Multiple myeloma is a cancer of the plasma cells in the bone marrow. As you might expect from a cancer that originates inside the bones, it can directly harm your bones, with the possibilities ranging from pain to bone loss to an increased risk of fractures. That’s why it’s very important for you and your healthcare team to stay on top of your bone health during your multiple myeloma treatment. The Reason You Have Weak Bones Two types of bone cells work together inside your body to keep your bones strong and healthy. One type, known as osteoclasts, break down old bone, and the other type, osteoblasts, put new bone in its place. But when your plasma cells become malignant myeloma cells, they produce a substance that interferes with those two groups of cells’ abilities to do their jobs correctly. Not enough new bone is produced to replace the old bone that gets dissolved or broken down, and the bone that’s left is weak and easily broken. The result: you must be constantly vigilant about accidentally fracturing one of your already vulnerable bones. Common Treatments for Bone Disease If your doctor decides you need treatment for multiple myeloma bone disease, the most likely first course of treatment will be a prescription for bisphosphonates. These drugs can arrest symptoms like bone pain and reduce the risk of bone fracture. (People who have bone loss as the result of osteoporosis but do not have multiple myeloma take a similar but less potent version.) A typical course of treatment is administered via IV every four weeks for approximately two years. Along the way, your doctor will run some blood tests to monitor your creatinine levels to make sure the bone treatment isn’t harming your kidneys (already compromised by the myeloma) or damaging your jawbone. Your doctor may also consider an orthopedic intervention or radiation therapy in an effort to reduce any bone pain you’re experiencing. The orthopedic interventions could include physical therapy, bone splinting or surgery. Possible surgical procedures could include repairs to any compression fractures to your spine that may have occurred or procedures to prevent future fractures from occurring. You might also be a candidate for a minimally invasive surgical procedure to stabilize and reinforce the bones of your spine (vertebra). Finally, your healthcare team may run some lab tests to monitor your bone health along the way. A Case for Exercise You might be afraid to move around too much, for fear of fracturing or destabilizing a bone. But, exercise and physical activity can strengthen your bones. Exercise can help reduce some of the fatigue that often accompanies multiple myeloma and multiple myeloma treatment. The exercise can make you stronger. It can also help you feel calmer, less anxious and better equipped to cope with the stress that accompanies cancer treatment. However, a complete assessment is recommended before you start an exercise plan. You may need to be evaluated for stability and balance as well as spinal cord compression risk. Whether you’re walking, riding a stationary bike, or performing some other type of physical activity, you’ll want to be extra careful because of your increased risk for bone fractures. You may also need to take regular breaks and balance your activity with periods of rest. Diet and Supplements Your doctor will probably encourage you to embrace a well-balanced diet that incorporates fruits, veggies, protein and carbohydrates. Chances are, you’ll receive a recommendation to take a calcium supplement and perhaps also a vitamin D supplement to support your bones. Some supplements can work against the medical treatments that you may undergo, so be sure to consult your doctor before adding a vitamin or mineral supplement to your daily routine. As many as 90 percent of people with multiple myeloma will develop some type of bone lesions during the course of their disease and treatment, so it’s important to discuss preventive care to maximize bone health with your healthcare provider.