Bone disease is a key feature of multiple myeloma.37 Nearly 80% of patients have abnormalities in bone radiographs at diagnosis and up to 90% of patients develop bone complications over the disease course.37-40 Bone disease is characterized by lytic lesions commonly found in the vertebrae, ribs, skull, shoulders, pelvis, and long bones.39 Bone disease can lead to severe bone pain, hypercalcemia, skeletal related events (SREs), and significant morbidity and mortality in patients with multiple myeloma.6,39,41
Osteolytic lesions develop as a result of uncoupled bone remodeling found in multiple myeloma.37,39,40 This dysregulation results in the development of lesions that appear as holes in the radiograph and rarely heal, even when patients are in remission, and may result in skeletal related events.39,40 Approximately 40% of patients have SREs at diagnosis, defined as spinal cord compression, pathological fracture, radiation to bone, and surgery to bone.42 SREs cause significant burden to the patient including disability, walking impairment, and bone pain due to pathologic fractures.43
Patients with prior SREs are at a greater risk of experiencing subsequent SREs. In addition, studies have shown that compared with other malignancies, patients with multiple myeloma have the highest incidence of pathologic fracture (43%), which can contribute to increased morbidity.44
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