Current concepts in the management of bone lesions in multiple myeloma

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.