[ZParvin]

Taking Zometa for a myeloma-related fracture

by ZParvin on Sun Jun 08, 2014 3:19 pm

Hi. I was hoping someone could help me with an answer. My dad was only recently( less than a month ago) diagnosed with kappa light chain multiple myeloma. He's 57 years old and has begun chemo with Velcade, thalidomide and dexamethasone.

What I had a small concern was that a family friend who is an orthopaedic surgeon asked my father to find out whether taking Zometa ( zolendronate - 4 mg IV, monthly) was advisable. My father has a single cortex fracture in the left femur (near the calcar). The orthopaedic surgeon says it may impair bone remodelling and in turn delay fracture healing.

Just wondering if anyone had any advice on the matter?

Any thoughts would be greatly appreciated.

Thank you in advance!

[NStewart]

Re: Taking Zometa for a myeloma-related fracture

by NStewart on Sun Jun 08, 2014 9:05 pm

I suddenly went from "watch and wait" status to active treatment of myeloma when I developed a pathologic fracture of my left humerus. I was immediately started on a treatment regimen of Revlimid (lenalidomide), dex and Zometa infusions once a month. My humerus healed completely. My orthopedic surgeon was quite surprised at how well it healed. He thought that he might eventually have to put a rod in my arm.

So, healing does take place in the bones when you are on Zometa infusions.

Nancy in Phila

[ZParvin]

Re: Taking Zometa for a myeloma-related fracture

by ZParvin on Sun Jun 08, 2014 11:28 pm

Dear NSTEWART,

Thank you very much for your insight and your advice.

[Dr. Ken Shain]

Re: Taking Zometa for a myeloma-related fracture

by Dr. Ken Shain on Tue Jun 10, 2014 8:49 am

I would recommend that Zometa be a part of your father's treatment regimen. In the setting of multiple myeloma, the fracture was related to disease and to a lack or diminished bone health. Zometa (and Aredia [pamidronate]) increase bone health and strength in bones weakened by multiple myeloma.

If f there is a surgery (rod placement etc for the fracture) I hold Zometa until healed and for an additional month or so. There is some safety data suggesting that this is adequate. http://www.ccjm.org/content/77/11/751.full

In the setting of your father, risk benefit (from the information shared) favors the use of Zometa.
Zometa decreases skeletal related event and improves overall survival in multiple myeloma (at least relative or other non-same in class bisphosphonates). http://www.ncbi.nlm.nih.gov/pubmed/22498739

This does not mean bisphophonates or RANKL inhibitors are perfect. There are side effects from long term (years) use. So dental hygiene / health and monitoring are important - secondary to ONJ risk (though with appropriate care this risk is very low) as well as fractures (also very rare).

I hope that this helps.