The Pathophysiology of Myeloma Bone Disease: Bone Remodelling and the Role of Osteoclasts

One of the most devastating effects of multiple myeloma is the severe bone disease that affects over 80% of patients during their disease course. In the vast majority, this is irreversible and significantly adds to the already heavy disease burden. Over the last decade, the pathophysiology and complexity of bone destruction in myeloma have become increasingly evident, here we explore the multiple normal physiological pathways and cell types that are disrupted in myeloma and can therefore be implicated in the evolution of bone destruction in this disease. As these pathways become clearer, they open up the possibility of targeted interventions which are explored elsewhere in this text.