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Lytic Lesions, Bone Health, Myeloma-

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In (MM) patients receiving long-term therapy (dexamethasone), glucocorticoids induce fractures in 30 to 50% and osteonecrosis in 9 to 40%

You have been diagnosed with a blood cancer called multiple myeloma (MM). You are trying to understand your diagnostic criteria. If you are focusing specifically on your bone health, please focus on:

  • Bone marrow biopsy (BMB)-
  • Serum Calcium (calcium IN your blood)  
  • Imaging studies (x-ray, CT scans, MRI’s, etc.)

It is important to note that thousands of people walk around daily with monoclonal proteins IN there blood. Yes, technically any m-spike as one of your diagnostic criteria, indicates monoclonal proteins aka multiple myeloma.

I am simply saying that small amounts of m-proteins in your blood may be okay. The issue is any damage done by MM.


For example, if your bone marrow biopsy indicates say, only 5% or 10% MM in your bone marrow then you are probably okay. It is only if the percentage of monoclonal proteins in your marrow increases and causes bone damage.

Further, you assume, like all MM patients do, that it is your incurable blood cancer that is the cause of your bone damage. After all, MM eats bones so this assumption is logical.

According to the articles linked and excerpted below, the dexamethasone that you taken off and on for years now, causes “glucocorticoid-induced osteoporosis (GIOP). The bone damage that MM survivors attribute to their disease might not be the only reason for their lytic lesions.

First and foremost, it is important for MM patients to understand that “denosumab is superior to bisphosphonates” regarding strengthening your bones. As least it is from a conventional (FDA) standpoint.

There are a host of evidence-based but non-conventional or natural  bone heath therapies. See the info linked below.

  • I supplement with vitamin D3 (1000 mg x 2) daily-
  • I exercise on an elliptical every morning for about 30 min.
  • I take magneseum daily-
  • I take vitamin K2 daily-

My point is that bone health for multiple myeloma patients and survivors is a full-time job- and not necessarily conventional or FDA approved.  This therapy isn’t difficult, it’s just something that we must prioritize.

To say this differently, conventional therapies can cause reduced bone health and speed the formation of lytic lesions.

To Learn More about Bisphophonates- click now

Have you been diagnosed with multiple myeloma? Have you suffered bone damage? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor 
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

What to know about lytic lesions

“Lytic lesions refer to areas of bone destruction that result in holes. They typically occur due to a disease, such as cancer. In some cases, they may result in painful fractures that can be disabling and require surgery to reinforce and stabilize the bone.

Some people may also refer to lytic lesions as bone or osteolytic lesions. The term refers to spots of bone damage that can occur with conditions that affect bone. For example, evidence notes that up to 90% of people with multiple myeloma will develop lytic lesions during the course of the disease…

These lesions result in holes that can make bones more likely to break under minor pressure or injury. The bones that lytic lesions commonly affect include the spine, pelvis, ribs, skull, and the long bones of the arms and legs. Bone disease is a hallmark feature of multiple myeloma — research suggests that up to 80%Trusted Source of people with multiple myeloma have lytic lesions at the time of diagnosis…

As lytic lesions form, an individual’s bones break down quickly. During this process, large amounts of calcium enter the bloodstream. Hypercalcemia is a term that refers to high levelsTrusted Sourceof calcium in the blood.

If a person has hypercalcemia, they may experience symptoms, such asTrusted Source:

  • kidney problems
  • dehydration and extreme thirst
  • urinating more often
  • fatigue
  • constipation
  • confusion
  • abdominal pain
  • loss of appetite…


Lytic lesions describe areas of bone damage that typically occur due to rapidly dividing cells in the bone. Multiple myeloma is a cancer of the plasma cells and a common cause of lytic lesions.

Bones within a healthy skeleton undergo a process known as remodeling that allows them to regenerate. Multiple myeloma can disrupt the balance of this process. This can result in an increased rate of bone destruction that causes lytic lesions to form.

In addition to treating the underlying cause of the lesions, a person may also require other treatments to reinforce and stabilize their bones to prevent fractures.”

Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

“Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis. In May 2018, denosumab was approved for the treatment of GIOP in men and women at high risk of fracture. We undertook a systematic review and meta-analysis to summarize the efficacy and safety of denosumab in the prevention and treatment of GIOP…

Conclusion: Results suggest that denosumab is superior to bisphosphonates in its effects on lumbar spine and total hip BMD in patients with GIOP. There was no difference in the incidence of infections, adverse events or serious adverse events. Studies were underpowered to detect differences in the risk of fracture. Denosumab is a reasonable option for treatment of GIOP. However, further studies are needed to guide transitions off denosumab.”

Glucocorticoid-Induced Osteoporosis and Osteonecrosis

“Today, we know that glucocorticoid administration is the most common cause of secondary osteoporosis and the leading cause of nontraumatic osteonecrosis. In patients receiving long-term therapy, glucocorticoids induce fractures in 30 to 50% and osteonecrosis in 9 to 40% (,). Sadly, patients are seldom warned about these side effects and as a result, adverse skeletal events are the most common glucocorticoid-related complications associated with successful litigation ()…

Dexamethasone, Oral Tablet

“Serious side effects-

  • Osteoporosis (thinning of the bones)

How Much Vitamin D Do I Need?

“Vitamin D helps the body absorb calcium and phosphorus from the food you eat. So the nutrient is important for people with osteoporosis. Studies show that calcium and vitamin D together can build stronger bones in women after menopause. It also helps with other disorders that cause weak bones, like rickets. If you’re concerned about your bone health, ask your doctor if you should think about taking a supplement…”

Exercise for Your Bone Health

“Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only can exercise improve your bone health, it can also increase muscle strength, coordination, and balance, and lead to better overall health…”

Magnesium and Osteoporosis: Current State of Knowledge and Future Research Directions

“A tight control of magnesium homeostasis seems to be crucial for bone health. On the basis of experimental and epidemiological studies, both low and high magnesium have harmful effects on the bones…”

Bone health and osteoporosis: the role of vitamin K and potential antagonism by anticoagulants.

“The research suggests that at a minimum, clinicians should carefully assess anticoagulated patients for osteoporosis risk, monitor BMD, and refer them to dietitians for dietary and supplement advice on bone health…”


Leave a Comment:

Peggy Bartulovic says last year

Hello. I am a otherwise healthy 57 year old newly diagnosed with MM, stage 1, 1 lytic lesion in rib. Just completed 1 cycle of RVD. You mentioned denosumab is superior to biophosphates…I am prescribed Zometa.infusion 1x/month. Could you expand on the differences in the 2 classes of drugs. I am a pesonal trainerand do exercise daily. I do take D3, Magnesium and K. Could you also share what dose of K you take?
Thank you for the wealth of information you share. It is invaluable and much appreciated.

    David Emerson says last year

    Hi Peggy-

    I replied to you directly via email. Let me know if you have any questions.

    David Emerson

Ronald Quasebarth says a couple of years ago

Thanks again Dave. I’m soon to start chemo, 3 weeks, revlimid, daratumabab and dexamethosone. Dr Huff at Johns Hopkins.

    David Emerson says a couple of years ago

    Good luck Ron- hang in there,


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