Bone-Related Problems in Multiple Myeloma


Multiple myeloma can weaken your bones and increase your risk of fractures and bone pain. Myeloma cells can form tumors within the bone marrow and spread from the marrow to damage the bone tissue. Myeloma cells can cause bone marrow cells to remove calcium from the bone, which causes soft spots called osteolytic lesions.

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

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Slowing Bone Loss with Bisphosphonates

Our doctors use a group of drugs called bisphosphonates to slow bone loss in people with myeloma. Bisphosphonates are commonly used to treat osteoporosis. That’s the thinning of bone tissue and loss of bone density associated with aging. At higher doses, bisphosphonates can halt the progression of bone destruction due to myeloma and other cancers. Preventing bone destruction also relieves pain.

Bisphosphonate therapy for myeloma is given intravenously on a monthly basis. Unlike pain relievers, which start working immediately, bisphosphonates take some time to strengthen the bones. Eventually, they provide protection against fractures.

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 provide detailed information and guidance to help you and your dentist manage any side effects in the jaw. If you are undergoing extractions or other invasive dental procedures, you will need to wait until your mouth has completely healed before taking bisphosphonates.

Shrinking Bone Tumors

Bone damage can be treated using radiation therapy 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, to target the radiation beams to the specific site of a tumor with great precision.

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

Spinal Problems

Back pain is often the first symptom of multiple myeloma. 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 the bones in the spine or 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. Shooting pain in the arms or legs can mean 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. MSK’s spine tumor team includes international leaders in neurosurgery, orthopedic surgery, radiation oncology, and neuroradiology.

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

Minimally Invasive Spine Surgery Center
Learn how our doctors use minimally invasive techniques to remove tumors and stabilize the spine so patients can recover more quickly.

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

For people for whom a kyphoplasty is not effective, our interventional radiology team is exploring whether it helps to insert a stabilizing rod through the skin for spine support. This could avoid the need for surgery.