Beyond the myeloma: Unraveling the impact of bronj

Multiple myeloma (MM) is a malignant plasma cell disorder characterized by excessive production of monoclonal immunoglobulins and bone marrow infiltration, resulting in significant morbidity and mortality. It presents with bone pain, anemia, hypocalcemia, renal impairment, pathological fractures, recurrent infections, and skeletal complications. It’s pathogenesis involves genetic alterations, cytokine-mediated mechanisms, and changes in the bone marrow microenvironment, leading to increased osteoclastic activity and reduced osteoblastic function. It’s mainly treated by Bone-modifying agents such as bisphosphonates, zoledronic acid, and denosumab, they reduce skeletal complications and alleviate bone pain; however, they do not promote bone regeneration or repair. Zoledronic acid, a potent bisphosphonate, effectively reduces bone disease progression and improves survival but may cause adverse effects, particularly Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ). This case report presents cases of MM with oral complications associated with zoledronic acid therapy and prophylactic measures to be taken to prevent the disease and drug induced complications.