Multiple myeloma causes lytic or osteolytic lesions, which are areas of damage caused by cancerous plasma cells blocking normal bone growth. While painful, they can be managed.

Multiple myeloma is a type of blood cancer. It forms in plasma cells, which are made in the bone marrow.

Multiple myeloma causes cancer cells in the bone marrow to multiply rapidly. These cancer cells eventually crowd out and destroy healthy plasma cells and blood cells.

Plasma cells are responsible for producing antibodies, which help protect against disease. Multiple myeloma cells can cause the production of abnormal antibodies. These can slow blood flow.

Multiple myeloma most often occurs in bone marrow with the most activity, which can include the marrow in bones such as the:

  • shoulders
  • ribs
  • hips
  • spine
  • pelvic bones

Multiple myeloma is also characterized by the existence of multiple tumors. Read on to learn how multiple myeloma affects the bones, why it happens, and how to treat it.

Multiple myeloma causes osteolytic lesions or lytic lesions. These are areas of bone destruction created by accumulations of cancerous plasma cells in the bone marrow. The cancer prevents these areas of bone from regenerating as they should.

Osteolytic lesions are painful. According to the Multiple Myeloma Research Foundation, approximately 85% of people diagnosed with multiple myeloma experience some degree of bone damage or loss.

Osteolytic lesions appear as multiple small holes in the bone on an X-ray. The affected bone can be described as having a moth-eaten appearance.

In addition, some people might show focal lesions, which are abnormal areas that signal the development of a lytic lesion within 18–24 months.

In the body, cells known as osteoclasts break down bone, whereas osteoblasts generate new bone. These cells are activated as needed by special proteins that help make sure our bones regenerate in a balanced way.

Multiple myeloma causes an expression of too much protein in a way that leads to excessive bone breakdown that isn’t properly balanced by new bone growth.

Multiple myeloma can cause the bones to break down quickly, which raises calcium in the blood. This is known as hypercalcemia.

In addition, multiple myeloma can also cause nerve damage or pain when a tumor presses up against a nerve. Tumors can also compress the spinal cord, which can result in back pain and muscle weakness.

What is the common site of bone lesions in multiple myeloma?

The most commonly affected bones are in the hips, back, or skull. You are also more likely to develop breaks or fractures as a result of this bone damage.

To identify bone disease caused by multiple myeloma, a doctor will need to see the bone deterioration on an imaging test. This may include:

  • X-ray
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • positron emission tomography (PET scan)

An X-ray is usually the first choice, but depending on the suspected stage, one of the other diagnostic tests may provide a better, more sensitive image.

Multiple myeloma can be painful. While the first priority is treating the myeloma itself, several treatment options are available that focus purely on relieving your pain. Medical and natural treatment options are available to treat bone pain and lesions.

Always talk with your doctor before starting a new treatment. Some treatments may help bone pain but won’t stop the cancer from growing.

Medical treatments

Medical treatment options include:

  • Analgesics: “Analgesics” is an umbrella term for different pain relievers. Opioids, such as morphine and codeine, are the analgesics most likely used to treat bone pain.
  • Bisphosphonates: These prescription medications can prevent the bone cells from breaking down and damaging the bone. You can take them by mouth or receive them through a vein (intravenously), and they include pamidronate and zoledronate.
  • Denosumab: This is a monoclonal antibody drug given as a monthly injection. It targets the protein that controls bone regrowth. It’s given as a monthly subcutaneous injection (a shot under the skin).
  • Anticonvulsants and antidepressants: These medications are sometimes used to treat pain stemming from nerve damage. They can sometimes interrupt or slow down the pain signals that the nerve cells send to the brain.
  • Surgery: Surgery is most often used to treat fractures. During surgery, a doctor may insert rods or plates into the fracture to support fragile and weakened bones.
  • Radiation therapy: Radiation therapy is often used to attempt to shrink tumors. This can help relieve pinched nerves or compressed spinal cords.
  • Bracing: Some people can find some pain relief by wearing a brace, especially if they have a compression fracture.

Over-the-counter (OTC) medications may interact with your other pain medications or cancer treatments. Consult your doctor before taking any OTC medications.

Natural treatments

Natural treatments are most frequently used with medical interventions such as medications and surgery. Natural treatments can provide strong pain relief, with options including:

  • Physical therapy: Physical therapy can include general strength building, or it can be used to expand the range of motion or strength of an area of the body after bone damage or surgery.
  • Exercise therapy: Exercise therapy can promote healthy bones and reduce future pain.
  • Massage therapy: Massage therapy can relieve muscle, joint, and bone pain.
  • Acupuncture: Acupuncture is a safe treatment for promoting nerve health. It also helps with bone pain relief.

That said, speak to your doctor to make sure these natural treatments are right for you based on your general health and symptoms.

Natural supplements

Some natural supplements can help both your pain levels and your overall health.

Like OTC medications, they can interact with other medications you’re already taking. Never take any new supplements without first talking with your doctor.

While more study is needed to support the effectiveness of some natural supplements in relevance to multiple myeloma, some research has suggested the benefits of the following:

  • fish oil
  • magnesium
  • curcumin
  • vitamin D
  • vitamin A
  • vitamin C
  • probiotics

Fish oil, in particular — whether in capsule or liquid form — contains an abundance of omega-3 fatty acids. Omega-3s can help improve peripheral nerve health and reduce painful nerve damage and inflammation.

Magnesium can also:

  • improve nerve health
  • strengthen bones
  • prevent future bone pain
  • regulate calcium levels to prevent hypercalcemia or too much calcium in the blood

Should I take calcium to strengthen my bones?

Some people take calcium supplements in an attempt to strengthen their bones, but this can be dangerous.

Because calcium from the broken-down bones is already flooding the bloodstream, adding calcium supplements could result in hypercalcemia.

That said, some people may need to take calcium supplements. Always consult with your doctor before trying calcium supplements.

According to the American Cancer Society, which relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, the 5-year survival rate for multiple myeloma is 57%.

Both the multiple myeloma itself and the resulting bone damage can lead to several serious long-term effects. The most obvious are chronic bone weakness and bone pain.

Bone lesions and soft spots that occur because of multiple myeloma are difficult to treat. They may cause continued fractures, even if the cancer itself has gone into remission.

If tumors press up against your nerves or cause spinal cord compression, you may experience long-term nervous system damage. Some multiple myeloma treatments can also cause nerve damage. Many people develop tingling or pain in areas of nerve damage.

Can bone lesions from multiple myeloma heal?

In most cases, your bone lesions will not heal fully. This is because, even if your cancer enters remission, you may still not generate enough osteoblasts to repair the affected bones.

Multiple myeloma is a cancer of the blood. It starts in the plasma cells, which are made in the bone marrow. The cancerous cells multiply rapidly and take the place of healthy plasma cells and blood cells.

These abnormal cells produce faulty antibodies that slow down blood flow. They also cause specific areas of bone destruction, called osteolytic lesions or lytic lesions, since they impede the normal regeneration process of the bone. Treatments can help you manage the pain caused by these lesions.