Treatment of myeloma bone disease: When, how often, and for how long?

The landscape of MM has changed dramatically in recent years. Several new and more effective treatments have been introduced that not only makes patients live longer but also brings them into a deeper remission. This makes the potential total exposure of bone protective treatment much higher but perhaps also less needed. New and more precise imagining techniques have been introduced making detection of bone disease more sensitive, and the introduction of SLiM-CRAB criteria have changed the parameters used in old clinical trials investigating treatment of MM bone disease. New data have also emerged investigating the effect of the RANKL inhibitor denosumab compared to zoledronic acid (ZOL). Randomized trials have investigated longer treatment durations, which becomes more relevant as patients now live longer. In addition in this review, data regarding interval between individual treatment, impact of remission status, new data in relation to rebound after discontinuation and of denosumab, as well as the rational for drug holidays before dental procedures will also be discussed.