Effective treatment with preventing skeletal-related event development in multiple myeloma patients

Introduction: Osteolytic bone disease is the hallmark of multiple myeloma (MM) patients caused by an excessive osteoclast activation and impaired osteoblast function. It occurs in up to 80-90% of patients at the diagnosis or during the disease. Osteolytic lesions lead to skeletal-related events (SREs) such as pathological fractures, severe bone pain or spinal cord compression. Consequently, SREs are associated with reduced quality of life and potentially decreased survival. Areas covered: Bone-targeted therapy with bisphosphonates (BPs) including zoledronic acid or pamidronate has long been the standard of care, showing a significant effect on the prevention of the SREs; however, renal toxicity may limit their use. Denosumab, a monoclonal antibody anti-RANKL has been approved for the treatment of bone disease also in patients with renal insufficiency. The efficacy and the possible toxic effects of these drugs are discussed in this review balancing effective treatment with preventing SREs development in MM patients. Expert opinion: Bone modifying agents (BMAs) including BPs and denosumab are effective in the prevention of SREs in MM patients. Overall, these drugs are manageable with a low incidence of side effects. The effect of BMAs on MM patient survival in the era of the new drugs is still debated.