Pathophysiology of myeloma bone disease

Multiple myeloma is characterized by a unique form of destructive bone disease, which occurs in the majority of patients. The bone destruction, which is progressive, is responsible for the most prominent and distressing clinical features of this disease, namely intractable bone pain, fractures occurring either spontaneously or following trivial injury, and hypercalcemia with its attendant symptoms and signs. Although myeloma is a disease with protean features resulting from the effects of the disease on multiple organ systems, perhaps its most important clinical manifestation, and certainly the one that most often heralds the onset of the disease, is its effects on the skeleton. This chapter will focus on the pathophysiology of the bone lesions in myeloma.