How Multiple Myeloma Affects Bones

For most people living with multiple myeloma, bone pain tops the list of symptoms — and no wonder, given the disease causes cancerous plasma cells to build up in bone marrow (the soft tissue in bones).

Research shows that 80 percent of people who are newly diagnosed with multiple myeloma develop holes, weak spots, and other types of damage in bones.

These damaged areas, called lytic lesions, are painful, but there are things you can do to help protect your bones, ease the pain, and preserve a positive quality of life.

How Multiple Myeloma Damages Bones

Healthy bones are constantly remodeling themselves. “They maintain a balance between forming new bone and destructing existing bone,” says Elan Gorshein, DO, a hematologist and assistant professor of medicine at Yale School of Medicine in New Haven, Connecticut. In a nutshell, cells called osteoclasts break down old bone tissue, and cells called osteoblasts repair bones and build them up.

Multiple myeloma disrupts this natural bone-remodeling process. “It causes the osteoclasts to break down bone without stopping, and it inhibits osteoblasts from forming, so they can’t do their repair work,” explains Azra Borogovac, MD, a hematologist and assistant clinical professor of hematology at City of Hope Orange County Lennar Foundation Cancer Center in Irvine, California. When this happens, the bones become weak, leading to lytic lesions and potentially osteoporosis.

Approximately 90 percent of people with multiple myeloma will develop these lytic bone lesions, according to research. They can occur anywhere, but the spine, rib cage, and pelvis are most likely to be affected. “These lesions can lead to bone pain and, sometimes, compression of the spinal cord or other fractures, which may require emergency treatment,” Dr. Borogovac notes.

How to Keep Your Bones Healthy

Medication and lifestyle changes can go a long way toward protecting your bones. Here are some smart strategies:

Stay on Top of Your Medication

It’s important to take all your medications as prescribed. “In order to maintain or prevent damage to bone integrity, it is critical for patients with multiple myeloma to take their myeloma-directed therapy, as well as their bone-modifying agents,” says Dr. Gorshein.

Keep in mind that treatments targeting the cancer itself will also benefit bone health by decreasing the number of myeloma cells that cause the imbalance behind the bone disease in the first place. “The best way to protect the bones in a patient with multiple myeloma is to treat the disease itself,” says Borogovac.

Eat Healthy

A study found that a diet high in fruit may reduce the risk of a condition called monoclonal gammopathy of undetermined significance, which can turn into multiple myeloma. Eating fruit at least three times a week was associated with the greatest benefit.

In addition to maintaining an overall healthy diet, you may want to pay special attention to specific nutrients. “Since it’s common that patients with multiple myeloma have deficits in vitamin D, supplementation may be beneficial,” says Borogovac. But check with your doctor before starting it, she says.

Exercise

Weight-bearing activities boost bone health for everyone. And if you’re living with multiple myeloma, there are even more reasons to work out. One study found that doing aerobics, lifting weights, or combining both could help people with multiple myeloma feel less tired and help prevent muscle weakness.

According to Gorshein, it’s not just weight-bearing activity that’s important. “Physical activity such as walking, jogging, running, biking, and swimming can also help bone health in multiple myeloma patients,” he says. “And yoga may be helpful in maintaining a strong sense of balance and flexibility, which can help prevent falls and fractures.”

Consider Surgery

Sometimes, when fractures happen or spinal compression seems likely, a procedure can stabilize the bones and relieve pressure on the spinal cord. “Surgical interventions may be used to help support bones,” says Gorshein.

Quit Smoking

“Tobacco cessation is important to protect bone health,” says Gorshein. One review found that quitting smoking can improve bone health and help prevent fractures. So if you’re still smoking, it’s definitely time to quit.