Key role for bisphosphonates in reducing myeloma bone damage

NEW YORK (Reuters Health) - Because of their ability to prevent, reduce, and delay skeletal complications with multiple myeloma, bisphosphonates are an essential component of treatment for this malignancy, according to an expert panel for the European Myeloma Network.

This conclusion is based on a review of data from randomized clinical trials, clinical practice guidelines, and other literature. Seven major placebo-controlled trials and two major pamidronate-controlled trials were included in the analysis. The findings are reported in the August issue of the Annals of Oncology.

"The purpose of this paper is to review the current evidence for the use of bisphosphonates in multiple myeloma and provide European Union-specific recommendations to support the clinical practice of treating myeloma bone disease," lead author Dr. E. Terpos, from Alexandra University Hospital, Athens, Greece, and colleagues explain.

The strongest (grade A) recommendations include:

--Bisphosphonates should be given to patients with osteolytic bone lesions or pathological fractures.

--When oral bisphosphonates are used, precautions should be taken to prevent diarrhea, nausea, and other gastrointestinal complications.

Other recommendations include:

--Bisphosphonates should be given to patients requiring chemotherapy with no evidence of bone lesions on plain radiographs (grade B).

--Transient acute phase reactions are no reason for discontinuing bisphosphonate therapy and can be treated with therapeutic analgesics (grade B).

--Calcium and vitamin D3 treatment should be considered to prevent electrolyte imbalance (grade B).

--Bisphosphonates should be given to patients with osteopenia (grade C).

--Bisphosphonates should not be used as treatment for monoclonal gammopathy of undetermined significance or asymptomatic multiple myeloma (grade C).

The report also discusses osteonecrosis of the jaw, an uncommon but serious complication of intravenous bisphosphonate therapy that occurs most often after dental surgery. The authors note, "Recent retrospective data indicate that a modified dosing regimen and preventive measures can greatly reduce the incidence of osteonecrosis of the jaw."

Ann Oncol 2009;20:1303-1317.

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