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Adding bisphosphonates to myeloma treatment decreases fractures of the vertebra and bone pain, affirm the results of a review of 20 trials with a total of 6,692 participants. However, no one drug proved superior.

Bisphosphonates are specific inhibitors of osteoclastic activity and used in the treatment of persons with multiple myeloma to reduce vertebral fractures and pain, explained Ambuj Kumar of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida in Tampa, and colleagues in their update of a 2010 review for The Cochrane Library. The researchers sought to determine whether adding these agents to standard therapy for multiple myeloma improves overall and progression-free survival and decreases skeletal-related morbidity.

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Although pooled results showed no direct effect of bisphosphonates on overall or progression-free survival compared with placebo or no treatment, zolendrate appeared to provide an overall survival benefit compared with etinodrate and with placebo. However, zolendrate was not superior to pamidronate or clodronate for improving overall survival or in any other outcomes. Pooled analysis did show bisphos-phonates to be more effective than placebo or no treatment in preventing pathological vertebral fractures and skeletal-related events, and in ameliorating pain.

The reviewers also found that adverse effects of bisphosphonates appear to be rare. For example, osteonecrosis of the jaw was no more common in bisphosphonate users than in those receiving placebos or no treatment. Similarly, no statistically significant increase in GI symptoms or in hypocalcemia was seen in bisphosphonate use compared with placebo use or no treatment. No difference in the incidence of hypocalcemia, renal dysfunction, or GI toxicity was seen among the bisphosphonates used. ONA