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Ask The Nurse: myeloma bone disease

Ask The Nurse // 1st February 2021

One of the most common complications of myeloma is myeloma bone disease, with it affecting around 90% of patients at some point over the course of their myeloma. It can cause pain and mobility issues, and in rare cases can cause serious complications such as spinal cord compression. For many myeloma patients it is the complication that impacts their life the most and we regularly get calls and questions from patients and carers wanting to know more about it and what they can do prevent it or treat it.

In this month’s blog, we answer your questions about myeloma bone disease.

What is myeloma bone disease?

Myeloma bone disease occurs when bones become thinner, weaker and prone to breaks due to the presence of myeloma cells in the bone marrow.

Although bone is made up of minerals, it is a living tissue containing blood vessels, nerves and cells. It is not static and like other tissues of our body (e.g. skin) it is in a constant state of renewal. In the bones, this renewal process is called remodelling. It is a delicate balance with the cells responsible for bone building and bone breakdown working in harmony to ensure healthy bone is maintained.

Myeloma cells disrupt this delicate balance. They produce chemical signals which cause the bone to break down faster than it can be rebuilt, resulting in areas of thinned bone and holes (lytic lesions).

How is myeloma bone disease treated?

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

Anti-myeloma treatment: Successfully treating the myeloma is the main way to prevent bone damage. It reduces the progression of myeloma bone disease which in turn can ease pain.

Bisphosphonates: A type of supportive drug given to prevent bone complications (e.g. fractures). They work by slowing down further bone breakdown.

Painkillers: There are many different types of painkiller used in myeloma. It is important that you find one that works best for you, so speak to your healthcare team if a particular painkiller is not working or is causing side effects. If you are having persistent problems with pain, you can ask to be referred to a pain specialist.

Radiotherapy: Radiotherapy can be used to relieve localised pain by killing myeloma cells in a specific area.

Surgical interventions: These can be used to strengthen areas of bone that have fractured or are in danger of fracturing. Please note surgical intervention would not occur until the myeloma itself is under control.

Patient support services: Many patient support services can help with pain and mobility issues. 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. They offer a holistic approach and focus on quality of life.

Living with pain can also impact mental health, so if you are struggling speak to your team about support for your mental wellbeing.

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, if you are receiving bisphosphonates as part of your supportive treatment, you may be advised to take calcium and vitamin D supplements. This is because low calcium levels (hypocalcaemia) have been reported as a potential side effect of bisphosphonates, so supplements will help maintain the calcium levels in your body if necessary.

Even if you are not taking bisphosphonates, calcium and vitamin D are important nutrients for bone health and you need to make sure you are getting the right level from your diet to keep your bones healthy and strong.

For most people there is no need to take a calcium supplement. However, vitamin D is a little different. Many people in the UK have low levels of vitamin D during autumn and winter because of the lack of sunlight. Therefore, it is recommended that all adults in the UK (including myeloma patients) consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

If you decide to take a supplement, it is very important to let your haematologist know in the first instance.

Is bone damage inevitable and is it reversible?

Myeloma bone disease is a common complication of myeloma, however, the extent of bone disease differs between patients and is not always inevitable. Although myeloma bone disease increases the risk of fractures, not all patients will experience them. Furthermore, serious fractures, like spinal collapse or spinal cord compression, are rare. Bone damage can be prevented by detecting myeloma and/or subsequent relapses early, assessing the extent of bone disease accurately and getting the right treatment including bisphosphonates. It is currently recommended that all myeloma patients, even those without signs of myeloma bone disease, receive a bisphosphonate for up to two years following diagnosis and again at relapse.

 

For more information about myeloma bone disease, you can read the Myeloma UK “Bone disease and bisphosphonates Infoguide”, which is available to download from the Myeloma UK website.

If you have any questions about myeloma bone disease or complications of myeloma you can get in touch with us through the Infoline (0800 980 3332 (UK) or 1800 937 773 (Ireland)) or the Ask The Nurse email service.

Best wishes
The Myeloma Information Specialists