Complications of Bisphosphonate Therapy in Multiple Myeloma: A Review

Background: Patients affected by Multiple Myeloma (MM), osteoporosis and oncologic diseases characterized by bone damage are successfully treated with Bisphosphonates (BPs), a very powerful inhibitors of bone resorption able to correct tumoral hypercalcaemia and to prevent pathological fractures. Among the adverse effects of the pharmacologic treatment, Osteonecrosis of the Jaw (ONJ) is known as the most typical and the worst. Recently, ocular involvement associated with BPs therapy has been suggested: uveitis and scleritis are the most commonly reported events. Methods: We reviewed scientific literature to determine possible adverse ocular side effects associated with the use of BPs. Clinical studies were collected by using key-words (BPs, zoledronic acid, ocular effects, uveitis, eye and BPs). The World Health Organization’s Causality Assessment Guide was used to categorize an adverse ocular drug reaction. Conclusion: Although the present review was inconclusive in determining the real incidence of the ocular related events, patients that need a treatment with BPs, should be informed on the possibility to develop ocular side effects, which are probably sustained by an inflammatory mechanism which involves IL- 6, TNFa, and other similar cytokines. Uveitis and scleritis are the most frequent, but they can be successfully managed with corticosteroid treatment.