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Spring 1994 Volume 1, Issue 6:
Bone Problems In Multiple Myeloma Highlights Of A Discussion At The 2nd Annual Patient Seminar
One of the questions covered at the second annual patient seminar was: What can be done specifically about the bone problems that develop in myeloma
Obviously, bone problems are among the most common and disabling aspects of multiple myeloma. Active myeloma both destroys the bones as well as blocking bone healing. The bone destruction is painful in itself and leads to great weakening of the bones such that fracture or collapse (e.g. of a vertebra) is common.

If multiple areas of bone are painful or are causing trouble, the best approach is to attempt to achieve overall control of the myeloma using chemotherapy. If there is an acute localized problem, for example with collapse of a vertebra or with pressure on a nerve, local radiation treatment is extremely useful both to relieve the pain and reduce any pressure upon vital tissues. Myeloma does not always show on routine x-ray pictures, and MRI or CT scanning may be essential to identify the exact problem. Until pain is controlled with chemotherapy and/or radiation, proper use of narcotics and other measures to control pain are essential. (Pain control is discussed in Volume 1 Number 8 of Myeloma Today.).

Other very helpful measures include temporary use of a back brace or back support to stabilize the spine or rib cage areas and reduce pain with movement. Typically these are not recommended for long term use since measures should be directed towards relief of the pain, but support by a brace or a corset can be dramatically helpful in the early stages of remobilization following a period of active myeloma.

Management of bone problems is also important on a long term basis. Patients can have difficulty with everything from rolling over in bed, to getting up, walking, breathing and eating. General physical rehabilitation may be crucial in an effort to return to more normal activities. It is obviously important to keep the lungs expanded to prevent the development of infection. If there has been spinal collapse and curvature, eating small meals may be helpful in avoiding discomfort with eating.

What can be done to strengthen the weakened bones? By gradually increasing your exercise routine, bone healing can be stimulated. Walking and swimming are useful and safe. The best tactic is to achieve the best possible response with standard or high dose chemotherapy. Patients who have a very complete response to chemotherapy are the most likely to have bone healing and some recovery of function and physical activity. This is one of the advantages of high dose chemotherapy with transplantation support, which produces the best quality of remission.

Overall bone density can be improved in patients who are in a stable remission phase using extra calcium in the diet as well as vitamin D supplements. A useful source of extra calcium is Tums antacid tablets. Since it is important not to take extra calcium and vitamin D when myeloma is in an active phase, such supplements should only be used in consultation with a patient's primary physician. An additional type of drug which can improve bone strength is bisphosphonates. Outside of the US, clodronate is a type of dichloro bisphosphonate available in oral capsule form. This blocks the tendency for bone destruction and can accelerate bone healing. A similar drug which is now available in the United States is pamidronate (Aredia), which is available by intravenous injection. Although only studied very recently in multiple myeloma, it seems that it can also produce benefit in terms of recovery of bone strength when administered on a regular basis every one to two months for a period of several injections. Using this schedule, improvement in bone pain is common and it is possible to document improvement in bone strength using densitometry measurements.

These are just some of the considerations in dealing with the very troublesome bone problems which can emerge in patients with multiple myeloma. Because of these specialized problems it is a topic which can be usefully explored through the IMF patient to patient network. Other patients who have faced similar problems can discuss how they have managed to solve this or that difficulty and perhaps give some helpful tips or suggestions that you can explore with your own personal physician. It is important not to get too discouraged during the acute active phase of myeloma. When remission is achieved, remarkable improvement in bone pain can occur. Talking to someone in remission can be helpful in gaining some reassurance about what is possible.

In Myeloma Today Volume 1 Number 7, Dr. Francesca Thompson contributed an article focusing in detail on bone disease. The article is entitled, "Myeloma is Also a Bone Disease, A Primer For Patients And Their Doctors".

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