Bisphosphonate guidelines for treatment and prevention of myeloma bone disease

Oi Lin Lee, Noemi Horvath, Cindy Lee, Doug Joshua, Joy Ho, Jeff Szer, Hang Quach, Andrew Spencer, Simon James Harrison, Peter Mollee, Andrew W Roberts, Dipti Talaulikar, Ross D Brown, Bradley M Augustson, Silvia Ling, Wilfrid J Jaksic, John Gibson, Anna Kalff, Anna Johnston, Akash Kalro & 3 others Chris Ward, H. Miles Prince, Andrew C W Zannettino

Research output: Contribution to journalLetter

Abstract

Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.

LanguageEnglish
Pages938-951
Number of pages14
JournalInternal Medicine Journal
Volume47
Issue number8
DOIs
StatePublished - 1 Aug 2017
Externally publishedYes

Keywords

  • bisphosphonate
  • myeloma
  • osteoblast
  • osteoclast
  • osteolysis
  • skeletal-related event (SRE)

Cite this

Lee, O. L., Horvath, N., Lee, C., Joshua, D., Ho, J., Szer, J., ... Zannettino, A. C. W. (2017). Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. Internal Medicine Journal, 47(8), 938-951. DOI: 10.1111/imj.13502
Lee, Oi Lin ; Horvath, Noemi ; Lee, Cindy ; Joshua, Doug ; Ho, Joy ; Szer, Jeff ; Quach, Hang ; Spencer, Andrew ; Harrison, Simon James ; Mollee, Peter ; Roberts, Andrew W ; Talaulikar, Dipti ; Brown, Ross D ; Augustson, Bradley M ; Ling, Silvia ; Jaksic, Wilfrid J ; Gibson, John ; Kalff, Anna ; Johnston, Anna ; Kalro, Akash ; Ward, Chris ; Prince, H. Miles ; Zannettino, Andrew C W. / Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. In: Internal Medicine Journal. 2017 ; Vol. 47, No. 8. pp. 938-951
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abstract = "Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80{\%} of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.",
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Lee, OL, Horvath, N, Lee, C, Joshua, D, Ho, J, Szer, J, Quach, H, Spencer, A, Harrison, SJ, Mollee, P, Roberts, AW, Talaulikar, D, Brown, RD, Augustson, BM, Ling, S, Jaksic, WJ, Gibson, J, Kalff, A, Johnston, A, Kalro, A, Ward, C, Prince, HM & Zannettino, ACW 2017, 'Bisphosphonate guidelines for treatment and prevention of myeloma bone disease' Internal Medicine Journal, vol 47, no. 8, pp. 938-951. DOI: 10.1111/imj.13502

Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. / Lee, Oi Lin; Horvath, Noemi; Lee, Cindy; Joshua, Doug; Ho, Joy; Szer, Jeff; Quach, Hang; Spencer, Andrew; Harrison, Simon James; Mollee, Peter; Roberts, Andrew W; Talaulikar, Dipti; Brown, Ross D; Augustson, Bradley M; Ling, Silvia; Jaksic, Wilfrid J; Gibson, John; Kalff, Anna; Johnston, Anna; Kalro, Akash; Ward, Chris; Prince, H. Miles; Zannettino, Andrew C W.

In: Internal Medicine Journal, Vol. 47, No. 8, 01.08.2017, p. 938-951.

Research output: Contribution to journalLetter

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T1 - Bisphosphonate guidelines for treatment and prevention of myeloma bone disease

AU - Lee,Oi Lin

AU - Horvath,Noemi

AU - Lee,Cindy

AU - Joshua,Doug

AU - Ho,Joy

AU - Szer,Jeff

AU - Quach,Hang

AU - Spencer,Andrew

AU - Harrison,Simon James

AU - Mollee,Peter

AU - Roberts,Andrew W

AU - Talaulikar,Dipti

AU - Brown,Ross D

AU - Augustson,Bradley M

AU - Ling,Silvia

AU - Jaksic,Wilfrid J

AU - Gibson,John

AU - Kalff,Anna

AU - Johnston,Anna

AU - Kalro,Akash

AU - Ward,Chris

AU - Prince,H. Miles

AU - Zannettino,Andrew C W

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N2 - Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.

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KW - myeloma

KW - osteoblast

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KW - osteolysis

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Lee OL, Horvath N, Lee C, Joshua D, Ho J, Szer J et al. Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. Internal Medicine Journal. 2017 Aug 1;47(8):938-951. Available from, DOI: 10.1111/imj.13502