Bone problems and myeloma
Bisphosphonates are drugs that help strengthen weakened bones and reduce pain. They also help delay bone damage. You may start treatment with them before you have any bone problems. Some bisphosphonates may also help treat myeloma.
The bisphosphonates that are most often used are:
They may be given as a drip into a vein (intravenous infusion) once a month. Some are given as tablets.
Side effects are usually mild. They include indigestion and feeling sick (nausea) and flu-like symptoms after a bisphosphonate drip. Rarely, bisphosphonates can cause damage to the jaw bone.
Radiotherapy uses high-energy rays to destroy the myeloma cells. You may have it to reduce bone pain and to allow the bones to repair themselves.
Radiotherapy can also be used when myeloma in the spine is causing pressure on the spinal cord. This is called spinal cord compression.
In advanced myeloma, radiotherapy can be given to reduce symptoms and control the myeloma for some time.
You have radiotherapy in the hospital radiotherapy department. If you are having a course of treatment you will have a planning appointment. The radiotherapy staff work out the exact dose of radiotherapy and the area to be treated.
Treatment may be given daily (Monday to Friday) for 1 to 3 weeks, with a rest at the weekends. Some people may only need 1 or 2 treatments.
The side effects are usually mild and depend on the area being treated.
Tiredness is a common side effect. If treatment is given close to the tummy or bowel, other side effects can include feeling sick or diarrhoea.
Tell the radiotherapy team about any side effects you have. They can prescribe drugs to help and give you advice to help you to manage them. We have more information about radiotherapy side effects.
Some people may need surgery to repair bones damaged or weakened by myeloma. If some of the bones in the spine (vertebrae) are weakened by the myeloma, they may collapse. This is called a compression fracture. It can cause pain, difficulty moving around and can make you shorter. It is often treated:
- with painkillers
- with bed rest
- by wearing a spinal brace.
Surgery can also be used to treat compression fractures of the spine. Your doctor or specialist nurse will explain if this is suitable for you. They usually try other ways to control the pain first.
Possible operations are:
The surgeon or radiologist injects a special cement into the vertebrae. This can strengthen the bone and relieve pain caused by a compression fracture.
- Balloon kyphoplasty
The surgeon or radiologist inserts a balloon, called an inflatable bone tamp, into the vertebrae and then slowly inflates it. Once the bone is at its normal height, the balloon is removed. This leaves a space, where bone cement is injected (like a vertebroplasty). This improves the strength of the spine, which can relieve pain and help you move around more easily.
These operations can only be carried out in specialist centres. Side effects are not common, but they can include infection or damage to the nerves in the spine.
The most common symptom of myeloma is bone pain. Always tell your doctor or nurse about any pain. Pain from bone damage may continue even after myeloma is in remission. But there are different ways to treat it.
If you get a new pain, or your pain is not controlled, tell your doctor or nurse straight away. There are different people who can help when you have pain. Doctors and nurses who specialise in controlling pain are called palliative care specialists.
Treatments for bone pain may include:
- painkilling drugs
Your team may also talk to you about other ways of managing pain such as:
- nerve blocks
- TENS machines
- relaxation techniques.
Different painkillers are used to treat different levels of pain. You can usually take them by mouth. You can also have them as skin patches or sometimes by an injection under the skin, or into a vein.
Your doctor or nurse will assess the pain by asking you questions about it. Give them as much information as you can. This helps them to plan the best pain control for you. It can help to use a pain diary to keep a record of the pain. They will explain about different ways the pain can be controlled.
Anti-inflammatory drugs, such as ibuprofen, may cause kidney damage in people with myeloma. You should check with your doctor or nurse before taking these.
Bone damage causes calcium to be released from the bones into the blood. High levels of calcium in the blood is called hypercalcaemia.
Some of the symptoms are:
- feeling sick
- feeling thirsty
- feeling drowsy
- feeling confused
- feeling constipated
- passing urine (pee) often.
You will have regular blood tests to check your calcium levels. Hypercalcaemia may be found before you have any symptoms.
If you have hypercalcaemia your doctor may advise you to drink lots of liquids. You are also likely to have a drip (intravenous infusion) of fluids into a vein. This helps your kidneys filter the calcium from your blood and into your urine.
Your doctor may give you a bisphosphonate drug to reduce the level of calcium. You have it into a vein over a few hours. This usually brings the calcium level in your blood down over about 2 to 3 days. If your calcium level starts to rise again, you may need another dose.
Myeloma can develop in the bones of the spine. Sometimes this can weaken the bone and put pressure on the spinal cord. This is called spinal cord compression. It can damage the nerves in the back causing different symptoms. Some of the symptoms include:
- pain in your back or neck that is new or becomes suddenly worse
- feeling unsteady on your feet, such as difficulty walking or weakness in your legs
- numbness or pins and needles in your toes, fingers or buttocks that is new or suddenly worse
- problems passing urine or problems with bowel control
If you have any of these symptoms, it is very important to contact your specialist doctor or nurse straight away. Spinal cord compression needs to be treated as soon as possible to prevent permanent damage.
Spinal cord compression is usually treated with steroids and radiotherapy. Sometimes chemotherapy is used or occasionally surgery.