The Orthobullets Podcast Foundations | Pathology | Multiple Myeloma
Nov 8, 2025
Explore the intricacies of multiple myeloma, a complex condition affecting bone health. The discussion covers its common symptoms, risk factors, and how it uniquely impacts different demographics. Dive into the pathophysiology and discover how malignant plasma cells wreak havoc on bone integrity. Learn about advanced imaging techniques that reveal hidden lesions and the significance of laboratory findings in diagnosis. Gain insights into nonoperative management strategies and the critical decision-making surrounding surgical interventions.
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Core Definition And Diagnostic Threshold
- Multiple myeloma is a plasma cell malignancy causing skeletal lesions, hypercalcemia, renal insufficiency, and anemia.
- Diagnosis requires bone marrow biopsy with monoclonal plasma cells ≥10%.
Mechanism Behind Lytic Bone Lesions
- Myeloma stimulates osteoclasts via RANKL and suppresses osteoprotegerin, driving lytic bone disease.
- Osteoblastic activity is reduced, producing punched-out lytic lesions without sclerotic borders.
Use Skeletal Survey Over Bone Scan
- Obtain a skeletal survey when you suspect myeloma because bone scans can be cold in about 30% of patients.
- Radiographs show punched-out lytic lesions only after >50% bone destruction has occurred.