One study suggests that bortezomib inhibited osteoclast function, reduced bone resorption markers and normalized the RANKL/osteoprotegerin ratio in MM patients, while increasing osteoblast differentiation and activity, elevating bone formation indicators, and decreasing dickkopf-1 protein levels.23 In a Phase 2 study of transplant-eligible NDMM patients, RAD induction regimen (lenalidomide, adriamycin and dexamethasone) significantly reduced CTX and tartrate resistant acid phosphatase 5b (TRACP-5b) and also increased bone alkaline phosphatase (BALP), PINP and osteocalcin. Here, ACP5 is linked to Miyoshi myopathy.