When a patient with multiple myeloma achieves complete remission, does the risk of bone disease subside?

FAQ Library published on October 24, 2019
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Matthew T. Drake, MD, PhD
Associate Professor of Medicine
Consultant, Division of Hematology
Mayo Clinic
Rochester, Minnesota

Welcome to Managing Myeloma. My name is Dr. Matthew Drake. I’m frequently asked, “When patients with multiple myeloma achieve complete remission, does the risk of bone disease subside?” Unfortunately, the answer is no. The risk of developing complications in the skeleton does not decrease completely, it does become reduced and the reason is because myeloma cells make factors which affect the bone cells. There are two primary bone types of cells we think of: the osteoblast which build bone, and the osteoclast which remove bone, and also a third type of bone cell called the osteocyte which is basically osteoblast that have become imbedded in bone. Basically, when patients with myeloma achieve a complete remission, it’s good because then fewer of those factors are being made but the challenge is that some of those factors may still be made. In addition, the myeloma cells, the way that they work is that they impact the bone cells, particularly bone-forming cells are never as active again as they were previous to the myeloma. When the bone resorbing cells or the bone cells which remove bone scoop out bone, unfortunately in multiple myeloma, usually when that occurs in the normal process when bone is removed then the bone-forming cells come back and replace that bone, but unfortunately in myeloma, because of the factors made by the myeloma cells, even when myeloma is in complete remission, those bone-forming cells are really never able to go back and put bone back where this bone has already been removed. The risk for bone disease or the development of complications of the skeleton does reduce, but unfortunately never reaches the level it would have if myeloma had not been present in the first place. Thank you for viewing this activity.

Last modified: October 24, 2019