[jhorner]

Bisphosphonate treatment with smoldering myeloma?

by jhorner on Mon Jun 02, 2014 2:52 pm

Hello,

I am 48 years old, and my skeletal survey showed osteopenia of the axial skeleton as well as the long bones of my arms. The bone density (DEXA) confirmed moderate osteopenia. Should I be on bisphosphonates?

Are there any other smoldering myeloma patients that are being treated for bone loss with bisphosphonates? If so what is the treatment criteria and the treatment you are using?

Thank you

[Dr. Jason Valent]

Re: Bisphosphonate treatment with smoldering myeloma?

by Dr. Jason Valent on Mon Jun 02, 2014 5:41 pm

There is data from Italy to suggest that bisphosphonate treatment in the smoldering patient can reduce skeletal events at the time of progression to symptomatic disease but does not prevent disease progression. The schedule used was monthly treatment for a year but given osteoporosis data of once yearly treatment with zoledronic acid, I don't use such a vigorous schedule.

It would not be unreasonable to use in your case.

[jhorner]

Re: Bisphosphonate treatment with smoldering myeloma?

by jhorner on Mon Jun 02, 2014 6:14 pm

Thank you very much for your reply Dr. Valent as I appreciate it very much. What is the recommended Zometa schedule for osteopenia vs. osteoporosis?

[Beacon Staff]

Re: Bisphosphonate treatment with smoldering myeloma?

by Beacon Staff on Tue Jun 03, 2014 4:00 am

Jhorner, just as an FYI, this Beacon news article may be worth consulting (as well as the journal article it discusses):

"Experts Publish Treatment Recommendations For Multiple Myeloma-Related Bone Disease", Jun 26, 2013.

It includes the following summary statement:

"In patients with smoldering, or asymptomatic, myeloma, the experts note that both Zometa and Aredia re­duce the risk of developing bone disease, but neither slow progression to multiple myeloma. Thus, they suggest that low- and intermediate-risk asymptomatic patients who have osteoporosis be treated with bis­phos­phonates at doses used for osteoporosis. For patients with high-risk smoldering myeloma and bone loss that may be myeloma-related, especially if the patients have abnormal MRIs, the experts recom­mend using bisphosphonates at the doses used for symptomatic myeloma."

All the Beacon's news and opinion articles related to bone disease can be found at the bone disease topic (tag) page:

https://myelomabeacon.org/tag/bone-disease/

[Dr. Jason Valent]

Re: Bisphosphonate treatment with smoldering myeloma?

by Dr. Jason Valent on Wed Jun 04, 2014 1:33 pm

I think the once yearly dosing in your case is reasonable.