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What Medicines Are Used to Protect Bones in Myeloma Patients?

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Published on February 17, 2020

Key Takeaways

Multiple myeloma experts Dr. Krina Patel, from The University of Texas MD Anderson Cancer Center, and Dr. Sagar Lonial, from the Winship Cancer Institute, discuss different options for strengthening bones in myeloma patients and potential side effects. Watch as they also explain how supplements and exercise can help, and the factors to consider when deciding which bone-strengthening treatment is the best fit for an individual.

This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.

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Transcript | What Medicines Are Used to Protect Bones in Myeloma Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jack Aiello:                 

Dr. Patel, can you talk about the usage of bisphosphonates?

Dr. Patel:                     

Sure. We know that even in smoldering patients, this came up recently, but even in smoldering patients, if they have bone loss of any kind, we know that bisphosphonates actually does help protect bones. Then there are some changes it can do the immune system that it actually helps. 

So, it’s really, really important, especially if you have bone disease, that we have some type of bone-strengthening medicine to help. It’s not something, “Oh, I gave you a dose and your bones are perfectly normal in a couple weeks,” but over time, it does help strengthen your bones a lot faster. 

In terms of zoledronic acid (Zometa) versus denosumab (Xgeva), we don’t know. We have both options, which is great. 

Jack Aiello:                

Xgeva is the other name for denosumab. 

Dr. Patel:                     

Denosumab, sorry. So, denosumab versus Zometa, we have a lot more data with Zometa. Denosumab could be more expensive for some of my patients if the insurance doesn’t approve it. So, some of those things come into play. My dentists love denosumab, because the half-life is 30 days. So, if someone needs something in the future with your teeth, they think that it decreases the risk, but in the end, we pick whichever one makes the most sense. 

But there’s a trial that was done head to head, but a lot of issues to say one is better than the other. It was made to say that they’re both equivalent to make sure you don’t get factors and things like that from myeloma. 

Dr. Lonial:                 

I think it’s important that patients take calcium and vitamin D supplementation, particularly if they’re on denosumab. That’s a really big deal. Zometa may give you some level of hypocalcemia, but with denosumab, it’s much, much lower. So, I think making sure you’re on some sort of calcium supplementation is important. 

Jack Aiello:                 

Why would you recommend denosumab over Xgeva? I’m sorry, over pamidronic acid (Aredia) or Zometa? 

Dr. Lonial:                  

If somebody’s got renal dysfunction, I think that’s an easy one. At least in our hands, if people develop bone disease in the context of being on zoledronic acid, that in my mind is a reason to think about switching because it’s a different mechanism, but that’s me. 

Dr. Patel:                     

I have some patients who have side effects from the infusions. So, then if we try to switch over and see if the subcutaneous injection, they have less side effects. But vice versa, I’ve had a couple of patients with denosumab get really bad skin rash. It’s very rare, but then we switch to the other one. So, it’s sort of patient-specific. 

Jack Aiello:                

How long do you recommend someone be on bisphosphonates? 

Dr. Patel:                    

So, I guess it depends on when. If it’s early and newly diagnosed, we usually do Zometa for two years. Denosumab in the trials continues forever. We have trials and then we have actual life. So, most of my patients after two years, we stop unless there’s a lot of bone disease and then we try to keep going. In relapsed/refractory, we try to just keep going, especially if there are new bone lesions. It’s depends on where we are in the stage of myeloma. 

Jack Aiello:                 

And Dr. Lonial, kind of the same? 

Dr. Lonial:                  

Yeah. One year, we go to every three months and we tend to go a little bit longer than two years, but there’s no hard data one way or the other. 

Jack Aiello:                 

Right. You’re really trying to avoid the osteonecrosis of the jaw and the negative effects that it can have. 

Dr. Lonial:                 

It’s still a pretty low number. 

Jack Aiello:                

There was a question that came in that said for patients that cannot bisphosphonates, are there other bone-building therapies out there? We’ve talked about denosumab or Xgeva. Is there anything else? 

Dr. Patel:                    

Not that I know of. This is where we say let’s make sure your vitamin D, your calcium, all of that is up to par. If we can do bone-strengthening exercises, but that completely depends on where the bone lesions are how much we really – I have my patients see our orthopedics docs. 

If there are certain lesions that I don’t want to cause fractures or things like that, we come up with a plan of what’s okay. Swimming is okay and walking is okay, but not weightlifting, things like that. We sort of have a team approach of giving patients what type of bone-strengthening exercises  are the best for them.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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