I remember being told by my doctors early on in the process that bones have a great ability to heal. For me, my bone pain went away very quickly once I began chemotherapy treatment. Is that typical?
And is it true that much of the bone loss can be reversed in time by the natural healing power of our bones?
Forums
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MichaelKevinWalsh - Name: Michael Kevin Walsh
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: November 8, 2013
- Age at diagnosis: 53
Re: Bone pain, bone healing, and treatment?
Multiple myeloma specialists have varying and sometimes opposing opinions on the question of bone damage healing itself.
My guess would be that healing depends on the size and shape of the bone damage initially. For instance, I would not be surprised to learn that a fractured bone would knit together fairly well, but a hole in the bone, say the size of a quarter, may not.
In my own experience with three plasmacytomas that were each treated with radiation therapy, I've observed that they have healed only to a very limited extent, per PET/CT's, over the past few years. I have very little, if any pain most of the time from those areas.
Best,
Steve
My guess would be that healing depends on the size and shape of the bone damage initially. For instance, I would not be surprised to learn that a fractured bone would knit together fairly well, but a hole in the bone, say the size of a quarter, may not.
In my own experience with three plasmacytomas that were each treated with radiation therapy, I've observed that they have healed only to a very limited extent, per PET/CT's, over the past few years. I have very little, if any pain most of the time from those areas.
Best,
Steve
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Steve - Name: Steve
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: December 2009
- Age at diagnosis: 55
Re: Bone pain, bone healing, and treatment?
In my case shortly after diagnosis and before treatment began, I developed pretty bad back and rib pain. I had to use a wheelchair to avoid walking for long distances. I thought my back must have been destroyed with bone damage. My doctors told me the first step to treating the back pain was to treat the disease, and they were right. Within a few weeks of being treated with Velcade and dexamethasone, the pain went away completely.
From reading about myeloma the last three years and from talking with my doctors I have learned that myeloma bone damage is very slow to heal and may not heal at all. Other types of bone damage do heal quickly, but for some reason myeloma bone damage does not. This is one reason early diagnosis and treatment for myeloma can make a big difference in outcome and quality of life.
I have read that it is not fully understood why myeloma bone damage does not heal well even with minimal residual disease and this is something that is still being researched. In my case, like many others, I did not have any major lesions but “innumerable micro lesions”. In three years, despite being treated with bisphosphonates for all three years, nothing has changed.
From reading about myeloma the last three years and from talking with my doctors I have learned that myeloma bone damage is very slow to heal and may not heal at all. Other types of bone damage do heal quickly, but for some reason myeloma bone damage does not. This is one reason early diagnosis and treatment for myeloma can make a big difference in outcome and quality of life.
I have read that it is not fully understood why myeloma bone damage does not heal well even with minimal residual disease and this is something that is still being researched. In my case, like many others, I did not have any major lesions but “innumerable micro lesions”. In three years, despite being treated with bisphosphonates for all three years, nothing has changed.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Bone pain, bone healing, and treatment?
But it is possible. I just had a PET CT a few days ago - and it's clean! No active tumors. Whew! (I'm on carfilzomib, Revlimid and dexamethasone). The radiologist said that my bone is healing in some places. He didn't say how much it's healing, but as recently as January I had metabolically active tumors. So my bone hasn't had much time to heal, and yet the healing is already visible on the PET.
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Bone pain, bone healing, and treatment?
I, too, have read the differing professional opinions on this forum concerning whether lytic lesions due to multiple myeloma can in fact heal over time.
It's interesting that this publication on bisphosphonate therapy (which is a good, easy-to-understand guidebook) is pretty direct about claiming that bisphosphonate therapy can potentially lead to bone healing:
It's interesting that this publication on bisphosphonate therapy (which is a good, easy-to-understand guidebook) is pretty direct about claiming that bisphosphonate therapy can potentially lead to bone healing:
Since bone damage is caused by the increased numbers and activity of these osteoclasts, treatment with bisphosphonates reduces bone damage and, when the myeloma is well controlled, allows bone HEALING to occur.
Bisphosphonates have several beneficial effects, including:
- Preventing further bone damage
- Reducing bone pain and the need for painkillers
- Correcting and preventing hypercalcemia
- Reducing the need for radiotherapy
- Reducing pathologic fractures due to myeloma (i.e., fracture at a site where myeloma has weakened the bone)
- Improving quality of life
- IMPROVING THE CHANCES OF HEALING and recovering bone strength.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Bone pain, bone healing, and treatment?
There are many different bisphosphonates and very limited head-to-head studies on these to determine benefits versus risks.
Zoledronic acid, most frequently used in multiple myeloma, has been stated to have some anti-myeloma activity, but actually has not been compared to all possible bisphosphonates to suggest others do not have the same, not all bisphosphonates are administered IV.
For those with multiple myeloma with kidney disease, bisphosphonates can lead to acute failure. Since many chemotherapay regimens lead to dry mouth and can result in poor dental health, the risk of osteonecrosis of the jaw exists. Not all get the worst forms of this, some are very mild indeed.
The dosage of bisphosphonates in multiple myeloma is much much higher than used for treating osteoporosis and the chemical stays bound to bone for at least a decade, making the bones rock hard strong, so much so that, for some, the possibility of transverse femoral fractures is raised.
Although many oncologists deem bisphosphonate treatment as part and parcel of multiple myeloma treatment where lesions exist or not, especially as multiple myeloma and its treatments (e.g. steriods) weaken / soften bones, I see very little research looking at the bone strength pre- treatment using DEXA scans to compare with bone strength after different different treatments and grades of remission.
There are far too many gaps in basic multiple myeloma research which tends to feature the drug companies particular biases to get their drugs onto the multiple myeloma market if possible. That is why there is lack of consensus on treatments amongst multiple myeloma specialists, not just the issue of the heterogeneous nature of multiple myeloma in individuals.
Zoledronic acid, most frequently used in multiple myeloma, has been stated to have some anti-myeloma activity, but actually has not been compared to all possible bisphosphonates to suggest others do not have the same, not all bisphosphonates are administered IV.
For those with multiple myeloma with kidney disease, bisphosphonates can lead to acute failure. Since many chemotherapay regimens lead to dry mouth and can result in poor dental health, the risk of osteonecrosis of the jaw exists. Not all get the worst forms of this, some are very mild indeed.
The dosage of bisphosphonates in multiple myeloma is much much higher than used for treating osteoporosis and the chemical stays bound to bone for at least a decade, making the bones rock hard strong, so much so that, for some, the possibility of transverse femoral fractures is raised.
Although many oncologists deem bisphosphonate treatment as part and parcel of multiple myeloma treatment where lesions exist or not, especially as multiple myeloma and its treatments (e.g. steriods) weaken / soften bones, I see very little research looking at the bone strength pre- treatment using DEXA scans to compare with bone strength after different different treatments and grades of remission.
There are far too many gaps in basic multiple myeloma research which tends to feature the drug companies particular biases to get their drugs onto the multiple myeloma market if possible. That is why there is lack of consensus on treatments amongst multiple myeloma specialists, not just the issue of the heterogeneous nature of multiple myeloma in individuals.
Re: Bone pain, bone healing, and treatment?
Great news that your pain resolved quickly. That is common for patients who are responding to treatment.
Most of the time, while the pain improves and there is no longer any active myeloma in the bone lesions, the bone lesions themselves may never heal. With treatment and the use of bisphosphonates, the risk of fractures decreases, even if the bone lesions remain.
Jlk
Most of the time, while the pain improves and there is no longer any active myeloma in the bone lesions, the bone lesions themselves may never heal. With treatment and the use of bisphosphonates, the risk of fractures decreases, even if the bone lesions remain.
Jlk
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Dr. Jonathan Kaufman - Name: Jonathan Kaufman, M.D.
Beacon Medical Advisor
Re: Bone pain, bone healing, and treatment?
As soon as treatment started, the worst of my bone pain disappeared - this was my fractured vertebrae pain. It took a while for my myeloma to be brought under control, as such. My paraprotein levels would sometimes be above 30 g/L (3 g/dL) and sometimes below. I could usually tell when they were above 30 g/L coz my back would ache in the bone.
I reached remission a couple of years ago and haven't been on Zometa for a couple of years (I can't remember when I stopped taking it).
At diagnosis, I had a CT scan of part of my spine.
Four years later, I had a CT scan on the same part of my spine. It wasn't taken on the same machine, but it was taken at the same practice.
As they had my old scan on file, I asked for a copy of both my scans (to give to my physiotherapist).
Did my big fracture heal - No. By then I had 2 other compression fractures.
BUT
It was easy to see an increase in bone density in the later scan. I could match up specific lesions between the scans, and the size of the holes were decreasing.
I discussed it with a couple of doctors and they suggested that it wasn't "real" bone but more like "scar" bone.
The holes are still present in my spine, but the bone that I have around them has been strengthened.
I reached remission a couple of years ago and haven't been on Zometa for a couple of years (I can't remember when I stopped taking it).
At diagnosis, I had a CT scan of part of my spine.
Four years later, I had a CT scan on the same part of my spine. It wasn't taken on the same machine, but it was taken at the same practice.
As they had my old scan on file, I asked for a copy of both my scans (to give to my physiotherapist).
Did my big fracture heal - No. By then I had 2 other compression fractures.
BUT
It was easy to see an increase in bone density in the later scan. I could match up specific lesions between the scans, and the size of the holes were decreasing.
I discussed it with a couple of doctors and they suggested that it wasn't "real" bone but more like "scar" bone.
The holes are still present in my spine, but the bone that I have around them has been strengthened.
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LibbyC - Name: LibbyC
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2009
- Age at diagnosis: 43
Re: Bone pain, bone healing, and treatment?
A myeloma "tumor" formed at the top of my humerus, thinning the bone walls and leading eventually to a break. That's how we discovered my myeloma.
Initially, it wasn't healing at all. We chalked that up to aggressive myeloma therapy, including radiation in that area, chemotherapy and, soon after, an autologous bone marrow transplant. I have been on Zometa since the break was discovered.
During my recovery from the transplant, I started to get more use and range of motion in my right arm, but it was coming very, very slowly and in very small increments. 10 months after the initial break, and 4 months after my transplant, the orthopedic surgeon decided it had healed as much as possible, and started steering me toward a mechanical replacement.
Last week (12 months after the break), at a visit intended to discuss / schedule the replacement surgery, he noticed that healing had accelerated. I had noticed significantly more range / strength in the arm as well. So we are sitting on it for now, and hoping for the best.
The only thing that had changed in my life was that I started back to work, which includes a lot of work with a computer mouse, and me dragging suitcases through a number of airports. That could be a factor.
I don't expect a 100% recovery, and I know the scar bone will never be as strong as the original. I am hoping it will heal enough to eliminate the need for special techniques to accomplish day-to-day activities, like pulling on a sweater, carrying groceries, and driving.
I can do all those things now, just not fast or gracefully.
Initially, it wasn't healing at all. We chalked that up to aggressive myeloma therapy, including radiation in that area, chemotherapy and, soon after, an autologous bone marrow transplant. I have been on Zometa since the break was discovered.
During my recovery from the transplant, I started to get more use and range of motion in my right arm, but it was coming very, very slowly and in very small increments. 10 months after the initial break, and 4 months after my transplant, the orthopedic surgeon decided it had healed as much as possible, and started steering me toward a mechanical replacement.
Last week (12 months after the break), at a visit intended to discuss / schedule the replacement surgery, he noticed that healing had accelerated. I had noticed significantly more range / strength in the arm as well. So we are sitting on it for now, and hoping for the best.
The only thing that had changed in my life was that I started back to work, which includes a lot of work with a computer mouse, and me dragging suitcases through a number of airports. That could be a factor.
I don't expect a 100% recovery, and I know the scar bone will never be as strong as the original. I am hoping it will heal enough to eliminate the need for special techniques to accomplish day-to-day activities, like pulling on a sweater, carrying groceries, and driving.
I can do all those things now, just not fast or gracefully.
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Sailor Mike - Name: Mike Verla
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: February 2014
- Age at diagnosis: 62
Re: Bone pain, bone healing, and treatment?
I was initially diagnosed with a solitary plasmacytoma in the second cervical vertebra. The vertebra was quite painful, and I could not turn my head to the left. After radiation, the bone pain dissipated, but the damage to the vertebra still made it difficult to turn to the left. The neurosurgeon at that time told me that the bone would heal over time. That was 4 years ago.
There has been no healing and, after moving to NY, I had cement injected into the area. The neurosurgeon who did the operation said that bones damaged by myeloma never heal.
So I experienced both sides of the discussion, and my experience was that there was no healing.
There has been no healing and, after moving to NY, I had cement injected into the area. The neurosurgeon who did the operation said that bones damaged by myeloma never heal.
So I experienced both sides of the discussion, and my experience was that there was no healing.
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Cerberus - Name: martin
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2010
- Age at diagnosis: 57
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