We just started Zometa therapy, about once a month. I had no idea how it works, until my doctor explained it. It seems like a catch-22 therapy with multiple myeloma. This is my understanding of Zometa and multiple myeloma.
Multiple myeloma may cause bone lesions, thus weakening bones. Chemotherapy such as CyBorD attacks the multiple myeloma cells. Chemotherapy does NOT directly help the bones, it just thwarts the multiple myeloma disease from attacking the bones, causing more lesions, and weakening the bones.
This is where Zometa comes in. Zometa therapy is meant to "strengthen" the bones. Normally, bone is continually built up, and continually deconstructed by the body. Zometa stops the body's natural process of deconstructing bone, while also allowing for the natural process of the body to build the bone up.
In theory this "strengthens" the bone. However, the drawback is that the bone too rigid and brittle, since the old bone is never deconstructed. By "strengthening" the bone, Zometa is actually "weakening" it.
I'd like to hear your thoughts on my understanding of Zometa. I am also curious to hear if anyone has gotten any bone fractures because of Zometa.
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Re: The Catch-22 of Zometa
I think the summary you have written is correct, InQ. It mirrors some of what was written, in somewhat more technical language, in this posting and the ones that follow it:
https://myelomabeacon.org/forum/don-baylor-multiple-myeloma-in-the-spotlight-t3092.html#p17574
The only part of what you wrote that may not be completely correct is the part about myeloma treatment not helping the bones. This seems to be true for Revlimid. However, there is some evidence, I believe, that Velcade may help a bit with the process of bone rebuilding. (This is mentioned, I believe, in the news article referred to in one of the posts in the discussion I linked to above.)
The one thing I'm not 100 percent certain about is what you wrote about why Zometa may cause the bone that it rebuilds to be more brittle than "normal" bone. What you've written seems plausible, but I guess I hadn't seen it described that way.
https://myelomabeacon.org/forum/don-baylor-multiple-myeloma-in-the-spotlight-t3092.html#p17574
The only part of what you wrote that may not be completely correct is the part about myeloma treatment not helping the bones. This seems to be true for Revlimid. However, there is some evidence, I believe, that Velcade may help a bit with the process of bone rebuilding. (This is mentioned, I believe, in the news article referred to in one of the posts in the discussion I linked to above.)
The one thing I'm not 100 percent certain about is what you wrote about why Zometa may cause the bone that it rebuilds to be more brittle than "normal" bone. What you've written seems plausible, but I guess I hadn't seen it described that way.
Re: The Catch-22 of Zometa
In the Wikipedia article about bisphosphonates, there is a really thorough review of this class of treatments. Bisphosphonates such as Zometa or Aredia are used for multiple myeloma in order to prevent the further loss of bone caused by the disease, and to help the bones build up again. There is a rare chance of unusual sheer fractures of bones, and also of osteonecrosis of the jaw, which is why bisphosphonate treatments are used cautiously.
I know that I have had the maximum recommended for me at this time in my cancer journey, but they surely helped me with bone healing, since I did have fractures. Hope that helps..
I know that I have had the maximum recommended for me at this time in my cancer journey, but they surely helped me with bone healing, since I did have fractures. Hope that helps..
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: The Catch-22 of Zometa
lnQ,
Thank you for posting about Zometa. I will soon start this treatment as well. Great questions and information. I also posted about the Zometa treatment as a monthly treatment [link to discussion]. My oncologist would prefer to do every three months but has to go off the protocol shown in research and studies. He also told me that the Zometa can stay in your bones for up to a year. Of course, it lessens as time goes on, so that's why constant treatment is needed.
Nancy, you said that your at the end of your Zometa treatments and had the maximum amount. Did you have monthly treatments? I also had multiple broken / fractured ribs and some of them are slow to heal. did you oncologist ever mention a treatment every 3 months instead of monthly?
Maybe I am totally wrong but my thoughts are if I have the ability to take it longer I should have treatments every three months.
One last thing, how do you know that its working? Do you get some type of bone scan?
Thank You,George
Thank you for posting about Zometa. I will soon start this treatment as well. Great questions and information. I also posted about the Zometa treatment as a monthly treatment [link to discussion]. My oncologist would prefer to do every three months but has to go off the protocol shown in research and studies. He also told me that the Zometa can stay in your bones for up to a year. Of course, it lessens as time goes on, so that's why constant treatment is needed.
Nancy, you said that your at the end of your Zometa treatments and had the maximum amount. Did you have monthly treatments? I also had multiple broken / fractured ribs and some of them are slow to heal. did you oncologist ever mention a treatment every 3 months instead of monthly?
Maybe I am totally wrong but my thoughts are if I have the ability to take it longer I should have treatments every three months.
One last thing, how do you know that its working? Do you get some type of bone scan?
Thank You,George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: The Catch-22 of Zometa
Hi George, Actually I was on Aredia [pamidronate], not Zometa. When I started treatments, Zometa was not yet widely used here! But, I was on monthly treatments for approx. a year, then on treatments every two months, and then in the last year every three months.
The funny thing about my Aredia treatments was that when I started I was on a four hour infusion! This was to protect the kidneys. But later the protocol for that changed to a two hour infusion. The other patients taking Zometa were only on about a 15 min. treatment!
This is the Canadian system I have experienced, of course. There is a recommended maximum, but I think that if I were to start breaking bones again, I would talk to my doctor about getting more treatments of bisphosphonates.
I knew this was working because I am no longer in pain, and also from my skeletal annual X-ray surveys, which showed healing in some areas. I haven't had any MRI's though ... again, that could be yet in the future for me. With myeloma there is always this uncertainty actually!
The funny thing about my Aredia treatments was that when I started I was on a four hour infusion! This was to protect the kidneys. But later the protocol for that changed to a two hour infusion. The other patients taking Zometa were only on about a 15 min. treatment!
This is the Canadian system I have experienced, of course. There is a recommended maximum, but I think that if I were to start breaking bones again, I would talk to my doctor about getting more treatments of bisphosphonates.
I knew this was working because I am no longer in pain, and also from my skeletal annual X-ray surveys, which showed healing in some areas. I haven't had any MRI's though ... again, that could be yet in the future for me. With myeloma there is always this uncertainty actually!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: The Catch-22 of Zometa
Nancy,
Thank you very much for the information. I will soon be having my first visit to the hospital where I will be having a bone marrow harvest and at some point a transplant. I am going to have a lot of questions for them and the Zometa treatments will be one of them.
I am going back to work soon so it looks like having the Zometa treatments on a Fridays would be beneficial if I became too sick to work. I have lost so much time away from work already.
Thank you all for the posting. George
Thank you very much for the information. I will soon be having my first visit to the hospital where I will be having a bone marrow harvest and at some point a transplant. I am going to have a lot of questions for them and the Zometa treatments will be one of them.
I am going back to work soon so it looks like having the Zometa treatments on a Fridays would be beneficial if I became too sick to work. I have lost so much time away from work already.
Thank you all for the posting. George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: The Catch-22 of Zometa
" I am also curious to hear if anyone has gotten any bone fractures because of Zometa."
How would one really know? The fact that Zometa, as I understand it, works very slowly it would seem that knowing whether a bone was weak to begin with or weakened would be difficult to determine. As an example, my first clue that I had bone problems came when I leaned both hands on the kitchen counter and my collar bone broke. This was something I had likely done thousands of times, but that morning something was different.
I was told by my orthopedist that a break from multiple myeloma can create a weakness. He explained that when the fracture heals it is stronger than the bone next to it and deprives the bone of some resiliency making it easier to break near the fracture..
It seems from reading post on here that bone fractures lessen or stop considerably after a reasonable series of treatments. That isn't scientific, but does seem to prevail.
How would one really know? The fact that Zometa, as I understand it, works very slowly it would seem that knowing whether a bone was weak to begin with or weakened would be difficult to determine. As an example, my first clue that I had bone problems came when I leaned both hands on the kitchen counter and my collar bone broke. This was something I had likely done thousands of times, but that morning something was different.
I was told by my orthopedist that a break from multiple myeloma can create a weakness. He explained that when the fracture heals it is stronger than the bone next to it and deprives the bone of some resiliency making it easier to break near the fracture..
It seems from reading post on here that bone fractures lessen or stop considerably after a reasonable series of treatments. That isn't scientific, but does seem to prevail.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: The Catch-22 of Zometa
Maybe the following excerpt can shed some light on this issue. For what is worth, I have been taking Zometa for about 2 years and have not experienced any fractures.
For those having trouble with the medical lingo in the excerpt, reduction in bone toughness is basically the ability to sustain deformity without breaking, i.e. making the bones brittle. At least that's how I understand it.
TD Luo and MR Allen, Short-courses of dexamethasone abolish bisphosphonate-induced reductions in bone toughness, Bone. 2013 Sep;56(1):199-203.
Highlights:
Atypical femoral fractures, which display characteristics of brittle material failure, have been associated with potent remodeling suppression drugs. Given the millions of individuals treated with this class of drugs it is likely that other factors play a role in these fractures. Some evidence suggests that concomitant use of corticosteroids may contribute to the pathogenesis although data in this area is lacking. The goal of this study was to assess the combined role of bisphosphonates and dexamethasone on bone mechanical properties. Skeletally mature beagle dogs were either untreated controls, or treated with zoledronic acid (ZOL), dexamethasone (DEX), or ZOL + DEX. Zoledronic acid (0.06 mg/kg) was given monthly via IV infusion for 9 months. DEX (5 mg) was administered daily for one week during each of the last three months of the 9 month experiment. Ribs were harvested and assessed for bone geometry, mechanical properties, and remodeling rate (n = 3-6 specimens per group). DEX significantly suppressed intracortical remodeling compared to vehicle controls while both ZOL and the combination of DEX + ZOL nearly abolished intracortical remodeling. ZOL treatment resulted in significantly lower bone toughness, determined from 3-point bending tests, compared to all other treatment groups while the toughness in ZOL + DEX animals was identical to those of untreated controls. These findings suggest that short-courses of dexamethasone not only do not adversely affect toughness in the setting of bisphosphonates, but also actually reverse the adverse effects of its treatment. Understanding the mechanism for this tissue-level effect could lead to novel approaches for reducing the risk of atypical femoral fractures.
http://linkinghub.elsevier.com/retrieve/pii/S8756-3282(13)00222-6
For those having trouble with the medical lingo in the excerpt, reduction in bone toughness is basically the ability to sustain deformity without breaking, i.e. making the bones brittle. At least that's how I understand it.
TD Luo and MR Allen, Short-courses of dexamethasone abolish bisphosphonate-induced reductions in bone toughness, Bone. 2013 Sep;56(1):199-203.
Highlights:
- Bisphosphonate-induced reductions in toughness have been documented in dogs and these changes are consistent with atypical femoral fractures.
- Treatment with dexamethasone reversed zoledronate-induced reductions in toughness.
- These data document that adverse mechanical effects of bisphosphonates can be attenuated in vivo.
Atypical femoral fractures, which display characteristics of brittle material failure, have been associated with potent remodeling suppression drugs. Given the millions of individuals treated with this class of drugs it is likely that other factors play a role in these fractures. Some evidence suggests that concomitant use of corticosteroids may contribute to the pathogenesis although data in this area is lacking. The goal of this study was to assess the combined role of bisphosphonates and dexamethasone on bone mechanical properties. Skeletally mature beagle dogs were either untreated controls, or treated with zoledronic acid (ZOL), dexamethasone (DEX), or ZOL + DEX. Zoledronic acid (0.06 mg/kg) was given monthly via IV infusion for 9 months. DEX (5 mg) was administered daily for one week during each of the last three months of the 9 month experiment. Ribs were harvested and assessed for bone geometry, mechanical properties, and remodeling rate (n = 3-6 specimens per group). DEX significantly suppressed intracortical remodeling compared to vehicle controls while both ZOL and the combination of DEX + ZOL nearly abolished intracortical remodeling. ZOL treatment resulted in significantly lower bone toughness, determined from 3-point bending tests, compared to all other treatment groups while the toughness in ZOL + DEX animals was identical to those of untreated controls. These findings suggest that short-courses of dexamethasone not only do not adversely affect toughness in the setting of bisphosphonates, but also actually reverse the adverse effects of its treatment. Understanding the mechanism for this tissue-level effect could lead to novel approaches for reducing the risk of atypical femoral fractures.
http://linkinghub.elsevier.com/retrieve/pii/S8756-3282(13)00222-6
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ivanm - Name: Ivan Mitev
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August, 2011
- Age at diagnosis: 37
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