Bone problems and myeloma
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 called palliative care 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
- radiotherapy
- surgery, including vertebroplasty or kyphoplasty.
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 doctor or nurse before taking these. We have more information about ways to manage pain.
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 you may start taking 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 and can happen for a few days after the infusion. They include indigestion, feeling sick (nausea) and flu-like symptoms.
Rarely, bisphosphonates can cause damage to the jawbone. This is called osteonecrosis of the jaw. Your doctor will usually advise you to see a dentist before starting treatment. It is important to tell your dentist you will be taking bisphosphonates. Tell your doctor if you need any dental work while having this treatment.
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 control the myeloma for some time.
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How is radiotherapy given?
You have radiotherapy in the hospital radiotherapy department. If you are having a course of treatment, you will go to the department before your treatment starts. The radiotherapy staff work out the exact dose of radiotherapy, the area to be treated and how many treatments you need.
Treatment may be given daily (Monday to Friday) for 1 to 3 weeks, with a rest at the weekends. Some people only need 1 or 2 treatments. Each treatment is called a fraction.
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Side effects
Side effects are usually mild, but this depends 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. They 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.
Surgery
Some people need 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 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 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 of controlling your pain first.
Possible operations include the following:
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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.
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Balloon kyphoplasty
The surgeon or radiologist inserts a balloon, called an inflatable bone tamp, into the vertebrae and then slowly inflates it. 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 done in specialist centres. Side effects are not common, but they can include infection or damage to the nerves in the spine.
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 spinal cord compression. 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 in your toes, fingers or buttocks that is new or suddenly gets worse
- a feeling of unsteadiness on your feet
- weakness in your legs
- problems passing urine (peeing) or problems with bowel control.
If you have any of these symptoms, it is very important to tell your doctor or specialist nurse straight away.
Spinal cord compression should be treated as soon as possible to prevent permanent damage. It 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)
- feeling thirsty
- feeling drowsy
- feeling confused
- feeling unwell
- feeling constipated
- passing urine 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 to 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
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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 cancerinformationteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22
Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22
M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22
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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. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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