Learn About Myeloma Symptoms in Older Adults

What is Multiple Myeloma and Why It Affects Older Adults

Multiple myeloma is a type of cancer that develops in plasma cells, which are white blood cells found in bone marrow. Plasma cells normally produce antibodies that help your immune system fight infections. In myeloma, these cells become abnormal and multiply uncontrollably, crowding out healthy blood cells and damaging bone tissue.

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Myeloma is primarily a disease of older adults. According to the American Cancer Society, the average age at diagnosis is 70 years old. About 34,920 new cases of myeloma are diagnosed each year in the United States, and roughly 12,410 people die from the disease annually. The incidence has been rising over the past few decades, though survival rates have improved significantly due to newer treatment options.

The disease develops slowly in most cases. Many people have a condition called monoclonal gammopathy of undetermined significance (MGUS) for years before it develops into myeloma. MGUS occurs in about 3% of people over age 70, but only a small percentage progress to myeloma each year. Understanding whether someone has MGUS or active myeloma is crucial because treatment decisions depend on this distinction.

African American populations have about twice the incidence of myeloma compared to Caucasian populations and tend to develop it at younger ages. Men are more likely to develop myeloma than women. Family history may play a role—having a first-degree relative with myeloma or MGUS increases risk, though most people with myeloma have no family history of the disease.

Practical takeaway: Understanding that myeloma is a disease that typically develops in older age and progresses slowly helps contextualize why screening and monitoring are important. If you or an older loved one experience persistent symptoms like bone pain, fatigue, or recurrent infections, discussing these with a doctor can lead to appropriate testing.

Common Early Symptoms of Myeloma in Older Adults

Many older adults with early-stage myeloma experience no symptoms at all. In fact, about 25% of myeloma cases are discovered incidentally during routine blood work or imaging for unrelated conditions. This is why understanding the warning signs matters—some symptoms can develop gradually and be mistaken for normal aging.

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Bone pain is the most common symptom, occurring in about 70% of newly diagnosed patients. This pain typically affects the back, ribs, and pelvis. It often worsens with movement and may be severe enough to limit daily activities. Older adults sometimes attribute this pain to arthritis or osteoporosis, which can delay diagnosis. Unlike arthritis pain that may improve with rest, myeloma-related bone pain often persists and may worsen over time.

Fatigue and weakness affect many patients. This exhaustion differs from normal tiredness—people describe it as persistent weakness that doesn't improve with rest. Fatigue can develop because myeloma cells crowd out red blood cells, leading to anemia. It can also result from the disease itself or from kidney problems that sometimes accompany myeloma. Older adults may initially attribute this fatigue to aging, depression, or other chronic conditions.

Other early symptoms may include:

• Recurrent infections (such as pneumonia or urinary tract infections) due to weakened immunity
• Nausea, constipation, or loss of appetite, which may relate to high calcium levels in the blood
• Confusion, difficulty concentrating, or mood changes, also related to calcium imbalances
• Thirst and frequent urination, sometimes mistaken for diabetes
• Shortness of breath, particularly if anemia develops

Practical takeaway: If you experience unexplained bone pain, persistent fatigue that doesn't improve with rest, or recurrent infections, mention these specifically to your doctor rather than assuming they're part of normal aging. Keeping a simple symptom log for a few weeks can help you describe patterns clearly to your healthcare provider.

How Myeloma Damages Bones and Causes Pain

Bone damage in myeloma occurs through a specific biological process. Myeloma cells produce substances that activate osteoclasts—cells that break down bone tissue. Simultaneously, the abnormal plasma cells suppress osteoblasts, which normally build new bone. This imbalance means bone is broken down much faster than it's replaced, weakening the skeleton and causing pain.

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About 80% of myeloma patients develop bone lesions—areas of bone damage—visible on imaging tests. These lesions often appear as "punched-out" holes on X-rays, particularly in the skull, spine, ribs, and pelvis. Older adults are particularly vulnerable because they naturally have lower bone density, a condition called osteoporosis. When myeloma develops in someone with pre-existing bone loss, the damage can be more severe.

The bone pain from myeloma can lead to serious complications. Vertebral compression fractures occur when damaged spine bones collapse, causing sudden severe pain, loss of height, or nerve compression. Some patients develop spinal cord compression, a medical emergency requiring immediate treatment to prevent permanent paralysis. Pathologic fractures—breaks in weakened bones—can happen from falls or even sudden movements.

Bone pain location varies by person. Back pain is most common because the spine bears significant weight and contains substantial bone marrow. Rib pain may worsen with breathing or coughing. Pelvic pain can be constant and severe. Some patients experience pain in multiple locations simultaneously. The intensity may fluctuate but often increases over weeks or months if untreated.

Imaging studies help detect bone damage:

• X-rays reveal lytic lesions (holes in bone) and fractures
• CT scans provide more detailed views of bone damage
• MRI scans show both bone damage and soft tissue involvement
• PET scans identify areas of disease activity throughout the body

Practical takeaway: Unexplained bone pain in older adults should prompt discussion about imaging studies. If bone pain develops suddenly or is accompanied by numbness, tingling, or weakness in the legs, seek urgent medical evaluation for possible spinal involvement.

Anemia, Infections, and Other Systemic Symptoms

Anemia frequently develops in myeloma patients because abnormal plasma cells crowd out the red blood cells produced in bone marrow. Approximately 73% of newly diagnosed myeloma patients have anemia. This causes fatigue, shortness of breath, dizziness, and pale skin. Older adults with anemia may experience worsening of heart problems or increased risk of falls due to dizziness.

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Myeloma produces abnormal antibodies called M-proteins that don't protect against infection. Additionally, myeloma suppresses the production of normal antibodies. This combination leaves the immune system weakened. Patients experience recurrent bacterial infections, including pneumonia, urinary tract infections, and skin infections. Some develop serious infections like sepsis. Infections are a leading cause of morbidity and mortality in myeloma patients, making prevention crucial.

High calcium levels in the blood, called hypercalcemia, occurs in about 13% of newly diagnosed patients and develops in more patients over time. This happens because damaged bone releases calcium into the bloodstream. Symptoms of high calcium include severe thirst, frequent urination, nausea, constipation, confusion, and weakness. Severe hypercalcemia can cause kidney damage and mental status changes. Older adults with kidney problems face particular risk.

Kidney problems develop in about 50% of myeloma patients. The abnormal antibodies produced by myeloma cells can damage kidney tubules. Light chains—protein fragments from M-proteins—accumulate in the kidneys, causing a condition called myeloma kidney disease. High calcium levels and dehydration worsen kidney function. Some patients develop chronic kidney disease requiring dialysis.

Blood clotting abnormalities sometimes occur, though less commonly than other complications. Myeloma can affect platelet function or coagulation factors, increasing bleeding or clotting risk. Patients may develop bruising easily or experience blood clots in legs or lungs.

Practical takeaway: If you develop recurrent infections