Multiple myeloma is a type of cancer that primarily affects plasma cells in the bone marrow, and it is especially common in older adults, typically diagnosed around the age of 69 or later. This disease has a profound impact on bone health in seniors, leading to a range of complications that can severely affect their quality of life.
At its core, multiple myeloma causes abnormal plasma cells to multiply uncontrollably within the bone marrow. These cancerous cells produce abnormal proteins and crowd out healthy bone marrow cells, which are responsible for producing normal blood cells. This crowding effect can lead to anemia and weaken the body’s ability to fight infections. More importantly for bone health, these malignant cells disrupt the normal balance of bone remodeling—a process where old bone is broken down by cells called osteoclasts and new bone is formed by osteoblasts.
In seniors with multiple myeloma, the cancerous plasma cells stimulate osteoclasts to become overactive while simultaneously suppressing osteoblast activity. This imbalance causes excessive bone resorption (breakdown) without adequate new bone formation, leading to weakened bones. The result is the development of bone lesions, areas where the bone becomes thin, fragile, and prone to fractures. These lesions often appear in the spine, ribs, pelvis, and long bones, causing significant bone pain, which is frequently one of the first symptoms noticed.
Because older adults often already have some degree of bone loss due to osteoporosis or previous fractures, multiple myeloma compounds these issues, increasing the risk of fractures and skeletal complications. Fractures in seniors can lead to decreased mobility, chronic pain, and a higher risk of disability and mortality. Vertebral fractures, in particular, can cause spinal deformities and height loss, further impairing physical function.
The disease also affects bone health indirectly. The abnormal proteins produced by myeloma cells can deposit in tissues, including the kidneys, leading to kidney damage. Poor kidney function can alter calcium metabolism, which is crucial for maintaining healthy bones. Additionally, treatments for multiple myeloma, such as corticosteroids and certain chemotherapy drugs, can contribute to bone loss and increase fracture risk.
Managing bone health in seniors with multiple myeloma requires a comprehensive approach. Doctors often use medications called bisphosphonates or newer agents like denosumab to inhibit osteoclast activity, helping to reduce bone destruction and lower the risk of fractures. Pain management, physical therapy, and sometimes surgical interventions are also important to maintain mobility and quality of life.
Because seniors may have other health conditions and decreased organ function, treatment plans must be carefully tailored. Frailty, a common condition in older adults characterized by reduced physical reserve, can influence how well a person tolerates treatment and recovers from bone complications. Assessing frailty and overall health status helps guide decisions about therapy intensity and supportive care.
In summary, multiple myeloma severely disrupts bone health in seniors by promoting bone destruction, causing painful lesions, increasing fracture risk, and complicating overall health. The interplay between the disease, age-related bone loss, and treatment side effects makes managing bone health a critical and complex aspect of care for elderly patients with multiple myeloma.