Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement

Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis...

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Main Author: Patrizia Tosi
Format: Article
Language:English
Published: Wiley 2013-01-01
Series:Scientifica
Online Access:http://dx.doi.org/10.1155/2013/104546
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author Patrizia Tosi
author_facet Patrizia Tosi
author_sort Patrizia Tosi
collection DOAJ
description Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. A multidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma.
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spelling doaj-art-da94908d20984b0f83ad682b9f05fe6e2025-02-03T01:25:32ZengWileyScientifica2090-908X2013-01-01201310.1155/2013/104546104546Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal InvolvementPatrizia Tosi0Hematology Unit, Department of Oncology and Hematology, Infermi Hospital, Viale Settembrini 2, 47100 Rimini, ItalyBone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. A multidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma.http://dx.doi.org/10.1155/2013/104546
spellingShingle Patrizia Tosi
Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
Scientifica
title Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
title_full Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
title_fullStr Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
title_full_unstemmed Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
title_short Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement
title_sort diagnosis and treatment of bone disease in multiple myeloma spotlight on spinal involvement
url http://dx.doi.org/10.1155/2013/104546
work_keys_str_mv AT patriziatosi diagnosisandtreatmentofbonediseaseinmultiplemyelomaspotlightonspinalinvolvement