What are the International Myeloma Working Group (IMWG) practice treatment guidelines for bone disease associated with multiple myeloma (MM)?

Updated: Mar 06, 2020
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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In May 2013, the International Myeloma Working Group (IMWG) released practice guidelines for the management of multiple myeloma–related bone disease. [46]  The recommendations, which were based on a review of the literature through August 2012 and a consensus of an interdisciplinary panel of experts, include the following:

  • Consideration of bisphosphonates in all patients receiving first-line antimyeloma therapy, regardless of the presence of osteolytic bone lesions on conventional radiography
  • Intravenous (IV) zoledronic acid or pamidronate for preventing skeletal-related events; because of its potential antimyeloma effects and survival benefits, zoledronic acid is preferred in patients with newly diagnosed multiple myeloma
  • Bisphosphonates should be administered IV every 3 to 4 weeks during initial therapy, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw
  • Zoledronic acid or pamidronate should be continued in patients with active disease and should be resumed after disease relapse
  • Kyphoplasty should be considered for symptomatic vertebral compression fractures
  • Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability
  • Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression

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