Temporary diagnostics and treatment of myeloma bone disease in clinical practice

Czech version

Authors: V. Ščudla ¹; Z. Adam ²
Authors‘ workplace: III. interní – nefrologická, revmatologická a endokrinologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Josef Zadražil, CSc. ¹; Interní hematologická a onkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Mayer, CSc. ²
Published in: Vnitř Lék 2012; 58(7 a 8): 164-174
Category: 60th Birthday prof. MUDr. Miroslav Penka, CSc.

Overview

The presented paper demonstrates clinical manifestations of myeloma bone disease and its position within diagnostics, differential diagnostics and stratification of multiple myeloma. Attention is drawn to the role of conventional and modern imaging techniques, especially to whole body magnetic resonance (WB-MR), positron emission tomography/computed tomography, and other radionuclide imaging methods (MIBI scintigraphy of the skeleton). We touch also the role of dual energy X-ray absorptiometry, and the evaluation of biomarkers of bone metabolism in the assessment of the state and evolution of myeloma bone disease. We aim at present therapeutic modalities of myeloma bone disease with stress on bisphosphonate therapy, and we outline also new perspective alternatives of targeted therapy based on pathogenesis of myeloma bone disease, i.e. the use of antagonists and inhibitors of those molecules that interfere with osteoclastic bone resorption and osteoblastic osteoformation, e.g. monoclonal antibody against RANKL (denosumab) or proteasome inhibitors (bortezomib, carfilzomib). We conclude that effective diagnostics and treatment of myeloma bone disease significantly contributes to the improvement of quality of life and overall survival in patients with multiple myeloma.

Key words:
myeloma bone disease – whole body-magnetic resonance – positron emission tomography/computed tomography – biomarkers of bone metabolism – bisphosphonates – denosumab – bortezomib

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