Management of bone disease in myeloma patients: zoledronic acid or denosumab?

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  • ABE Masahiro
    Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School
  • MIKI Hirokazu
    Division of Transfusion and Cell Therapy Medicine, Tokushima University Hospital
  • NAKAMURA Shingen
    Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School

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Other Title
  • 骨髄腫骨病変の管理：ゾレドロン酸かデノスマブか
  • コツズイシュコツ ビョウヘン ノ カンリ : ゾレドロンサン カ デノスマブ カ

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Abstract

With improvement of survival owing to the recent implementation of new anti-myeloma (MM) agents, bone management will become more important for maintaining the quality of life (QoL) of patients. Bisphosphonates are currently the standard of care for MM-related bone disease. Zoledronic acid is recommended for newly diagnosed MM patients receiving front-line anti-MM treatment regardless of existing detectable bone lesions. Intriguingly, an overall survival benefit has been observed with zoledronic acid in patients on anti-MM treatment with documented bone disease at baseline. Denosumab, a human monoclonal antibody against RANKL, has been demonstrated to reduce bone-related events in patients with MM as effectively as zoledronic acid. Hypocalcemia is generally accepted as occurring more frequently and more severely with denosumab than with zoledronic acid, especially in patients with renal insufficiency. Bisphosphonates but not denosumab deposit in bone with a long half-life, which may make a difference in long-term efficacy as well as adverse effects. Clinical benefits of long-term anti-resorptive therapies after achieving a good response should be clarified, in order to avoid the emergence of severe complications. Impacts of new agents in combination with these anti-resorptive agents on bone metabolism have yet to be studied.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 56 (8), 997-1004, 2015

    The Japanese Society of Hematology

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