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Intern Med J. 2017 Aug;47(8):938-951. doi: 10.1111/imj.13502.

Bisphosphonate guidelines for treatment and prevention of myeloma bone disease.

Lee OL1, Horvath N1,2, Lee C2,3, Joshua D2,4,5, Ho J2,4,5, Szer J2,6,7, Quach H2,6,8, Spencer A2,6,9, Harrison S2,6,10, Mollee P2,11,12, Roberts AW2,6,7,13, Talaulikar D2,14,15, Brown R2,4, Augustson B2,16, Ling S2,17,18, Jaksic W2,3, Gibson J2,4,5, Kalff A2,9, Johnston A2,19,20, Kalro A2,21, Ward C2,5,22, Prince HM2,6,10, Zannettino A2,23,24.

Author information

1
Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
2
Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.
3
Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
4
Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
5
Department of Cancer and Haematology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
6
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
7
Department of Clinical Haematology and BMT, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
8
Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.
9
Department of Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.
10
Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
11
Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
12
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
13
Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
14
Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
15
College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia.
16
Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
17
Department of Haematology, Liverpool Hospital, Sydney, New South Wales, Australia.
18
South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
19
Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
20
Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
21
Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
22
Department of Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
23
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
24
Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Abstract

Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.

KEYWORDS:

bisphosphonate; myeloma; osteoblast; osteoclast; osteolysis; skeletal-related event (SRE)

PMID:
28782211
DOI:
10.1111/imj.13502
[Indexed for MEDLINE]

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