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Bone disease in multiple myeloma
Bone disease is a key feature of multiple myeloma.52 Nearly 80% of patients have
abnormalities in bone radiographs at diagnosis and up to 90% of patients develop bone complications over
the disease course.52-55 Bone disease is characterized by lytic lesions
commonly found in the vertebrae, ribs, skull, shoulders, pelvis, and long bones.54 Bone disease can lead
to severe bone pain, hypercalcemia, skeletal related events (SREs), and significant morbidity and
mortality in patients with multiple myeloma.7,54,56
What are osteolytic lesions and what is their impact?
Osteolytic lesions develop as a result of uncoupled bone remodeling found in
multiple myeloma.40,42,43 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.54,55 Approximately 40% of patients have SREs at diagnosis,
defined as spinal cord compression, pathological fracture, radiation to bone, and surgery to
bone.57 SREs cause significant burden to the patient including
disability, walking impairment, and bone pain due to pathologic fractures.58
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.59
Multiple myeloma skeletal related events52,54,57,60