![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
![Publish Open Access Finland]({"type":"image" , "src" : "/sda/110396/JournalAd-OA-Agreements.gif"})
![Annals of medicine, now fully Open Access!]({"type":"image" , "src" : "/sda/110590/IANN-Hematology.gif"})
ABSTRACT
Introduction: Over 80% of the patients with multiple myeloma (MM) develop myeloma bone disease (MBD) during the disease course. The clinical consequences include serious skeletal-related events (SRE) that impact survival and quality of life. Bisphosphonates are the mainstay in the treatment of MBD. Currently, new therapeutic strategies are being introduced and broaden the therapeutic options in MBD.
Areas covered: The purpose of this review is to summarize the current clinical management of MBD and present novel data regarding monoclonal antibodies against the receptor activator of NF-kappa B ligand (RANKL) and sclerostin that may change the clinical practice.
Expert opinion: Our better understanding of the pathophysiology of MBD has identified several factors as potential therapeutic targets. Recent data have shown that the RANKL inhibitor denosumab constitutes a new promising option. The non-inferiority compared with bisphosphonates in terms of SRE prevention, the potential survival benefit, the convenience of subcutaneous administration, and the favorable toxicity profile makes denosumab a valuable alternative for physicians in the current treatment of MBD. Anti-sclerostin antibodies are currently under clinical development. Further investigations are needed to address open questions in the field including the value of anabolic agents combined with anti-resorptive and anti-MM drugs in MBD.
Article highlights
The armamentarium of treatment options in MM patients to prevent MBD complications has enhanced with the recent addition of denosumab.
Denosumab inhibits osteoclasts by blocking RANK/RANKL interaction.
Denosumab has the potential to become a new standard of care in the treatment of MBD and constitutes a valuable alternative for the treatment of MBD with a favorable toxicity profile.
Anti-sclerostin mon.oclonal antibodies have shown preclinical activity and have to be further evaluated in clinical studies for treating MBD.
Further investigations are needed to determine the optimal combinatory bone-targeting and anti-myeloma regimen.
Declaration of interest
E Terpos has received honoraria from Amgen, Celgene, Genesis, Janssen, Novartis, BMS, and Takeda. They are also a member of steering committees for Amgen and Takeda and an independent data monitoring committee for Celgene. They have also received research grants from Amgen, Janssen, and Takeda. MA Dimpoulos has received honoraria from Amgen, Celgene, Genesis, Janssen, BMS, and Takeda. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.