Myeloma and bone health

Your bones are living tissue. Throughout your life, your body breaks down old bone and replaces it with new bone in a constant cycle.

Myeloma cells in the bone marrow disturb this balance. They cause some parts of your bone to break down faster than your body can rebuild it. This makes the bones weaker and more likely to break (fracture).

Bone problems vary from person to person. Some people with myeloma have mild changes, while others have more significant bone damage. These changes are known as myeloma bone disease. You will have bone scans throughout your care so your healthcare team can check your bones and monitor any changes over time.

The charity Myeloma UK has developed a detailed guide on how myeloma affects your bones. You can visit their website to find out more.

You may develop some of the complications listed below. Your healthcare team may already have talked to you about treatments that can help to keep these complications to a minimum. You can also talk to them any time if you have any questions or worries.

Osteopenia

A general loss of bone density. When bone density is reduced, the inside of your bones become weaker because they lose calcium.

Lytic lesions

Small areas where the bone becomes weaker or thinner. These can appear in different sizes and in different places for each person.

Bone fractures

A fracture happens when a weakened bone partly or completely breaks. This can happen in any bone affected by myeloma.

Pain

Pain is common with bone disease and usually affects areas where the bone is damaged. The level of pain can vary from person to person. Tell your healthcare team about any pain you have so they can support you. You should also let them know straight away if you develop sudden or severe pain.

Hypercalcaemia

Hypercalcaemia means there is too much calcium in your blood. This can happen when bones break down and release extra calcium into the body.

Hypercalcaemia can make you feel sick, tired, thirsty or confused. It may also make you pee more. If it continues for a long time, it can affect your kidneys. However, it is usually spotted early through blood tests and treated promptly. It is also less common once you start your myeloma treatment.

The spine is made up of 33 bones called vertebrae. They are stacked on top of each other to support your body and help you stand and move.  

The vertebrae are round and have a hole in the middle where the spinal cord sits. The spinal cord carries messages from your brain to the rest of your body, controlling movement and sensation.   

Spinal fracture

Myeloma can weaken the bones in your spine (vertebrae). If a weakened vertebra is put under more strain or pressure than it can safely withstand, it may break or collapse. This is called a pathological spinal fracture. The degree of collapse can vary from mild to severe. 

Sometimes, a group of myeloma cells called a plasmacytoma can grow inside or outside a vertebra and make it more likely to break. 

A spinal fracture can cause pain and may change the shape or stability of the spine. In some cases, part of the fractured bone can press on the spinal cord or nearby nerves. This is called spinal cord compression, and you can find out more about the symptoms further down the page. 

If you have a spinal fracture, your doctors will check where it is exactly, and how much of your spine is affected. This can be different for different people. They will then decide on the best treatment, while also treating the myeloma.

Changes in the shape of your spine

Doctors may call this a spinal deformity. It means that your spine is not in its usual shape. The most common spinal deformity is called kyphosis.

Kyphosis can happen when a spinal fracture causes the bones in your spine to collapse and form a wedge shape. This can cause the spine to curve forwards. How much your spine curves depends on how many spinal bones are affected.

Plasmacytoma

A plasmacytoma is a lump made of abnormal plasma cells (a type of blood cell). 

Plasma cells normally help the body fight infection. However, in myeloma these cells grow in an uncontrolled way and can form a tumour in the bone or soft tissue. 

Spinal cord compression

Very rarely, a spinal fracture or a plasmacytoma can press on the spinal cord and damage the nerves. This is called spinal cord compression and it is a medical emergency.

Symptoms to look out for:

• severe, persistent or worsening pain anywhere in your back or neck
• back or neck pain that wakes you up at night
• back pain that gets worse when you are standing, moving or sitting
• muscle pain or cramping in the legs when walking or exercising
• a tight, band-like feeling around your body
• pain that gets worse when you strain, for example when coughing, sneezing or pooing
• pins and needles, numbness or changes in sensations in limbs
• weakness in your legs or arms
• difficulty walking or keeping your balance
• numbness around your back passage, buttocks or genitals
• losing the sensation or urge to pee or poo
• difficulty controlling your bladder or bowel (having ‘accidents’)
• loss of sexual sensation or new erection problems

If you notice any of these symptoms, go to your local Emergency Department (A&E) immediately.

There are a range of treatments available to help support your bones and spine. Treating the myeloma is one of the best ways to protect your bones, bring calcium levels in your blood back to normal, and reduce pain. Your healthcare team will talk you through the options and recommend what is most suitable for your individual situation. 

Not everyone will need all of the treatments listed below. If you have any questions or concerns, talk to your healthcare team. They will be happy to discuss these with you. 

Bisphosphonates and other supplements

These medicines help make bones stronger and are often given as part of standard treatment. You may recognise some of the names, such as:

• zoledronic acid (Zometa®)
• disodium pamidronate (Aredia®)
• sodium clodronate (Loron®, Clasteon® or Bonefos®)
• denosumab (Prolia® or Xgeva®)

We will also check your Vitamin D, calcium and magnesium levels. If needed, we may recommended supplements to support bone health alongside bisphosphonates. 

You can find more information about bisphosphonates on the Myeloma UK website.  

Pain relief medicines

Pain relief medicines can help manage your pain. Your healthcare team will recommend the most suitable option based on how severe your pain is. This may include:

• over-the-counter painkillers for mild pain
• stronger medicines for more severe pain, such as opioids
• other medicines for nerve pain

It’s important to talk to your healthcare team so they can help you find the right type and dose. They can also adjust your pain relief medicines until your pain is well controlled.

You can find more information about pain and myeloma on the Myeloma UK website.  

Radiotherapy

Radiotherapy uses radiation to help relieve pain and kill myeloma cells in a specific area of bone or plasmacytoma.

You can find more information about radiotherapy on the Myeloma UK website.

Chemotherapy

Chemotherapy helps kill myeloma cells and stop further damage to the bones.

Steroids

Steroids help reduce swelling and pain, especially if there is pressure on the spine. 

More information about two of the steroids we commonly use is available on the Myeloma UK website: 

• Dexamethasone – Treatment Guide 
• Prednisolone – Treatment Guide

Spinal brace

A spinal brace may be used to support your spine and help reduce pain, especially while you are having chemotherapy. To find out more about spinal braces, visit our page Understanding spinal braces: Information for people with myeloma.

Surgery

Non-spinal surgery

Sometimes you may need surgery in your arms or hips if a bone has broken, or if your orthopaedic team feels there is a high risk of a fracture. Surgery helps to repair the bone and supports your recovery.

Spinal surgery

Our specialist team, including neurosurgeons and advanced spinal nurse practitioners, will care for you and help you choose the best treatment plan for you. They will usually try a spinal brace first, as evidence shows it can help to reduce pain from spinal fractures and support your spine.

However, some people may still have ongoing pain after using a brace. Their spine may also be at risk of further fractures or there may be pressure on the spinal cord. In these cases, your team may recommend surgery to support your spine and prevent the problem from getting worse. They will discuss all options with you and support you in making the decision that is right for you.

For more information on managing spinal fractures in myeloma, visit the Myeloma UK website.

Physiotherapy

Physiotherapy can play an important role in your recovery. When you are in pain or having treatment, you may become less active. This can cause your muscles to become weaker, which can make movement and everyday activities more difficult. As a result, your pain may increase and you may feel more tired.

Your healthcare team will advise you when it is safe for you to begin exercising. A physiotherapist can then support you to safely rebuild your strength and fitness, and improve your movement. They can create an exercise plan tailored to your individual needs to help you return to the activities you enjoy.

If you feel physiotherapy would help you, ask your healthcare team to refer you.

Call the haematology helpline on 020 3447 7359 (Monday to Friday, 9am to 5pm) or 07852 220 900 (out of hours)