Clinical Edge

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Cochrane on Bisphosphonates in Multiple Myeloma

Cochrane; 2017 Dec 18; Mhaskar, Kumar, et al

Bisphosphonates in patients with multiple myeloma (MM) reduces pathological vertebral fractures, skeletal-related events, and pain, according to a Cochrane review of 24 trials involving nearly 7,300 participants. Among the findings:

  • Bisphosphonates did not improve overall or disease progression-free survival.
  • They reduced overall fractures and fractures of the vertebra, but not non-vertebral fractures.
  • They alleviated pain, with osteonecrosis the only major adverse event (event rate of 1/1,000 patients treated).
  • Zoledronate was more efficacious than than etidronate and placebo, but it did not improve overall survival or other outcomes better than pamidronate or clodronate.
  • No specific aminobisphosphonate or non-aminobisphosphonate was found to be superior for any outcome.


Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Bisphosphonates in multiple myeloma: An updated network meta-analysis. Cochrane Database of Systematic Reviews. 2017, Issue 12. Art. No.: CD003188. doi:10.1002/14651858.CD003188.pub4