Saturday, April 13, 2024

Maintaining bone health against multiple Myeloma

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Multiple myeloma is a cancer of plasma cells. Plasma cells normally make antibodies to fight infections but in myeloma, the cells become cancerous and multiply uncontrollably. This crowds out healthy cells in the bone marrow, leading to problems like anemia, bleeding, and infections.
Approximately 1% of all cancer diagnoses in the world are multiple myeloma and 90% of them suffer from bone disease. This happens because myeloma cells release substances like DCR3, RANKL, IL-6, and Activin-A, which supercharge bone-breaking cells. This breakdown, called osteolysis, leads to bone pain, fractures, limited mobility, and a poorer quality of life. It increases the risk of fractures 9 times and of death by 20%.

l Fractures especially spinal compression fractures and nerve compression in the spine
l Poor bone quality with muscle loss and severe pain in the bone
l Blood clot formation / Deep Vein Thrombosis (DVT)
l High blood calcium levels
l Kidney failure

Regular Vitamin D supplements 2000 (IU) per day
High-quality diet involving green vegetables, dry fruits, milk, and cheese.
Regular exercises involving the back/spine and lower limbs
Physiotherapy to prevent loss of muscle mass
Radiotherapy of spine and bony lesions
Preventive surgery like ‘kyphoplasty’ and ‘vertebroplasty’ for pain relief and improved mobility
Blood thinners like apixaban to prevent DVT
Need to maintain good dental hygiene and monitor kidney function tests and blood calcium levels
Newer agents with anabolic effects such as anti-sclerostin antibodies, parathyroid hormone, anti-dickkopf-1 antibodies, and others have shown potential in the repair of MBD lesions
Bisphosphonates like zoledronic acid and pamidronate to increase bone-forming cells (osteoblasts) are given once a month as an injection of 4mg
Denosumab (monoclonal human antibody-60mg subcutaneous) and sotatercept that targets the “rank” pathway are given once in 1 month for initial treatment and then continued once in 6 months as an injection up to 3 years

(The author, Dr. Pranshul Bishnoi, is a Consultant- Orthopaedic, at Manipal Hospital.)

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