[LHA in AZ]

Treatment for bone loss in MGUS

by LHA in AZ on Sat Sep 20, 2014 12:21 pm

I've been diagnosed with MGUS (IgM) since 2007 and have severe osteoporosis, having been diagnosed with osteopenia in 1994. I'm 64 years old, in relative good health.

As an MGUS patient, I've responded to Actonel (risedronate), not responded to Evista (ralox­i­fene), and my rhuemotologist is now recommending Prolia (denosumab).

Has Prolia been found as an effective option for treating osteoporosis in MGUS patients. Also, what's the reservation an endocrinologist might have in using Forteo (teriparatide) in someone with MGUS?

More generally, what's the "gold standard" for treating osteoporosis in MGUS patients?

Would appreciate your help in this.

[Dr. Adam Cohen]

Re: Treatment for bone loss in MGUS

by Dr. Adam Cohen on Tue Sep 23, 2014 10:00 pm

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.

Hope this helps.

[LHA in AZ]

Re: Treatment for bone loss in MGUS

by LHA in AZ on Thu Sep 25, 2014 11:54 pm

Thanks so much Dr. Cohen for your reply and for explaining that there's no gold standard in the treatment of osteoporosis for MGUS patients.

Since I've taken Actonel (risedronate, a bisphosphonate) for a little more than 6 years, my rheu­matologist is recommending a change away from a bisphosphonate to Prolia (denosu­mab, Xgeva). Is this a viable option?

Thanks so much.

[Multibilly]

Re: Treatment for bone loss in MGUS

by Multibilly on Fri Sep 26, 2014 8:15 am

LHA,

I'm not a doc, so I'm not going to make a recommendation here.

But I might suggest also getting an opinion from your multiple myeloma doctor regarding this switch. He might have a different take on things.

Note that while Zometa and Actonel are both in the bisphosphonate family, they are based on different chemical compounds. Zometa is also given intravenously, but you would only have to do that once a year, per Dr. Cohen's suggestion.

Prolia is a drug used in the RANKL antibody therapy approach, which is discussed at the end of this thread:

"Back pain - how can you tell if it is myeloma-related?", Beacon forum discussion started Sep 24, 2014.

[LHA in AZ]

Re: Treatment for bone loss in MGUS

by LHA in AZ on Tue Sep 30, 2014 8:17 pm

Multibilly, thanks for your reply, the reference to the previous Beacon forum discussion, and to Prolia used in RANKL antibody therapy approach.

I have consulted with my MGUS doctor about the recommendation by the rheumatologist and the MGUS doctor concurs with the recommendation to try Prolia.

As I wrote earlier, I believe that because I have MGUS, I failed to respond to the most recent drug treatment of Evista. My recent dexa-scan results showed 15% bone loss in the spine (T -4) and 4% in the right hip (T -2.0) as compared to the previous scan. The treatment with bis­phos­phonates kept me at a level rate for the years under that treatment.

Again, thanks for your response. It's appreciated.