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Department of Haematology, Royal Adelaide Hospital, SA Health, Adelaide, Australia. |
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Adelaide Medical School, University of Adelaide, Adelaide, Australia. |
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Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia. |
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Precision Cancer Medicine Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia. |
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Department of Haematology, Sir Charles Gairdner Hospital, Western, Australia. |
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Haematology Department, the Kinghorn Cancer Centre, St Vincent's Hospital New South Wales. |
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ACT Pathology, Canberra Health Services, Australian Capital Territory, Australia. |
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School of Medicine and Psychology, Australian National University, Australian Capital Territory, Australia. |
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Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia. |
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Department of Clinical Haematology, Peter maccallum Cancer Centre, Melbourne, Victoria, Australia. |
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Sir Peter maccallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. |
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Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. |
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The University of Sydney, Sydney, New South Wales, Australia. |
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Sir Peter maccallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. |
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Department of Haematology, St Vincent's Hospital, Victoria, Texas, Australia. |
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Sir Peter maccallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. |
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Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. |
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Department of Haematology, Royal Adelaide Hospital, SA Health, Adelaide, Australia. |
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Adelaide Medical School, University of Adelaide, Adelaide, Australia. |
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Clinical Haematology, Peter maccallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia. |
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| Abstract |
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Multiple myeloma is a hematological malignancy characterized by clonal plasma cells proliferation within the bone marrow, often resulting in osteolytic bone disease. Traditionally, bisphosphonates such as zoledronic acid and pamidronate, have been used in the prophylaxis and treatment of myeloma bone disease (MBD).A comprehensive, systematic review using these key words, 'multiple myeloma,' 'myeloma bone disease,' 'bisphosphonates,' 'denosumab,' 'osteonecrosis' was conducted on Medline and Cochrane databases from 1995 to 2024. Priority was given to randomized, double-blinded clinical trials; with inclusion oflarge case cohort studies in view of the limited comparison between different bone resorptive agents in the treatment of myeloma bone disease.This updated guideline recommends a two-year course of bisphosphonates treatment, with suggested extension of dosing intervals if the disease remains stable.Denosumab, a monoclonal antibody targeting receptor activator of nuclear factor **B ligand (RANKL), has demonstrated efficacy and non-inferiority compared to zoledronic acid in the treatment of MBD and may serve as an alternative treatment option especially with renal impairment. Further research into the utility of bone turnover markers for guiding anti-resorptive therapy in myeloma bone disease may provide significant clinical benefit. In addition, therapeutic strategies aimed at enhancing osteoblastic activity represent a potential therapeutic strategy. |
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