Biology and treatment of myeloma related bone disease

• Published in: Metabolism, clinical and experimental Vol. 80; pp. 80 - 90
• Main Authors: Terpos, Evangelos, Christoulas, Dimitrios, Gavriatopoulou, Maria
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018
• Subjects: Animals; Bone Density Conservation Agents - therapeutic use; Bone disease; Bone Diseases - etiology; Bone Diseases - physiopathology; Bone Diseases - therapy; Bone Remodeling; Diphosphonates - therapeutic use; Humans; Multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - physiopathology; Multiple Myeloma - therapy; Receptor activator of nuclear factor-kB ligand (RANKL); Wnt pathway; Receptor activator of nuclear factor-kB ligand (RANKL); Bone disease; Wnt pathway; Multiple myeloma
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2017.11.012

Myeloma bone disease (MBD) is the most common complication of multiple myeloma (MM), resulting in skeleton-related events (SREs) such as severe bone pain, pathologic fractures, vertebral collapse, hypercalcemia, and spinal cord compression that cause significant morbidity and mortality. It is due to an increased activity of osteoclasts coupled to the suppressed bone formation by osteoblasts. Novel molecules and pathways that are implicated in osteoclast activation and osteoblast inhibition have recently been described, including the receptor activator of nuclear factor-kB ligand/osteoprotegerin pathway, activin-A and the wingless-type signaling inhibitors, dickkopf-1 (DKK-1) and sclerostin. These molecules interfere with tumor growth and survival, providing possible targets for the development of novel drugs for the management of lytic disease in myeloma but also for the treatment of MM itself. Currently, bisphosphonates are the mainstay of the treatment of myeloma bone disease although several novel agents such as denosumab and sotatercept appear promising. This review focuses on recent advances in MBD pathophysiology and treatment, in addition to the established therapeutic guidelines.