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. 2009 Sep 1;101(7):1130–1136. doi: 10.1038/sj.bjc.6605288

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Copyright © 2009 Cancer Research UK

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Bone turnover under normal and pathological conditions. (A) Normal bone remodelling reflects the balance between osteoclasts (OC) that resorb bone and osteoblasts (OB) that regenerate bone. (B) The presence of multiple myeloma cells (MM) alters bone homeostasis by cytokine production (e.g., interleukin (IL)-1β, receptor activator of nuclear factor-κB ligand (RANKL) and MIP-1α) that recruit and activate OC, increasing resorption. OC may also produce growth factors (IL-6) for MM cells, which may also secrete cytokines that suppress OB activity. The synergy between MM and OC confers them an advantage with respect to OB. (C) Cytokine exchanges between cells lead to net effects associated with payoff matrix entries.