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 .
VTD consolidation, without bisphosphonates, reduces bone resorption and is associated with a very low incidence of skeletal-related events in myeloma patients post ASCT
We prospect ively evaluated the effect of bortezomib , thalidomide and dexamethasone ( VTD ) consolidation on bone metabolism of 42 myeloma patients who underwent an autologous stem cell transplantation ( ASCT ) .  VTD started on day 100 post ASCT ; patients received four cycles of VTD ( first block ) , were followed without treatment for 100 days and then received another four VTD cycles ( second block ) . During this 12-month period , bisphosphonates were not administered . Best response included stringent complete remission ( sCR ) in 15 ( 35.7 % ) patients , complete response ( CR ) in 13 ( 30.9 % ) , vgPR in 7 ( 16.6 % ) , PR in 4 ( 9.5 % ) , while 3 ( 7.1 % ) patients developed a progressive disease ( PD ) . Importantly , 33.3 % and 47.6 % of patients improved their status of response after the first and second VTD block , respectively . VTD consolidation result ed in a significant reduction of circulating C-terminal cross-linking telopeptide of collagen type I ( CTX ) , soluble receptor activator of the nuclear factor-kappa B lig and ( sRANKL ) and osteocalcin ( OC ) , whereas bone-specific alkaline phosphatase ( bALP ) remained stable compared with pre-VTD values . During the study period , only one patient with a PD developed a skeletal-related event ( that is , radiation to bone ) . The median time to progression ( TTP ) after ASCT was 34 months and the median time of next treatment was 40 months . We conclude that VTD consolidation post ASCT reduces bone resorption and is associated with a very low incidence of skeletal-related events ( SREs ) despite the absence of bisphosphonates ; the later do not appear to be necessary in this context
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 .