The Treatment Plan Part: Bisphosphonates & Pathologic Fractures

There are many different treatments out there for Multiple Myeloma (MM) and there are constantly new medications being studied. There also several studies to test new drugs or new drug combinations occurring at any given time. There are multiple factors to why 1 combination may be good for a patient and not good for another patient even though they have the same cancer. It is a complicated and daunting task for newly diagnosed patients to figure out what options are even available. To further complicate issues, the experts disagree and often have varying opinions about the different treatments. There is also clinical data that is published regarding treatments and outcomes but these studies take time and are usually 5 years old by the time they get published. I guess what I am trying to convey is that treating any cancer can be very confusing and difficult. The treatment and strategies are constantly changing and improving.

One of the big problems / side effects of MM is pathological fractures. The overgrowth of plasma cells in the bone marrow causes enzymes to extract calcium from bones which causes the bone to become weaker and ultimately fracture from forces that would not normally cause a bone to break, hence the term "pathologic".  Often MM is diagnosed when a patient comes to the doctor with a broken rib from "coughing" or "playing with the grandchildren". This makes the doctor think about MM and run appropriate tests to look for the cancer. Even in recent years individuals with MM would have a pathological fracture of the spine or hip which would lead to their early death. It was and is not uncommon for a patient with MM die from a pathologic fracture related deterioration of health.

Part 1 of Jodi's Treatment:
Jodi has been fortunate to be included in a study for a treatment for bone regrowth. bisphosphonates are a class of drugs that have been around for a while and are used to treat osteoporosis. Modern versions of these drugs have been highly adapted and a recent study that uses high dose bisphosphonates to treat people with boney metastasis from other cancers and people with multiple myeloma has taken treatment of these pathologic fractures and prevention of further fractures to a new level.  The study is difficult to get included in as a patient, and has been extraordinarily well received by those in the study.  Eventually this treatment will be the standard of care for these cancer associated bone problems.

Jodi has started this treatment and has already seen improvement in her bone pain and strength. At her time of diagnoses she had multiple small pathologic lesions and some fractures. Fortunately it was early on the the disease state that she had not developed any spine fractures or hip fractures or other more serious fracture. Due to acceptance in this study her bones have already started to improve and strengthen which eliminates 1 aspect of concern regarding her diagnosis.

This image is not an image of Jodi's spine fortunately. This is a severe pathologic fracture from an unknown patient with MM, ultimately leading to neurologic dysfunction.