisphosphonates take some time to strengthen the bones, but eventually provide protection against fractures that result in pain.

Our doctors will review the side effects of bisphosphonates with you before prescribing them. In rare cases, bisphosphonate therapy can cause damage to kidneys or the jawbone. We will also provide detailed information and guidance to help you and your dentist manage any side effects of the jaw. You will be instructed to not take bisphosphonates if you are undergoing invasive dental procedures such as extractions and to wait until your mouth has completely healed before resuming bisphosphonates.

Shrinking Bone Tumors

Bone damage also can be treated using radiation therapy given to the affected area. Our doctors will direct an external source of high-intensity x-rays at bone tumors, causing them to shrink. Memorial Sloan Kettering doctors use state-of-the-art techniques such as image-guided radiation therapy (IGRT) to target the radiation beams to the specific site of the tumor with great precision.

When the myeloma cells die, the bone begins to replace the lost cancer tissue and becomes stronger, less painful, and less likely to break.

Spinal Problems

Back pain is often the first symptom of multiple myeloma, but because back problems are common, they might not initially be associated with the disease. However, a backache that lasts for months can be a signal that multiple myeloma is affecting bones in the spine and/or the ribs.

Sudden, severe back pain can be a sign of a fracture or of the collapse of a vertebra in the spine. Rapid escalation of pain or pain associated with muscle weakness may indicate a fracture causing spinal cord compression, which are conditions that need to be addressed urgently. Shooting pains in the arms and legs can also indicate that a tumor in the spinal column is pressing on nerves in that area.

You should notify your doctor immediately if you have these symptoms.

Experts in Spine Stabilization

Our doctors use a multidisciplinary approach to address damage to the vertebrae of the spine in people with multiple myeloma. Memorial Sloan Kettering’s spine tumor team includes international leaders in neurosurgery, orthopaedic surgery, radiation oncology, and neuroradiology who are innovators in the field.

Our interventional radiology team uses nonsurgical techniques to stabilize the spine and repair vertebral fractures prior to radiation therapy or surgery. These minimally invasive therapies are also used to provide pain relief for tumors that do not respond to radiation.

In a therapy called vertebroplasty, the physician injects a special kind of bone cement directly into a collapsed vertebra. Another technique is kyphoplasty, in which a small balloon called a tamp is inserted into the vertebral body and inflated. This creates a space into which the bone cement is then injected. The procedures are usually performed on an outpatient basis and can help improve your mobility and quality of life.

In patients for whom kyphoplasty is not effective, our interventional radiology team is beginning to explore the efficacy of inserting a stabilizing rod through the skin to provide spine support and avoid the need for surgery.