Bone loss in myeloma can be caused by the disease process and also the use of intensive chemotherapy and steroid use. Poor mobility, low levels of vitamin D and renal impairment are among other contributing factors.
Endocrine abnormalities include hypothyroidism and hypogonadism are frequent in intensively treated myeloma patients. Hypogonadism requires routine screening and appropriate specialist advice and treatment with hormone replacement. Women of child-bearing age may experience an early menopause following chemotherapy and/or radiotherapy and also require appropriate specialist advice and treatment if appropriate. Bone risk can be reduced by weight-bearing exercise, use of bisphosphonates, calcium and Vitamin D supplementation. Bisphosphonates are recommended routinely for all patients with myeloma but the optimal duration and scheduling of use remains unknown.
A body composition condition termed ‘sarcopenic obesity’ has been reported in intensively treated myeloma patients. In contrast to other cancers where cachexia is seen in advanced disease, sarcopenic obesity reflects the loss of muscle mass but an increase in fat and can further increase frailty and reduce mobility.