Bone Problems - Multiple Myeloma Center for Nurses

Bone Problems

Bone Problems

The presence of at least one osteolytic bone lesion is a myeloma-defining event.1

Bone complications are a hallmark of the disease: about 90% of patients will have bone lesions and experience associated complications.2,3

Signs and Symptoms

  • Malignant myeloma cells disrupt the normal process of new bone formation and resorption, inhibiting osteoblasts, which form new bone, and stimulating osteoclasts, which promote new bone resorption. This latter process also can lead to bone destruction when overactivated4
  • This dysregulated process can drive a number of symptoms, such as bone pain and fractures, spinal cord compression, osteopenia, and hypercalcemia5,6
  • Common sites of bone lesions and/or sites at risk of fractures include the vertebrae, flat bones (eg, ribs, skull, shoulders, pelvis), and long bones2,3


  1. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548.
  2. Brigle K, Pierre A, Finley-Oliver E, Faiman B, Tariman JD, Miceli T; International Myeloma Foundation Nurse Leadership Board. Myelosuppression, bone disease, and acute renal failure: evidence-based recommendations for oncologic emergencies. Clin J Oncol Nurs. 2017;21(5 suppl):60-76.
  3. Fernández de Larrea C, Jiménez R, Rosinol L, et al. Pattern of relapse and progression after autologous SCT as upfront treatment for multiple myeloma. Bone Marrow Transplant. 2014;49(2):223-227.
  4. Durie BGM. Patient handbook. 2018 ed. International Myeloma Foundation website. Accessed May 13, 2021.
  5. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33.
  6. Tricot G. Clinical manifestations. In: Hoffman R, Furie B, Benz EJ, McGlave P, Silberstein LE, Shattil SJ. Hematology: Basic Principles and Practice. 5th ed. New York, NY: Churchill Livingstone; 2008.