Zoledronic acid in the management of bone disease as a consequence of multiple myeloma: a review

Abstract

Background: Multiple myeloma (MM) is a haematological cancer associated with organ damage, essentially bone damage. MM continues to be considered an incurable disease and requires significant therapeutic resources.

Aim: This manuscript presents a literature review of the utility of zoledronic acid (zoledronate) in the management of bone disease in MM.

Discussion: The clinical benefit of bisphosphonates in the prevention and treatment of bone disease in MM has been demonstrated in the last 10 years. A recent network meta-analysis has evaluated 20 randomised clinical trials with nearly 7000 patients with myeloma enrolled and confirms the role of these agents in the prevention of pain, bone fractures and other skeletal-related events (SRE) in MM. However, their role on survival remains unclear. Zoledronate has shown significant reductions in SRE compared with placebo or other agents with acceptable tolerability, and recent studies have shown antitumoural effects for this agent, with a marginal survival benefit demonstrated in MM.

Conclusions: Zoledronate prevents SRE in MM and presents a marginal survival benefit that deserves further investigation in controlled studies. Current clinical guidelines should be followed regarding the appropriate use of zoledronate in MM, to enhance its effects and to minimise its potential toxicity.

Keywords: bisphosphonates; bone disease; multiple myeloma; zoledronic acid/zoledronate.