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