Ask the Nurse: myeloma bone disease

Updated: 01/05/2024

Myeloma bone disease is one of the most common complications of myeloma and affects around 9 out of every 10 patients at some point. For many myeloma patients, it is the complication that has the biggest impact on their lives. It can cause pain and mobility issues, and in rare cases, can cause serious complications. Although myeloma bone disease is not reversible, there are ways to slow its progression, prevent further damage and manage the effects. 

In this month’s blog, we answer some of the questions you ask our Myeloma Infoline team about myeloma bone disease. 

What is myeloma bone disease?

Myeloma cells in bone marrow can disrupt the normal maintenance of the bones. This causes bones to become thinner, weaker and prone to breaks or fractures. 

Bone is a living tissue containing blood vessels, nerves and cells. Bones are constantly being renewed, with old bone being broken down and new bone being created. This ensures that the bones of the body maintain their thickness, strength and health. This renewal process is called remodelling. 

Myeloma cells disrupt this delicate balance by producing chemical signals which cause the bone to break down faster than it can be rebuilt. This results in areas of thinned bone and holes which are called lytic lesions. 

How is myeloma bone disease diagnosed?

Because myeloma bone disease is a common complication at diagnosis, bone imaging tests are carried out alongside other tests to confirm a myeloma diagnosis. Sometimes, you may have imaging tests repeated at other times, particularly if you have new symptoms of bone-related disease at relapse. 

There are different imaging tests that might be used to help to identify affected bones and lytic lesions, depending on the circumstances. These include: 

  • X-rays – a series of X-rays investigating large portions of the body are called skeletal surveys 
  • Magnetic resonance imaging (MRI) 
  • Computerised tomography (CT) scan 
  • Positron emission tomography (PET) scan combined with CT scan (PET-CT scan) 

You can find out more about these tests, and other investigations for myeloma in our Tests and investigations in myeloma Infoguide

How is myeloma bone disease treated?

Currently, there are no treatments to repair bone damage already caused by myeloma. 
However, supportive treatments can be used to slow or prevent further damage, reduce pain or improve mobility. 

Successfully treating myeloma is the main way to prevent bone damage. Effective anti-myeloma treatments slow the progression of myeloma bone disease which in turn can ease pain.  

Bisphosphonates, such as zoledronic acid (Zometa®), are an important type of supportive treatment given to people with myeloma to prevent bone complications (e.g. fractures). They work by slowing down further bone breakdown and can help to reduce pain.  

You will likely receive bisphosphonates for at least two years following diagnosis, and again at relapse. Take a look at our blog about bisphosphonate treatment to find out more. 

How are the complications of myeloma bone disease managed?

Myeloma bone disease is a common complication of myeloma which many patients will experience at some point, but the extent of bone disease and the way it affects people can vary.  

Whilst damage caused by myeloma bone disease can’t be reversed, there are other treatments and interventions for managing the complications of myeloma bone disease. These include: 

  • Painkillers – there are many different types of painkillers used in myeloma so do talk to your healthcare team about your options to help find the one that works best for you. If you are having persistent problems with pain, ask to be referred to a pain specialist 
  • Radiotherapy – can be used to relieve localised pain by killing myeloma cells in a specific area 
  • Surgical interventions used to strengthen areas of bone that have fractured or are at risk of fracturing. Surgical interventions are usually only considered when the myeloma is under control 

If you feel affected by complications like pain and reduced mobility, do speak to your healthcare team and find out which patient support services are available. Living with pain can impact mental health, but your team can also help with support for your mental wellbeing. 

If your quality of life is impacted by your myeloma bone disease you can ask to be referred to palliative care. Although often associated with end-of-life care, palliative care teams are specialists in the management of symptoms and complications at all stages of illness. 

Can myeloma bone disease cause spinal fractures?

Although myeloma bone disease increases the risk of fractures, not all patients will experience them. However, some do experience serious fractures which can have lasting impact on quality of life.  

Sometimes, fractures occur in the vertebrae (the individual bones of the spine) causing them to collapse. These are known as spinal fractures, or vertebral compression fractures (VCFs). These can be serious and must be investigated by your healthcare team, but the damage can often be managed.  

You can read more about VCFs and the different treatment options, depending on your circumstances, in our Managing spinal fractures in myeloma Infoguide. If you are diagnosed with a VCF, your healthcare team will advise which options are most suitable for you. 

Managing complications of VCFs can be challenging. Some people find coming to terms with changes to their appearance difficult if they experience a forward curvature of the spine (kyphosis) or loss of height.   

Remember that you can talk to your healthcare team if you need support with the physical or emotional impacts of myeloma. You might also find it helpful to check our tips for maintaining your sense of self

Can calcium and vitamin D supplements help?

Taking calcium and vitamin D supplements will not repair the damage caused by myeloma bone disease and there is no evidence that they prevent the progression of myeloma bone disease or reduce the risk of fractures. 

However, because some bisphosphonate treatments can cause side effects like low calcium levels (hypocalcaemia), your healthcare team may recommend calcium and vitamin D supplements to help maintain healthy levels of calcium in your body. 

Even if you are not taking bisphosphonates, the NHS recommends that all adults in the UK consider taking a daily supplement containing 10 micrograms of vitamin D during autumn and winter. This is because at these times of the year, the sun on the skin is not strong enough for the body to make vitamin D, and it can be difficult to get all you need from diet alone. 

Always let your haematologist know about any supplements you are taking, or before starting a new one. This helps them to make you aware of any possible interactions with your prescribed medications or offer advice about the most effective times to take them. 

You can read more about myeloma bone disease in our Myeloma bone disease Infoguide or watch the recording from our Myeloma bone disease Digital Infoday Session

If you have any further questions or need support, contact us through the Myeloma Infoline at 0800 980 3332 (UK) or 1800 937 773 (Ireland) or use our Ask the Nurse email service.  

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