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Sydney 2005:
New Advances in the Management of Myeloma Bone Disease
By James Berenson, MD
Dr. Berenson presented new advances in the management of myeloma bone disease. A clinical consequence of MM is bone disease in non-vertebral bones and vertebral bodies, ultimately leading to spinal compression and impacting the patient's quality of life and survival. A review of a 21-month period showed that more than half of patients with MM develop bone fracture requiring radiotherapy. Vertebral compression is the most common complication leading to bone pain. Kyphoplasty, a minimally invasive and simple procedure, expands the collapsed vertebral body thereby reducing pain and improving patient function. An important therapy in managing patients with MM includes the use of bisphosphonates. Most of the trials of the last decade have shown a marked reduction of bone fractures with the use of IV bisphosphonate (pamidronate). More recently, the introduction of zoledronic acid, a more potent treatment, has shown to be effective in managing patients with MM and breast cancer. Dr. Berenson reviewed a trial comparing this newer agent to the pamidronate. The results from this trial showed that zoledronic acid was as effective as pamidronate; however, the infusion rate of zoledronic acid was modified to reduce the risk of renal impairment. Dr. Berenson advised the supplemental use of oral vitamin D and calcium with the administration of bisphosphonates to optimize the patient’s bone health. A possible risk of bisphosphonate use is osteonecrosis of the jaw. Several treatment options for osteonecrosis include good oral hygiene as prophylaxis and throughout the duration of treatment, as well as intermittent antibiotic use. He cautioned against surgical intervention. Dr. Berenson closed by comparing the benefit to risk ratio of bisphosphonate use. Benefits include reduced bone fractures, less radiotherapy, and decreased bone pain.

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