Here's what you should know about maintaining your bone health with multiple myeloma.

Why Multiple Myeloma Affects Your Bones

Multiple myeloma is a cancer of white blood cells that starts in the bone marrow. It can weaken your bones, increase your risk for breaks and cause pain. Myeloma cells can remove calcium from your bones an important nutrient that your bones need in order to keep them strong. Without enough calcium in your bones, soft spots, called osteolytic lesions, can form. Myeloma cells can remove excess calcium and cause hypercalcemia. When calcium levels become excessively high in your blood this can cause several issues. If you have multiple myeloma your doctor will closely monitor your blood calcium level and assess you for any symptoms of hypercalcemia. Hypercalcemia can be dangerous but there are effective treatments that can be used to correct calcium levels when they become abnormally high.

What Your Doctor Can Do

Besides treating the disease itself, your doctors will monitor your bone health with scans throughout your cancer care. They can use radiation to shrink bone tumors and relieve any pain. Sometimes other procedures or surgeries are also needed to reinforce weak bones, repair fractures, or help with pain. Often times following surgery or other procedures, you may also have radiation therapy to help prevent the myeloma cells from growing back in the same area. Doctors may also give you an osteoporosis drug called a bisphosphonate that helps keep your bones strong.

“I lost five inches in height, but I beat multiple myeloma,” says survivor Anna Quigley.

"We give bisphosphonates once a month or once every three months to maintain bone health," says Siddhartha Ganguly, MD, Deputy Director, Hematololgic Malignanices and Cellular Therapeutics at University of Kansas Medical Center.

What You Can Do

There are some things that weaken your bones and lead to breaks that are simply out of your control. But, there are other things that have a big impact on bone health that you can control.

Your nutrition plays a big part in your bone health. "We pay special attention to vitamin D levels and calcium intake in patients with multiple myeloma," Dr. Ganguly says.

Vitamin D helps your body absorb calcium. Your bones need calcium to stay strong. You can get vitamin D from the sun, from foods to which manufacturers add vitamin D, and from supplements. Adults from ages 51 to 70 should get 600 IUs a day from food or supplements. (The sun isn't a great source of vitamin D if you wear sunscreen to avoid skin cancer or don't get outdoors much.) After age 70, you need 800 IUs of vitamin D a day.

“If I have back pain, should I get an MRI for multiple myeloma?” Dr. Jens Hillengass answers.

Men ages 51 to 70 need 1,000 mg of calcium a day (and 1,200 a day after 70) and women that age need 1,200 mg. If you don't get enough from dairy, dark leafy greens, soy products, and foods fortified with calcium, get the rest from a supplement. But be careful not to overdo it. You shouldn't get more than 2,000 mg a day.

Exercise is also good for bone health, but it's important to work with your doctor and a physical therapist. Depending on where you have bone lesions, certain exercises might not be safe for you. A physical therapist who has access to images of your bones can help plan a safe exercise regimen.

When You Should See Your Doctor

Stay up to date with all your cancer care and follow up. "And also maintain your preventive checkups with your primary care physician," Dr. Ganguly says. "If you see a new mole, get it checked out. If you see a new lump, get it checked out. If your counts are low, get it checked out."

If you develop new bone pain, have worsening bone pain, or feel your bone pain has changed in quality, discuss this with your doctor and treatment team immediately.

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