Myeloma bone disease: A constant problem in the changing landscape of myeloma management

Outcomes for patients with multiple myeloma have improved markedly in recent years due to the introduction of highly effective immune-mediated anti-myeloma therapies in both newly diagnosed and relapsed patients. Conversely, while patients are living longer, myeloma bone disease continues to contribute significantly to morbidity and mortality. Routine incorporation of anti-resorptive therapies into patient management is recommended by consensus guidelines; however, patients continue to sustain skeletal-related events, including pathological fractures. In this review, we discuss the diagnosis and pathogenesis of myeloma bone disease and the evidence underpinning guideline recommendations for the use of bisphosphonates in patients with myeloma. We consider novel approaches to reducing bone disease presented by targeting osteoblastic activity, the impact of anti-myeloma therapies themselves on bone disease and the role of biomarkers to monitor disease activity and guide the intensity and duration of bone-targeted therapy.