Bone pain and skeletal-related events
Myeloma cells interact with cells within the bone marrow, causing disruption to the microenvironment and ultimately bone destruction with osteoporosis and/or the development of focal lytic lesions. This is commonly referred to as myeloma bone disease and occurs as a result of an increased activity of osteoclasts (cells responsible for bone breakdown) and reduced activity of osteoblasts (cells responsible for the formation of new bone) in the presence of myeloma cells (see Module 8).
Approximately 60% of patients have evidence of myeloma bone disease at the time of diagnosis and bone pain is one of the most common presenting symptoms. Overall, around 80% of patients will develop skeletal abnormalities at some point during the course of their myeloma. The areas most often affected are the spine, ribs, hips, skull and the long bones of the arms and legs – areas where there is active haematopoiesis in the bone marrow.
Areas not normally affected are the extremities such as the hands and feet where there is little bone marrow activity.
The specific symptoms of myeloma bone disease include:
- Pain
- Osteoporosis
- Pathological fractures
- Vertebral collapse and spinal cord compression
- Loss of height/kyphosis
- Hypercalcaemia