title: Mechanisms of bone destruction in multiple myeloma: the importance of an unbalanced process in determining the severity of lytic bone disease.
abstract: In order to clarify the mechanisms involved in the occurrence of lytic bone lesions (BL) in multiple myeloma (MM), we have compared the presenting myeloma-induced histological bone changes of 14 previously untreated MM patients with lytic BL with those of seven MM patients lacking lytic BL at presentation despite similar myeloma cell mass. A major unbalanced bone remodeling (increased bone resorption with normal to low bone formation) was the characteristic feature of patients presenting lytic BL. Furthermore, this unbalanced process was associated with a significant reduction of bone mass. Unexpectedly, a balanced bone remodeling (increase of both bone resorption and bone formation, without bone mass reduction) rather than a true lack of an excessive bone resorption was the usual feature of patients lacking lytic BL. Our current work clearly shows that a majority (72%) of patients with MM present an important unbalanced bone remodeling at diagnosis, leading to bone mass reduction and bone destruction (unbalanced MM). Some patients (20%) retain a balanced bone remodeling with initial absence of bone destruction (balanced MM). Few (8%) patients have pure osteoblastic MM without bone destruction.
authors.affiliation: Department of Immunorhumatologie, Centre Gui-de-Chauliac, Hôpital Saint-Eloi, Montpellier, France.
authors.forename: R
authors.initials: R
authors.lastname: Bataille
authors.forename: D
authors.initials: D
authors.lastname: Chappard
authors.forename: C
authors.initials: C
authors.lastname: Marcelli
authors.forename: P
authors.initials: P
authors.lastname: Dessauw
authors.forename: J
authors.initials: J
authors.lastname: Sany
authors.forename: P
authors.initials: P
authors.lastname: Baldet
authors.forename: C
authors.initials: C
authors.lastname: Alexandre
mesh_terms: D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D001862:Bone Resorption; D006801:Humans; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology; D010014:Osteolysis; D011859:Radiography