At the time of diagnosis, more than two-thirds of people with multiple myeloma have bone pain, typically in the back or chest and less often in the arms and legs. The pain is usually made worse by movement and does not occur at night except after a change in position. Patients may lose several inches in height because of the collapse of vertebrae.
    Weakness and fatigue are common and are often associated with anemia . Fever is rare, and when it occurs it is usually from an infection. Occasionally, there may be bleeding from the nose and gums or easy bruising. The initial symptoms may be from an acute infection, most often pneumonia, though meningitis or bloodstream infections may also occur. There may also be symptoms of elevated serum calcium ( see "Supportive Care" ).