Hematologic Malignancies and Bone

Hematologic malignancies can have multiple direct and indirect effects on bone including pathologic fractures, bone pain, and hypercalcemia. This chapter discusses the pathophysiology of skeletal lesions in hematologic malignancies, with a focus on the current understanding of their associated bone disease, and includes brief discussions of radiologic imaging of skeletal lesions, pharmacologic treatments, and other hematologic malignancies that affect the bone. Multiple myeloma (MM) has the highest incidence of bone involvement among malignant diseases and is the second most common hematologic malignancy, accounting for approximately 15% of all hematologic malignancies. Magnetic resonance imaging (MRI) is effective in identification of lytic lesions and is indicated for staging in patients with solitary plasmacytoma of the bone. Currently, bisphosphonates remain the standard of care for MM-related bone disease. Adult T-cell leukemia/lymphoma (ATLL), non-Hodgkin's lymphoma (NHL), and Hodgkin's disease (HD) are the other hematologic malignancies discussed in the chapter.