![]() Bone pain is treated with opiates, bisphosphonates, radiotherapy, vertebroplasty, or kyphoplasty nephrotoxic nonsteroidal anti-inflammatory drugs should be avoided. It is important that family physicians recognize and appropriately treat multiple myeloma complications. Melphalan, prednisolone, dexamethasone, vincristine, doxorubicin, bortezomib, and thalidomide and its analogue lenalidomide have been used successfully. Symptomatic multiple myeloma is treated with chemotherapy followed by autologous stem cell transplantation, if possible. Patients with monoclonal gammopathy of uncertain significance or smoldering multiple myeloma should be followed closely, but not treated. The differential diagnosis of monoclonal gammopathies includes monoclonal gammopathy of uncertain significance, smoldering (asymptomatic) and symptomatic multiple myeloma, amyloidosis, B-cell non-Hodgkin lymphoma, Waldenström macroglobulinemia, and rare plasma cell leukemia and heavy chain diseases. Nuclear bone scans and dual energy x-ray absorptiometry have no role in the diagnosis and staging of myeloma. ![]() Magnetic resonance imaging and positron emission tomography or computed tomography are emerging as useful tools in the evaluation of patients with myeloma magnetic resonance imaging is preferred for evaluating acute spinal compression. Skeletal radiographs are important in staging multiple myeloma and revealing lytic lesions, vertebral compression fractures, and osteoporosis. ![]() ![]() The disease is diagnosed with serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis. Incidental discovery on comprehensive laboratory panels is common. Typical symptoms are bone pain, malaise, anemia, renal insufficiency, and hypercalcemia. Multiple myeloma, the most common bone malignancy, is occurring with increasing frequency in older persons. ![]()
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