Bone-related problems in multiple myeloma

1. What happens to the bones in multiple myeloma?

The human body constantly replaces the material in the bones by breaking down existing bone and replacing it with new bone. Bone disease, where bone break downs faster than it can be replaced, is common in multiple myeloma, affecting about 85% of people with the disease. When multiple myeloma damages bones, it can lead to fractures, pain, muscle weakness, numbness, pins and needles, and too much calcium in the blood. Multiple myeloma mostly affects the spine, but can affect any bone, especially the longer bones in the legs and arms.

2. Pain in bone disease

Bone disease, fractures, or nerve damage near the bones can cause pain. This pain can affect your ability to move, socialize, and work, and also your energy level and mood. Treating bone disease and pain is very important to help people with multiple myeloma to live their lives to the fullest.

3. Treatment of bone disease

Treating bone disease may reduce the amount of pain you feel. The most common treatment options include a group of medicines called bisphosphonates, irradiation of damaged areas of a bone (radiotherapy), or surgery.

• Bisphosphonates: These are treatments that strengthen bones and prevent them from breaking. Bisphosphonates can cause local reactions at the injection site and problems with your kidneys, and some bisphosphonates can affect your teeth and jaw. These side effects can be treated with supplements that provide extra vitamin D3 and calcium, or by reducing or temporarily stopping the bisphosphonate treatment. Bisphosphonates can also help to reduce calcium levels in people who have too much calcium in their blood
• Radiotherapy: This treatment uses radiation to kill cancer cells, allowing new bone to grow
• Surgery: Surgery is used to treat bone disease in the spine. Broken back bones are fixed with a special bone cement, sometimes using a small balloon to keep the bones the correct distance away from each other and prevent damage to your nerves. Surgery may also be necessary if there are fractures in your back, arms, or legs that might damage the nerves, or if there is pressure on a nerve that affects your ability to move
• Devices to aid mobilization: Wearing a back or neck brace, or having a surgeon insert rods, nails, or plates, helps to stabilize the spine and may help to prevent more bone damage or nerve compression and relieve pain
• Multiple myeloma treatment: The medical treatment you receive to kill the cancerous myeloma cells can also help to prevent bone disease getting worse.

4. Treatment of pain caused by bone disease

As well as making bones stronger using the treatments described above, pain caused by bone disease can be treated with medicines, diet and lifestyle changes. Depending on what kind of pain is present, the pain treatment may be different, but you should always speak with your healthcare team before changing treatment.

Your healthcare team can also help to recommend pain treatments that can be bought over the counter at the pharmacy or prescribed by your doctor. Pain can also be reduced by lifestyle changes, including gentle exercise and avoiding smoking and drinking too much alcohol. Exercise helps to maintain mobility, increases bone health, and reduces pain and stress. Eating healthily is very important because this may help prevent nerve and bone damage and can also reduce stress. Your healthcare team may recommend supplements for calcium and vitamin D to keep your bones healthy. You might also like to try other complementary treatments to treat pain, such as massage, applying heat or cold to painful areas, physical therapy, acupuncture, counseling, meditation, hypnosis, or use of a low-voltage electric current (transcutaneous electrical nerve stimulation, also known as a TENS machine).

5. Caregivers of patients with limited mobility

If you look after someone with multiple myeloma who is not able to move very easily due to bone disease, then you may need to help them with some everyday tasks. These might include getting in or out of bed, chairs, or the shower, or helping them to be more comfortable in their chair or bed. They might also need help with keeping track of when they should take their medicines.

6. Communication with your healthcare team

Patients with multiple myeloma should let their healthcare team know about their pain symptoms so that they can work together to best treat it. Inform your healthcare team about how your treatments are making you feel and any new pains that have developed. You should always talk with your healthcare team before taking any new treatments, even those you can buy over the counter. If you feel severe pain, you should contact emergency services, and if your pain does not improve then you may need to be referred to a pain specialist for more specific treatment.