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Bone disease in myeloma: fractures and bone pain | CION Cancer Clinics
Myeloma causes bone pain and fractures because it makes the body dissolve bone faster than it rebuilds it. Treating the myeloma stops new damage. Pain relief, bone-strengthening drips, radiotherapy, cement for spine fractures and sometimes surgery ease pain and protect weak bones. New back pain with leg weakness or bladder trouble is an emergency: go to the nearest emergency department or call 108. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why does myeloma cause bone pain and fractures?
- How is bone disease in myeloma treated?
- What should you do when a new bone pain appears?
- What do the words on a bone scan report mean?
- What do families often believe about myeloma bone pain?
- How can you protect the bones at home?
- Common questions about myeloma bone pain and fractures
!
Back pain that cannot wait
New back pain with weakness, numbness or heaviness in the legs, trouble walking, or loss of control of the bladder or bowels can mean the spinal cord is being pressed. Go to the nearest emergency department or call 108 now. Say the person has myeloma. Do not wait to see if it settles overnight. The same applies to sudden confusion, extreme thirst or drowsiness, which can signal high calcium.
The short answer
Why does myeloma cause bone pain and fractures?
Myeloma cells upset the normal balance between breaking down old bone and building new bone. Bone is removed faster than it is replaced, leaving weak spots that hurt and can break with little force.
What is happening inside the bone
Healthy bone is constantly renewed. Myeloma cells release signals that speed up the cells that dissolve bone and slow down the cells that rebuild it. The result is holes, called lytic lesions, most often in the spine, ribs, pelvis, skull and upper arms and legs. A vertebra in the spine can collapse slightly, which is called a compression fracture. That is a common cause of sudden back pain and loss of height.
Why treating the myeloma matters most
Pain relief, bone-strengthening drips and radiotherapy all help. The single biggest step is treating the myeloma itself, because it stops new damage. Bone that has already been lost does not fully rebuild, but pain often eases a great deal once treatment starts working.
What this page cannot tell you
It cannot tell you whether a particular pain is from myeloma, from a fracture, or from something unrelated, such as a strained muscle. Only an examination and the right scan can answer that. It also cannot tell you how much your bones will recover.
Not sure whether this applies to you?
Ask an oncologistWhat can be done
How is bone disease in myeloma treated?
Most people receive several of these together. The team fits them to where the damage is and how much it hurts.
Pain relief
Paracetamol and stronger medicines such as morphine-type painkillers are used in steps. Some common painkillers of the anti-inflammatory kind can harm kidneys that myeloma has already strained, so always ask before taking any.
Bone-strengthening drips or injections
Zoledronic acid or denosumab slow the bone breakdown and lower the chance of new fractures. Most people with myeloma bone disease are offered one of them.
Radiotherapy
A short course aimed at one painful area can ease pain well and help a weakened bone. It is also used urgently when the spinal cord is pressed.
Cement for spine fractures
Vertebroplasty or kyphoplasty injects bone cement into a collapsed vertebra through a needle. It can reduce pain for selected people.
It does not suit every fracture, especially where bone presses on the nerves.Surgery
An orthopaedic surgeon may fix a broken or badly weakened long bone, such as the thigh bone, with a rod or plate. Spine surgery is used when the spine is unstable.
Braces and physiotherapy
A back brace can support the spine for a period. A physiotherapist teaches safe ways to move, lift and get out of bed.
If a new pain starts
What should you do when a new bone pain appears?
Check for red flags
Weakness in the legs, numbness, bladder or bowel trouble, confusion or a fall with a limb that looks wrong all need emergency care now.
Call the team the same day
Describe where the pain is, when it started, whether movement makes it worse and whether it wakes you at night.
Expect a scan
An X-ray, low-dose CT, MRI or PET-CT may be arranged, depending on the area and the question. MRI is the usual test when the spine is the worry.
Agree a plan
The team decides whether pain relief, radiotherapy, a cement procedure or a surgical opinion is needed, and how myeloma treatment continues alongside.
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On your scan report
What do the words on a bone scan report mean?
- Lytic lesion
- A hole or thin patch in the bone where myeloma has dissolved it.
- Compression or wedge fracture
- A vertebra in the spine that has partly collapsed under pressure.
- Pathological fracture
- A break caused by bone already weakened by disease, not by a large injury.
- Cord compression
- Bone or myeloma tissue pressing on the spinal cord. This is an emergency.
- Osteopenia
- Bone that is thinner than normal across a wide area.
- Whole-body low-dose CT
- A CT scan of the skeleton using a small radiation dose, used to look for bone damage throughout the body.
Commonly believed
What do families often believe about myeloma bone pain?
"Back pain at his age is just old age or a slipped disc."
That may be true, but in someone with myeloma, new or worsening back pain must be checked. Persistent back pain is one of the most common ways myeloma first shows itself.
"He should stay in bed so the bones do not break."
Long bed rest weakens muscles, thins bones further and raises the risk of clots and chest infections. Gentle, safe movement guided by a physiotherapist is usually better.
"Strong painkillers are addictive, so we should avoid them."
When prescribed and reviewed for cancer pain, morphine-type medicines are used safely every day. Uncontrolled pain stops eating, sleeping and moving, which slows recovery.
"A massage or oil pressing will ease the pain."
Firm pressure on a weakened rib or spine can cause a fracture. Avoid deep massage, chiropractic manipulation and forceful pressing over painful bones.
Living with it
How can you protect the bones at home?
Small changes in the home lower the chance of a fall or a fracture. They matter most in the first months, before treatment has taken hold.
Moving and lifting
Avoid lifting heavy buckets, gas cylinders or grandchildren. Bend at the knees, not the back. Roll onto the side before sitting up in bed. A physiotherapist can show the family how to help without pulling on the arms.
Making the home safer
Clear loose mats and wires. Add a grab rail and a non-slip mat in the bathroom, where most falls happen. A plastic stool for bathing and a raised seat for the toilet reduce strain. Keep a light on at night on the way to the bathroom.
Who this advice does not fully cover
If there is a fracture in the spine or a long bone, general advice is not enough. Follow the specific movement limits the orthopaedic surgeon or physiotherapist sets. At CION, the haematology team coordinates with radiation oncology, surgery and pain care, and reviews bone plans at a tumour board.
Questions we are asked
Common questions about myeloma bone pain and fractures
Will the bones heal once treatment starts?
Treatment stops new damage and pain often eases a lot. Fractures usually knit, though a collapsed vertebra keeps its new shape. The holes left by myeloma rarely fill in completely. Bone-strengthening medicines help protect what remains. Your team will track bone health on follow-up scans.
Which painkillers are safe with myeloma?
Paracetamol and prescribed morphine-type medicines are commonly used. Anti-inflammatory painkillers bought over the counter can harm the kidneys, which myeloma often affects already. Always ask the team before taking any painkiller, including those from a local pharmacy or given for another condition.
Does radiotherapy for bone pain have many side effects?
A short course to one area is usually well tolerated. Side effects depend on the site: tiredness is common, and treating the lower spine may upset the stomach for a few days. Pain can briefly flare before it improves. Your radiation oncologist will explain what to expect for the area being treated.
Is a cement procedure safe for my mother?
For selected people with painful spine fractures, it can reduce pain and is done through a needle. It is not suitable where bone presses on the nerves or the spine is unstable. The team decides after an MRI. Ask what the procedure aims to achieve and what the alternatives are.
Can he still walk and exercise?
Usually yes, and staying active helps. Short walks on flat ground are a good start. Avoid contact sports, heavy lifting and twisting movements. A physiotherapist can plan exercises that suit the bones that are affected. Stop and call the team if an activity brings on new sharp pain.
Why has she lost height?
Small collapses in the vertebrae of the spine shorten the back and can cause a stoop. It is common in myeloma bone disease. Tell the team about any noticeable height loss or new curve in the back, because a spine scan may be needed.
Should we buy calcium tablets?
Ask the team first. Calcium and vitamin D are often given alongside bone-strengthening medicines, but myeloma can also push calcium too high. Taking extra calcium without blood tests could be harmful. The team will check the level and advise.
Is bone disease treatment covered by schemes?
Coverage depends on the scheme, the procedure and the current rules, which change. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and cashless insurance may cover parts of radiotherapy, surgery and medicines. Bring your card and policy details and ask the team to check before a procedure is booked.
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Sources
- Cancer Research UK — Myeloma
- Macmillan Cancer Support — Myeloma
- NICE — Myeloma: diagnosis and management (NG35)
- American Cancer Society — Multiple Myeloma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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