Do you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?

Our practice is to give 2 years of bone-directed therapy in all comers. Preferably bisphosphonates over denosumab for cost reasons unless needed due to CKD or intolerance.

I agree that the case is less compelling for patients without skeletal lesions at baseline. An old RCT of bisphosphonates versus ...

Here's the dirty truth.

The overall survival benefit with zoledronic acid is only in patients with myeloma bone disease achieving <= a partial response. The skeletal risk reduction compared to placebo was dependent on myeloma control: a partial response was associated with a 26% reduced risk, VGPR 1...