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. Author manuscript; available in PMC: 2018 Dec 1.
Published in final edited form as: Crit Rev Oncol Hematol. 2017 Sep 8;120:217–226. doi: 10.1016/j.critrevonc.2017.09.003

Figure 5.

Figure 5

Myeloma bone disease. A. Myeloma cells secrete osteoclast activating factors (IL-6, IL-3) that stimulate osteoclast induced bone resorption. B. Stromal cells stimulate osteoclasts by increasing the RANK L production. C. Myeloma cells directly inhibit osteoblast differentiation by expressing osteoblast inhibitory factors (Dickkopf-1, secreted frizzled-related protein 2 (sFRP2)), which are blocked by anti-myeloma agent bortezomib (BMIB). Zoledronic acid (ZA), temozolomide (TM) and denosumab (DMAB) inhibit osteoclast bone resorption. OC=Osteoclast, OB=Osteoblast, SC=Stromal cell.