Bone problems and myeloma
Myeloma cells can damage bones and cause bone problems. There are different ways of managing or treating these problems.
Myeloma and bone problems
Myeloma cells can damage bones and cause bone problems. Areas of bone may get thinner and weaker, and may sometimes break (fracture). There are different ways of managing or treating these problems.
Treating bone pain
Bone pain is the most common symptom of myeloma. Pain from bone damage may continue even if the myeloma is in remission. This is because bone damage can continue to cause symptoms even though the myeloma is no longer there.
There are ways to treat bone pain. Always tell your doctor or nurse about any bone pain, including any new pain. There are doctors and nurses who specialise in controlling pain. They are called palliative care specialists or pain specialists. They are based in hospitals, hospices, palliative care units and pain clinics. They work with your myeloma team and your GP to make sure your pain is well controlled.
Treatments for bone pain may include:
- painkillers
- bisphosphonates - bone strengthening drugs
- radiotherapy
- surgery, including vertebroplasty or kyphoplasty, to repair bone damaged areas.
The healthcare team may also talk to you about other ways of managing pain, such as:
- physiotherapy
- nerve blocks
- TENS machines
- relaxation techniques.
Painkillers
Different painkillers are used to treat different types and levels of pain. You can usually take them by mouth. You can also have them as skin patches or sometimes as 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. It can help to keep a record of when you have the pain and what makes it better or worse in a pain diary. This information can help them to plan the best pain control for you.
Download our pain diary [PDF]
Anti-inflammatory drugs such as ibuprofen can cause kidney damage in people with myeloma. You should check with your cancer doctor or specialist nurse before taking these. We have more information about ways to manage pain.
Radiotherapy
Radiotherapy uses high-energy rays to destroy the myeloma cells. You may have it to reduce pain in bones and 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 help control the myeloma.
How is radiotherapy given?
You have radiotherapy in the hospital radiotherapy department. You will go to the department before your treatment starts. The radiotherapy staff will decide:
- the exact dose of radiotherapy
- the area to be treated
- how many treatments you need.
Each treatment is called a fraction.
Side effects of radiotherapy for myeloma
Side effects are usually mild, but this depends on the area being treated.
Tiredness (fatigue) is a common side effect. If treatment is given close to the tummy or bowel, other side effects can include feeling sick or diarrhoea. Side effects usually gradually improve a few weeks after treatment finishes.
Tell the radiotherapy team about any side effects you have. They can help you to manage them. We have more information about having radiotherapy.
Bisphosphonates
Bisphosphonates are drugs that can help strengthen weakened bones and reduce pain. They can also reduce high levels of calcium in the blood (hypercalcaemia). These drugs can help delay bone damage, so your doctor may give you them before you have any bone problems. Some bisphosphonates may also help treat myeloma.
The bisphosphonates most often used are:
Surgery
Some people need surgery to repair bones that have been 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 loss of height. It is often treated:
- with painkillers
- with bed rest
- by wearing a spinal brace.
Surgery may sometimes 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 of controlling your pain first.
Possible operations include the following:
-
Vertebroplasty
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 into the vertebrae and then slowly inflates it to create a space. The balloon is called an inflatable bone tamp. Bone cement is injected into the space, 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 done in specialist centres. Side effects are not common, but they can include infection or damage to the nerves in the spine.
Related pages
Treating spinal cord compression
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 malignant spinal cord compression. (MSCC). It can damage the nerves in the back. This causes:
- back or neck pain that is new or suddenly gets worse
- numbness or pins and needles anywhere in your body that is new or suddenly gets worse
- a feeling that your arms and hands are weak or not able to grip things properly
- a feeling of unsteadiness on your feet
- weakness in your legs
- problems passing urine (peeing) or only passing small amounts of urine
- problems with bowel control (incontinence or constipation).
If you have symptoms of MSCC, you should get medical advice immediately.
You should contact the hospital team where you usually go for cancer treatment and follow-up appointments. If you are unable to get in touch with anyone, go to the nearest Emergency Department (A&E) or contact your GP.
When you speak to a health professional:
- tell them you have cancer and are worried you may have spinal cord compression
- describe your symptoms
- tell them that you need to be seen straight away.
Spinal cord compression is an emergency that needs treatment as soon as possible. Do not wait for further symptoms to develop. The sooner MSCC is diagnosed, the sooner treatment can begin. If left untreated, MSCC can cause permanent nerve damage.
Spinal cord compression is usually treated with steroids and radiotherapy. Sometimes chemotherapy is used, or surgery may be needed.
Doctors will help manage any pain and bisphosphonates may be used to help to strengthen your bones.
Treating high calcium levels in the blood (hypercalcaemia)
Bone damage can cause calcium to be released from the bones into the blood. High levels of calcium in the blood is called hypercalcaemia.
Symptoms of hypercalcaemia include feeling:
- sick (nausea)
- thirsty
- drowsy
- confused and unwell
- constipated
- that you are passing urine more often.
But hypercalcaemia may be found before you have any symptoms. You will have regular blood tests to check your calcium levels.
If you develop hypercalcaemia, your doctor may advise you to start drinking 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 also give you a drug called a bisphosphonates reduce the level of calcium. The drug is given into a vein over a few hours. It helps the calcium go back into your bones. 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.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
-
References
Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Hughes D, Yong K, Ramasamy K, et al. Diagnosis and management of smouldering myeloma: A British Society for Haematology Good Practice Paper. Br J Haematol. 2024;204(4):1193-1206. Available from: www.doi.org/10.1111/bjh.19333
Sive J, Cuthill K, Hunter H, et al. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br J Haematol.2021;193(2):245-268. Available from: www.doi.org/10.1111/bjh.17410
Reviewer
Senior Clinical Research Fellow and Honorary Consultant in Molecular Diagnostics and Leukaemia
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.