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CME: Myeloma bone disease: Monitoring and management

Activity Description / Statement of Need:

In this online, self-learning activity:

Multiple myeloma (MM) is the most common hematologic malignancy after non-Hodgkin lymphoma, with an incidence of over 34,000 and an annual mortality rate of over 12,000. MM-induced osteocyte apoptosis facilitates MM cell survival, and patients with MM are at high risk for bone disease. Osteolytic lesions are reported in up to four out of five newly diagnosed with MM, and throughout their disease course, up to 90% of patients will eventually develop bone lesions. The presence of bone lesions increases MM patient risk for skeletal-related events (SREs), such as fractures, spinal cord compression, or need for surgery or radiotherapy. Bone disease and SREs can have serious consequences in MM, leading to worsened quality-of-life and prospects for survival. Patients who experience fracture after MM diagnosis have a two-fold increased risk of death relative to those who do not experience fracture. Yet bone disease frequently goes untreated in patients with MM, suggesting that clinicians are not familiar with the serious effects of MM.

Target Audience:

The following healthcare professionals: hematologists who treat patients with MM and medical oncologists; physician assistants, nurse practitioners, and pharmacists who treat patients with MM; and any other HCPs with an interest in or who commonly care for patients with MM.


Commercial Support Disclosure: This program is supported by an educational grant from Amgen.

This activity is free of charge.

Release Date: December 21, 2022 -- Expiration Date: December 21, 2024

Faculty: C. Ola Landgren, MD, PhD


Faculty introduction, disclosures

Overview of MM-related Bone Disease

  • Epidemiology of MM bone disease
  • Pathophysiology
    • Effect of lytic bone lesions
    • RANKL signaling pathway
  • Defining clinical features
  • Risk factors
  • Burden of MM bone disease
    • Pain and quality of life
    • Risk for SREs
    • Impact on survival and outcomes
  • Monitoring for bone disease
    • DXA scans
    • Whole-body cross-sectional imaging
    • Limitations of skeletal survey


Bone-Targeted Supportive Care

  • Guideline recommendations for initiation of bone-modifying agents
  • Treatment options
    • Bisphosphonates
      • Safety and efficacy
      • Selection among options
      • IV vs oral
      • Renal toxicity
    • Denosumab
      • Safety and efficacy
      • Use in patients with renal dysfunction
      • Use for patients eligible for ASCT
      • Impact on PFS
    • Rare but serious adverse events (ie, osteonecrosis of the jaw)
  • Case studies and clinical pearls

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Review the pathophysiology of MM-related bone disease and subsequent SREs, emphasizing relevant treatment targets
  • Describe the impact of MM-related bone disease and SREs on quality of life, morbidity, and mortality
  • Compare the safety and efficacy of bone-modifying agents for the management of MM-related bone disease, and apply them to patient cases based on guideline recommendations
  • Discuss evidence-based strategies for monitoring bone health in patients with both smoldering myeloma and active MM


ACCME Activity #202369985

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.


ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC Credit Type: Medical Knowledge

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABIM.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 0.75 contact hours (0.075 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-22-073-H01-P. This is an Knowledge (K)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME. ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Disclosure of Faculty:  C. Ola Landgren, MD, PhD, Chief, Myeloma Division, University of Miami Miller School of Medicine, has received financial compensation from: TGSK, Sanofi, Astra-Zeneca, Adaptive Biotech, Celgene, Janssen,Takeda, Merck, Amgen, BMS, Karyopharm, and Pfizer for consulting work.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Amgen.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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