**Bone Disease in Multiple Myeloma**

Maja Hinge, Thomas Lund, Jean-Marie Delaisse and Torben Plesner

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/55190

#### **1. Introduction**

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216 Multiple Myeloma - A Quick Reflection on the Fast Progress

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Osteolytic bone disease in multiple myeloma (MM) is a common event. Already at diagnosis, approximately eighty percent of patients present with abnormal bone structure [1;2]. During disease progression a large proportion of patients will develop ostelytic lesions [3]. MM bone disease not only results in a reduced quality of life due to pain, pathological fractures, or symptomatic hypercalcaemia [4]; but may also be *the* deciding factor that determines if a patient requires anti-myeloma treatment or if a watch and wait strategy can be applied [5]. In this chapter we will discuss the normal bone remodelling process, and how it is affected in MM. During the last decades, increased knowledge about bone pathophysiology in general has led to an improved understanding of MM bone disease. The description of the receptor activator of nuclear factor kappa B (RANK) and its ligand in the nineties was one of the most significant steps. We will also address how biochemical markers may be used to monitor the velocity of the different processes in bone remodelling. The next part of the chapter will be dedicated to the treatment of MM bone disease. For many years, bisphosphonates have been a cornerstone in the treatment of MM bone disease and despite the occurrence of osteonecrosis of the jaw that was first report‐ ed as a result of the of bisphosphonate treatment in the early part of this century, these agents remain the most important components of treatment for MM bone disease. Lastly, we will discuss how various anti-myeloma treatments may influence bone turnover. During the last decade a number of novel drugs have been approved for the treatment of MM and especially proteasome inhibitors seems to have a positive effect on MM bone disease besides their anti-myleoma effect.

© 2013 Hinge et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
