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 .
Natural history of osteonecrosis of the jaw in patients with multiple myeloma.
PURPOSE To evaluate the natural history of bisphosphonate-related  osteonecrosis of the jaw ( ONJ ) in patients with multiple myeloma . PATIENTS AND METHODS Ninety-seven patients with myeloma from the United States ( n = 37 ) and Greece ( n = 60 ) were observed prospect ively for a minimum 3.2 years after ONJ . Patients characteristics were similar with regard to age , bisphosphonate use , and myeloma therapy , except more autologous transplantations were performed on patients in the United States than in Greece ( 73 % v 28 % ; P < .0001 ) . RESULTS ONJ resolved in 60 patients ( 62 % ) , resolved and recurred in 12 patients ( 12 % ) , and did not heal in 25 patients ( 26 % ) . Dental procedures preceded ONJ in 46 patients ( 47 % ) and were more common in those with single episodes ( 35 of 60 , 58 % ) than recurrent or nonhealing ( 11 of 37 , 30 % ; P = .007 ) . Recurrent ONJ followed reinitiation of bisphosphonates in six of 12 patients . Greek patients had more bone pain than United States patients ( 60 % v 30 % , P = .001 ) and were less likely to restart bisphosphonates ( 5 % v 35 % , P < .0002 ) . Myeloma relapses were more common in patients with recurrent/nonhealing than single-episode ONJ ( 84 % v 62 % ; P = .02 ) . Median overall survival from myeloma diagnosis was 10.8 years ( 95 % CI ; 9.3 years to not reached ) and did not differ between patients with single , recurrent , and nonhealing ONJ ( P = .2 ) . CONCLUSION ONJ healed in 75 % of patients . Patients with spontaneous ONJ have a higher risk of nonhealing and recurrence . Reinitiating bisphosphonates after healing of ONJ is a reasonable option in patients experiencing relapse who are at risk of skeletal complications . Further studies of the pathogenesis and healing of ONJ are needed
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 .