Hi,
My mother has been told by the doctor to take bisphosphonates to prevent bone problems, although she doesn't have any bone problems or lesions and the imaging of her bones is fine.
I wonder is this drug given to all myeloma patients, or should she wait until she gets bone problems? What is most optimal?
I'm thinking of the severe side effects by using this drug.
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Lacerta - Who do you know with myeloma?: Mother
- When were you/they diagnosed?: Autumn 2015
- Age at diagnosis: 59
Re: Bisphosphonates to prevent bone problems
As you may be finding out, there is a mixed opinion as to whether bisphosphonates should be started when a person is diagnosed with myeloma or to wait until bone lesions are found. It would be beneficial to ask your mother's oncologist why s/he wants to start them when your mother has no evidence of bone problems.
One question I have is whether your mother has had only a skeletal x-ray, or has she also had an MRI and/or PET/CT scan to detect bone lesions? The skeletal x-ray is still used by many oncologists, mine included, but the recommendation is that MRI and/or PET/CT scans also be done.
Bottom line is that your mother is the one who should make the final decision about whether she wants to start a bisphosphonate infusion or wait until bone lesions develop, if they ever do.
Nancy in phila
One question I have is whether your mother has had only a skeletal x-ray, or has she also had an MRI and/or PET/CT scan to detect bone lesions? The skeletal x-ray is still used by many oncologists, mine included, but the recommendation is that MRI and/or PET/CT scans also be done.
Bottom line is that your mother is the one who should make the final decision about whether she wants to start a bisphosphonate infusion or wait until bone lesions develop, if they ever do.
Nancy in phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Bisphosphonates to prevent bone problems
Some bisphosphonates also have anti-myeloma properties. While by no means a cure for myeloma, every bit helps in preventing myeloma for progressing.
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Little Monkey - Name: Little Monkey
- Who do you know with myeloma?: Father-stage 1 multiple myeloma
- When were you/they diagnosed?: March/April of 2015
Re: Bisphosphonates to prevent bone problems
Agreed that you will hear a lot of pros and cons. Here comes a pro.
My hubby was diagnosed January 21, 2016 and because his complete skeletal survey showed NO lesions, it was decided to delay Zometa. Two weeks later his back was unbearable. Another two weeks and we insisted on an MRI. Two compression fractures and a third developing. He's on hydrocodone and has had two kyphoplasties.
I guess my point is, if she's had an MRI or PET, I'd feel better about delaying bisphosphonates.
My hubby was diagnosed January 21, 2016 and because his complete skeletal survey showed NO lesions, it was decided to delay Zometa. Two weeks later his back was unbearable. Another two weeks and we insisted on an MRI. Two compression fractures and a third developing. He's on hydrocodone and has had two kyphoplasties.
I guess my point is, if she's had an MRI or PET, I'd feel better about delaying bisphosphonates.
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wekebu - Name: Wendy
- Who do you know with myeloma?: Hubby
- When were you/they diagnosed?: Jan 2016
- Age at diagnosis: 55
Re: Bisphosphonates to prevent bone problems
Thanks for answers. I will make sure that she has been trough all the necessary tests.
I found out the following: The current ASCO guidelines do not suggest use of bisphosphonates in myeloma patients without bony lesions, lytic disease, or myeloma-related osteoporosis. Back pain alone is not considered sufficient justification for their use.
I found out the following: The current ASCO guidelines do not suggest use of bisphosphonates in myeloma patients without bony lesions, lytic disease, or myeloma-related osteoporosis. Back pain alone is not considered sufficient justification for their use.
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Lacerta - Who do you know with myeloma?: Mother
- When were you/they diagnosed?: Autumn 2015
- Age at diagnosis: 59
Re: Bisphosphonates to prevent bone problems
Hi,
From my research and going over my center's research, bisphosphonate (Zometa) therapy causes some apoptosis, also positively impairs migration of rogue osteoclasts to decrease the destruction that goes on with multiple myeloma. The bisphosphonate drug is attracted to exposed hydroxyapatite in the bone, and that is exposed when a fracture occurs.
So the bisphosphonate therapy actually physically occupies the space of the fracture so that osteoclasts cannot occupy the same space and cause further destruction. So that is considered a routine adjunctive care to myeloma patients, and it is generally recommended that it be given for at least the first 2 years after diagnosis. After that, it is mostly unclear how long to continue. My myeloma specialist has put me on a quarterly infusion but I have no issues with it. Also I presented with fractures, not just pain.
Best! BN
From my research and going over my center's research, bisphosphonate (Zometa) therapy causes some apoptosis, also positively impairs migration of rogue osteoclasts to decrease the destruction that goes on with multiple myeloma. The bisphosphonate drug is attracted to exposed hydroxyapatite in the bone, and that is exposed when a fracture occurs.
So the bisphosphonate therapy actually physically occupies the space of the fracture so that osteoclasts cannot occupy the same space and cause further destruction. So that is considered a routine adjunctive care to myeloma patients, and it is generally recommended that it be given for at least the first 2 years after diagnosis. After that, it is mostly unclear how long to continue. My myeloma specialist has put me on a quarterly infusion but I have no issues with it. Also I presented with fractures, not just pain.
Best! BN
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Bar-none - Who do you know with myeloma?: Me
- When were you/they diagnosed?: 3/14
Re: Bisphosphonates to prevent bone problems
Before committing to bisphosphonates you may want to research medication-induced osteonecrosis of the jaw. This is a side effect of bisphosphonates. Also, the use of bisphosphonates may limit the ability of the patient to undergo invasive oral surgery in the future. I had a column on this in the Beacon recently that has more detail.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Bisphosphonates to prevent bone problems
Hi,
goldmine raises a very good caution. In my case, my myeloma specialist went over the risk and recommended that I have a dental checkup and to take meticulous dental hygiene to avoid issues. Since I was current with no issues and a clean dental checkup we started Zometa.
From what I have read, if you think you will require any oral surgeries or extractions, those should be done and healed prior to starting. As always, best to work closely with an expert myeloma specialist prior and during all treatments.
I would add, if you have any dental or jaw related issues, have them treated first with the same oversight of a specialist.
Best! BN
goldmine raises a very good caution. In my case, my myeloma specialist went over the risk and recommended that I have a dental checkup and to take meticulous dental hygiene to avoid issues. Since I was current with no issues and a clean dental checkup we started Zometa.
From what I have read, if you think you will require any oral surgeries or extractions, those should be done and healed prior to starting. As always, best to work closely with an expert myeloma specialist prior and during all treatments.
I would add, if you have any dental or jaw related issues, have them treated first with the same oversight of a specialist.
Best! BN
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Bar-none - Who do you know with myeloma?: Me
- When were you/they diagnosed?: 3/14
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