Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .
Osteonecrosis of the jaw and renal safety in patients with newly diagnosed multiple myeloma: Medical Research Council Myeloma IX Study results
Bisphosphonates are recommended in patients with osteolytic lesions secondary to multiple myeloma . We report on the safety of bisphosphonate therapy with long‐term follow‐up in the Medical Research Council Myeloma IX study . Patients with newly diagnosed multiple myeloma were r and omised to zoledronic acid ( ZOL ; 4 mg intravenously every 21–28 d ) or clodronate ( CLO ; 1600 mg/d orally ) plus chemotherapy . Among 1960 patients ( 5·9‐year median follow‐up ) , both bisphosphonates were well tolerated . Acute renal failure events were similar between groups ( ZOL 5·2 % vs. CLO 5·8 % at 2 years ; incidence plateaued thereafter ) . The overall incidence of confirmed osteonecrosis of the jaw ( ONJ ) was low , but higher with ZOL ( ZOL 3·7 % vs. CLO 0·5 % ; P < 0·0001 ) . ONJ events were generally low grade and most occurred between 8 and 30 months ( median time to ONJ , 23·7 months ) . Among 10 patients with ONJ recovery data , four patients in the ZOL  group completely recovered , two patients improved , and three patients experienced no improvement ; one CLO patient experienced no improvement . Dental surgery or trauma preceded ONJ in six ZOL patients . The incidence of renal adverse events was similar for ZOL and  CLO . ONJ incidence remained low and was lower with CLO compared to ZOL . We have seen no further ONJ cases to date
Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .