Bone health in multiple myeloma: Expert shares ways to manage skeletal complications

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New Delhi: One of the most defining features of multiple myeloma is bone health degeneration. As per reports of the World Cancer Research Fund International, bone health can be enhanced through certain types and intensities of physical exercise. Multiple Myeloma is a type of cancer which arises in the bone marrow tissue present inside the bones. As can be expected from its location, it causes degeneration of bone health, which can present to the doctors as pain, tumours in bones or even frank fractures.

Dr Sahil Gaba, consultant, Orthopaedic and joint replacement, Amrita Hospital Faridabad shared with News9, “When diagnosed with this condition, your Oncologist and Orthopaedic surgeon will generally carry out a complete skeletal survey, conventionally with radiographs, but now more commonly with PET scan or whole-body CT. This will help formulate a personalised treatment plan for the patient.”

As bone mass decreases in multiple myeloma, certain drugs are used to increase bone mass and reduce the risk of fractures. According to Dr Gaba, “The most commonly used drugs are Zolendronic acid and Denosumab. Regular exercise can also maintain bone mass. A diet rich in calcium and vitamin D is suggested, and supplements may also be given. These measures will not only reduce the risk of fractures but also reduce bone pains in these patients. Bone pain may be treated by painkillers, but take these only after a discussion with your doctor as some painkillers can cause kidney problems.”

Bone Health in Multiple Myeloma

Radiation Oncologists may also be involved in the treatment. Radiotherapy can be used to kill cancer cells and reduce bone pain. One common manifestation of the disease is compression fractures of vertebrae, the bones that make up the spinal column. These are very painful and can cause neurological compromise as well. Two commonly used procedures for this are vertebroplasty and kyphoplasty. Vertebroplasty involves injecting cement into the bone, while kyphoplasty involves inflating a balloon in the vertebra followed by cement injection.

In case of fractures or impending fractures of long bones like the femur, surgical stabilisation of the fracture is required, most commonly by inserting rods in the bones. Spinal instrumentation may also be needed in patients with an unstable spine.

As can be inferred, optimal management of such patients involves a multidisciplinary approach.

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