Abstract:
Introduction. Bone lesions remain a serious, unresolved issue in patients with multiple myeloma. The management of
myeloma-related bone disease involves a multimodal approach, including chemotherapy, bone antiresorptive agents (bisphosphonates),
radiotherapy, pharmacological pain management, minimally invasive percutaneous orthopedic procedures,
and invasive surgical interventions.
Material and methods. A bibliographic search was conducted using databases such as PubMed, Hinari, SpringerLink, the
National Center for Biotechnology Information, and Medline. Articles published between 2000 and 2025 were selected
using the following keywords: “bone lesions in multiple myeloma” in combination with terms such as “conservative treatment,”
“surgical treatment,” “orthopedic surgery,” and “minimally invasive techniques” to maximize the search yield. Based
on the established search criteria, a total of 286 full-text articles were identified. The final bibliography includes 42 relevant
sources, deemed representative of the literature published on the topic of this review article.
Results. Bisphosphonates or denosumab should be considered the standard of care for the treatment of bone disease in
patients with multiple myeloma. Cement augmentation (polymethylmethacrylate) is effective in managing painful vertebral
compression fractures (percutaneous vertebroplasty, balloon-assisted percutaneous kyphoplasty). Radiotherapy is
recommended for uncontrolled pain in cases of spinal cord compression or pathological fractures of long bones, especially
in patients who show no response or minimal response to systemic treatment for multiple myeloma. Surgery should be
used to prevent and repair pathological fractures of long bones, spinal instability, and spinal cord compression caused by
bony fragments. Postoperative radiotherapy should be considered, particularly for long bone fractures, to achieve local
disease control and prevent implant failure.
Conclusions. The current concept in the management of patients with multiple myeloma and bone lesions is based on
developing an individualized approach that takes into account anatomical, biological, radiological, and social factors. The
selection of surgical techniques must be tailored to each patient, based on general medical condition, quality of life and
life expectancy, prior response to chemotherapy, fracture location, number, size and distribution of bone lesions, extent of
bone invasion, neurological status, and patient expectations.
