What is the Mayo Clinic philosophy about the use of bisphosphonates for myeloma?
We recommend pamidronate (Aredia) for patients with myeloma bone disease. Discontinuation of bisphosphonate in patients with osteoporosis is associated with resumption of bone loss in a few months. Because of this observation and because an extended trial shows continued benefit in myeloma patients, we recommend it be used indefinitely. If a skeletal related event occurs, pamidronate should still be continued. We do not recommend the routine use of pamidronate (Aredia) in myeloma patients without bone disease. However there are two situations in which patients without significant bone disease may benefit from the use of bisphosphonates: 1) when patients are being treated with significant doses of glucocorticoids, they may benefit from the use of a bisphosphonate to prevent progression of osteoporosis or even reverse it; and 2) in smoldering or indolent myeloma bisphosphonates may prevent or delay myeloma bone disease. The thinking with regard to the use of bisphosphonates in smoldering
