[smarty]

Bisphosphonates for MGUS & smoldering myeloma?

by smarty on Tue May 12, 2015 7:48 pm

I'm asymptomatic and wanted to get opinions on bisphosphonates.

My research indicates they basically increase bone density but not bone quality. Since bone density is already increased with MGUS, though of course unfavorably, what is the point of in­creasing it more? I refer to

JN Farr et al, "Altered cortical microarchitecture in patients with monoclonal gam­mop­athy of un­de­termined sig­nificance," Blood, January, 2014 (full text of article)

which with special tests determined that MGUS patients do indeed have increased bone size but bone quality is deteriorated.

Some claim the same is true for osteoporosis treatment with Fosomax, etc. as actually may be doing more harm than good.

Anyone with more information on this subject? Maybe I'm at a place where a little knowledge is dangerous, but I have always has a curious mind and want to understand as much as possible.

Smarty

[Cheryl G]

Re: Bisphosphonates for MGUS & smoldering myeloma?

by Cheryl G on Thu May 14, 2015 5:31 pm

Hi Smarty,

Dr. Cohen answered a question about bisphosphonates in patients with MGUS last fall here in the forum. It's in this discussion thread:

https://myelomabeacon.org/forum/osteopenia-osteoporosis-treatment-mgus-t4073.html

He wrote:

While there are studies suggesting that MGUS patients have higher risk of osteoporosis than the general population, there are no good studies looking at the best treatment for osteo­po­ro­sis specifically in MGUS patients, so there's not really a "gold standard."

In this situation, I will usually recommend zoledronic acid (aka Zometa or Reclast) on a once year­ly basis, just because of its efficacy as a skeletal-protective agent in patients with active mye­lo­ma and bone lesions. I'm not sure about the reason for your endocrinologist's hesita­tion regard­ing Forteo - you may just need to ask him/her.

I think what he wrote may at least partly address your question.

Bisphosphonates in general, and specific bisphosphonates like Zometa and Aredia, come up often here in the forum because there are a lot of questions about when you should use them, how long you should use them, etc. So you may want to do some searches from the forum search box on keywords like "bisphosphonates", "zometa", etc., to see if anything else comes up that might help with your question.

If you do find something, please let us know.

Good luck!