What is bisphosphonate therapy and how long should it be continued?

[Music] what is this phosphonate therapy and how long should it be continued what can we do to treat your bones directly well you receive chemotherapy or you receive treatment for your multiple myeloma and that pretty much is already a treatment for your bone disease so for instance we know that the plasma cells secrete cytokines that activate osteoclast the bone eating cells so when we already kid the abnormal plasma cells you already stopped the activation of the osteoclast so that's one major treatment the other kind of treatment we give to our patients are bisphosphonates this phosphonates are very active chemical substances that are given intravenously to our patients once a month and what those bisphosphonates do they inactivate and they kill the osteoclasts so this is very important and very specific to really reduce the activity of the cells that eat the bone or resolve the bone so that's why each patient who starts hemotherapy or treatment for multiple myeloma should also receive bisphosphonates I repeat the question is how long do we give the bisphosphonates usually we give the bisphosphonates and that's a recommendation by the American Society of Clinical Oncology for two years but in patients who are really in a complete remission I think the bisphosphonates can be either completed after one year or what you can also do and if the bisphosphonates instead of monthly every three months why is this you know that bisphosphonates have side effects such as the osteonecrosis of the jaw that's a necrosis of the maxilla or manipular your upper or lower jaw and we know that this risk increases miss the number of treatments so that's why recent studies show that if you give the bisphosphonates every three months instead of monthly you have the same effect so what do I do with my patients usually I give this for solids initially monthly for the first year but then later and the second year I stretch the end of every three months so year treatment first year monthly second year every three months I think is an appropriate treatment for multiple myeloma is bone disease bisphosphonates are very old drugs it's a substance most of the time the most used brand name is so meta or solid Roenick acid I think that's what most patients know it is a treatment that is killing the bone-eating cells we have bone eating and bone producing cells and they sit in the inner bone and they usually sit next to each other and our bodies turn over its eaten and it's built at the same time and at one point the myeloma cells if we have myeloma especially in those focal areas they produce substances that over activate those otherwise healthy upon eating cells or so clasts and to kind of stop that we give the bisphosphonates and those bisphosphonates kind of kill those or settlers that are too many and they also slow down the bone eating part of that they they kind of neutralize the acid that those osteoblasts produce by eating the bone should patients restart bisphosphonate therapy if their myeloma relapses usually and patients have relapse mind of a melanoma and they stopped the initial treatment whispers phosphonates we give at least money off bisphosphonates to our patients it might not be necessary if there's no extensive bone disease that the patients receive this postulate monthly in those cases we give our patients the bisphosphonates every three months in case patients have extensive bone disease and they present in their relapse see Mia or this extensive bone disease then usually I recommend that patients we see if monthly treatment whispers phosphonates but again that depends on the situation in case of a relapse [Music]