Background: Multiple myeloma is the malignant disease which most frequently leads to bone lesions. Approximately 80% of myeloma patients develop osteoporosis, lytic bone lesions (osteolysis) or fractures during the course of the disease. Of these patients 43% suffer pathological fractures most often of the vertebrae followed by fractures of the long bones.
Material and methods: The methods used in the described articles include, e.g. gene expression profiling, enzyme-linked immunosorbent assays and radiological techniques.
Results and discussion: Myeloma bone disease represents a threefold therapeutic problem: (i) per se because of the associated morbidity, mortality and the accompanying decrease of quality of life, (ii) as survival space for (residual) myeloma cells after primarily successful chemotherapy and subsequently necessary chemotherapeutic treatment, and (iii) the occurrence of bone lesions in asymptomatic patients is the most common cause for the initiation of treatment to avoid myeloma-induced fractures. Myeloma cells harbor a high median number of chromosomal aberrations and multiple changes in gene expression compared to normal bone marrow plasma cells leading to the aberrant production of survival, proliferation, pro-angiogenic and bone turnover influencing factors or the induction of those factors in the bone marrow microenvironment. This causes an imbalanced bone turnover in the sense of an increased number and activity of osteoclasts while bone formation by osteoblasts is almost completely suspended. Therapeutic approaches, systemically and locally therefore aim at stimulation of osteoblasts and inhibition of bone resorption.