Bone fractures and bone disease are two severe complications affecting myeloma patients. However, treatments such as radiation therapy, vertebroplasty, and kyphoplasty are all used to help myeloma patients combat weakening bone formation.

The most common type of lesions that develop in myeloma patients are in the spinal column. Patients may mistake pain from the lesion, often in the lower back and ribs, to be general back pain. One possible cause for the pain is vertebral compression fractures, also known as spinal fractures. This happens because the bone in the spine is too weak to withstand pressure. Multiple fractures in the spine can cause a hunchback condition from shortening of the spine.

While over-the-counter and prescription medication could reduce pain, radiation therapy, vertebroplasty, and kyphoplasty are alternative treatments to consider.

About 70 percent of myeloma patients with bone lesions receive radiation therapy to relieve pain. Patients receive fairly low doses of radiation to destroy myeloma cells and relief is felt a few days after treatment. Radiation therapy can be used alone or with other therapies to treat bone disease. Higher doses are not given because they could compromise future myeloma treatments. Too much radiation therapy may have an adverse effect on a patient’s bone marrow, which is important for maintaining the immune system.

Vertebroplasty is a minimally invasive procedure in which bone cement is injected into the fracture to stabilize the spinal column. The procedure is done under local or general anesthesia. Patients must remain in bed for one hour after the procedure to let the cement harden, and an overnight stay is required.

Another treatment option is kyphoplasty. This is a technique similar to vertebroplasty that uses orthopedic balloons to expand the fracture before bone cement is injected into the cavity. Local or general anesthesia is used, and the procedure takes less than one hour per fracture. Kyphoplasty is minimally invasive and uses only two small one-centimeter incisions. Patients recover overnight and can return to daily activities by the next day. Pain is usually decreased, and the treatment is compatible with other myeloma treatments.

A common complication with both vertebroplasty and kyphoplasty is cement leakage to areas outside of the fracture. Balloon kyphoplasty has a low risk of heart attacks, stroke, and clots (blood, fat, or cement) that migrate to the lungs.

Patients who have unstable spinal fractures or a history of blood clots are not recommended to have kyphoplasty done. Myeloma patients considering any of these procedures are advised to consult a doctor to find out if they qualify as candidates.

For more information on myeloma bone disease and these treatments, see the full article in the American Society of Hematology's 2008 Education Program Book, Hematology. Also see other Beacon articles related to myeloma bone disease: skeletal imaging, bisphosphonate treatment, and novel therapies. Information on vertebral compression fractures can be found on the International Myeloma Foundation Web site.