Treatment of multiple myeloma bone disease: experimental and clinical data.
BACKGROUND
Bone disease is present in the majority of patients with multiple myeloma and can seriously affect quality of life and survival rate. In addition to suppression of osteoclastogenesis, there have been developments made in terms of the therapeutic agents available, such as novel immunomodulating agents, proteasome and receptor activator of nuclear factor κB ligand inhibitors.


METHODS
AREAS COVERED include in vitro, in vivo and clinical evidence was collected using MEDLINE (1950 - May 2014), EMBASE (1980 - May 2014) and Google Scholar (1980 - May 2014) databases.


CONCLUSIONS
Bisphosphonates are the mainstay of myeloma bone disease treatment. Oral clodronate and intravenous pamidronate and zoledronic acid are currently used drugs and seem to have comparable results in preventing skeletal-related events of the disease. Zoledronate can also have survival benefits and based on the available evidence is the superior bisphosphonate; however, its side effects have to be monitored. Denosumab had comparable results with zoledronate on myeloma bone disease treatment; its use has not been completely proven yet. There is an expanding set of drugs, proteasome inhibitors, under investigation with great potential to reduce the negative effects of myeloma cells on bone. Future clinical studies should compare both the catabolic and anabolic effects of these agents on bone.
Aristotle University Medical School, "PapaGeorgiou" General Hospital, Academic Orthopaedic Unit , Thessaloniki , Greece etsiridis@doctors.org.uk.
Yvonne Mary
YM
Papamerkouriou
Eustathios
E
Kenanidis
Zakareya
Z
Gamie
Kyriakos
K
Papavasiliou
Thomas
T
Kostakos
Michael
M
Potoupnis
Ioannis
I
Sarris
Eleftherios
E
Tsiridis
John
J
Kyrkos
D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001847:Bone Diseases / Q000209:etiology / Q000628:therapy*; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy*; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D000077268:Pamidronate; D011788:Quality of Life; D000077211:Zoledronic Acid
D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D004164:Diphosphonates; D007093:Imidazoles; D000069448:Denosumab; D000077211:Zoledronic Acid; D000077268:Pamidronate
bisphosphonates; bone; immunomodulation; multiple; myeloma; osteoclast; proteasome