Centre for Metabolic Bone
Diseases at Sheffield (World Health Organization Collaborating Centre),
University of Sheffield Medical School, Sheffield, United
Kingdom.
[Record supplied by publisher]
BACKGROUND: Myelomatosis
is associated with considerable skeletal morbidity, particularly bone pain and
fractures. Hypercalcaemia is a common presenting feature but less common after
adequate chemotherapy. These complications are caused by progressive focal and
generalized osteolysis due, in turn, to increased activation of osteoclasts by
osteoclast activating factors. These include tumor neorosis factor-beta,
interleukin-1, and interleukin-6. The knowledge that disturbed bone remodeling
is due to the activation of authentic osteoclasts provides the rationale for the
use of bisphosphonates in myelomatosis. METHODS: This article reviews the place
of bisphosphonates in the management of myeloma. RESULTS: There is good evidence
that hypercalcaemia can be corrected with intravenous or oral bisphosphonates,
and they are now the specific treatment of choice. Several studies have shown
that their intravenous administration is beneficial in the acute management of
bone pain due to malignancy, but studies in myelomatosis are lacking. In
contrast, a number of well designed controlled studies have shown significant
effects of long term treatment with clodronate and pamidronate to decrease the
incidence of skeletal complications in myelomatosis. Benefits reported are a
decreased incidence of bone pain, hypercalcaemia, vertebral and long-bone
fractures, and the extension of osteolytic lesions. There may be a beneficial
effect on survival, but this is much less certain. CONCLUSIONS: These agents
provide a valuable adjunct to the management of myelomatosis. Copyright 2000
American Cancer Society.
