Apperley J F, Croucher P I
Department of Haematology, Imperial College School of Medicine, London, England.
Pathol Biol (Paris). 1999 Feb;47(2):178-81.
Bone disease is a frequent manifestation of multiple myeloma, and results in considerable morbidity. In this review we summarise the current theories as to the mechanism of bony destruction in this disease and discuss the interrelationships between the malignant plasma cells and those cells responsible for bone remodelling, i.e. the osteoclasts and osteoblasts. The bisphosphonates are a long established group of drugs known to have inhibitory effects on osteoclast activity, and in common use for osteoporosis and Paget's disease. Their role in myeloma is less clear. Several clinical studies, including phase III randomised placebo controlled trials, have been reported in recent years. Although these have tended to show a benefit for bisphosphonate treatment, we have not yet identified the most appropriate use of these agents. Two of the clinical trials have suggested that bisphosphonates may also have a beneficial effect on the underlying disease, a tantalizing theory which has been supported with some early laboratory data.
骨病是多发性骨髓瘤的常见表现，会导致相当高的发病率。在本综述中，我们总结了关于该疾病骨破坏机制的当前理论，并讨论了恶性浆细胞与负责骨重塑的细胞（即破骨细胞和成骨细胞）之间的相互关系。双膦酸盐是一类长期使用的药物，已知对破骨细胞活性有抑制作用，常用于治疗骨质疏松症和佩吉特病。它们在骨髓瘤中的作用尚不清楚。近年来已报道了多项临床研究，包括III期随机安慰剂对照试验。尽管这些研究倾向于表明双膦酸盐治疗有益，但我们尚未确定这些药物的最合适用法。两项临床试验表明，双膦酸盐可能对基础疾病也有有益作用，这一诱人的理论已得到一些早期实验室数据的支持。
