Background: Patients with multiple myeloma (MM) who have evidence of myeloma-related osseous disease should receive anti-resorptive therapy. However, there are often many delays in initiating therapy and some patients are never initiated on treatment despite best practice recommendations. In this study, we examined rates of anti-resorptive therapy for patients with lytic bone lesions seen on imaging and potential barriers for starting therapy. Methods: A retrospective chart review of patients diagnosed with MM between January & November 2022 at our institution was conducted. All patients diagnosed with MM were included in our analysis. Patient demographics and medical information were collected from the electronic medical record. Data was analyzed using descriptive statistics (mean, standard deviation, median, frequency, interquartile range (IQR)) & inferential statistics (t test, chi squared, ANOVA, Kruskal Wallis analyses). A p-value level of < 0.05 was considered significant. Results: Out of a cohort of 68 patients, 39 (57.4%) demonstrated lytic lesions on imaging. 23 (59%) of these patients were prescribed anti-resorptive therapy. The median time from diagnosis of MM to anti-resorptive prescription was 18 days (IQR=188.5) for a bisphosphonate and 57 days (IQR=190) for denosumab. For those who did receive anti-resorptive therapy, median time to prescription by insurance type, in days, was 23.5 for state, 36 for private, 48 for traditional Medicare, 144.5 for Medicaid expansion, and 175 for Medicare advantage (p=0.21). Insurance type, race, and sex were found to be unrelated to the lack of administration of anti-resorptive therapy. Our analysis demonstrates that factors, other than those studied, account for low administration rates of anti-resorptive therapy. Conclusions: There is a critical under-prescription of anti-resorptive therapy for patients with myeloma-related skeletal disease. While not significant, in this limited sample, large variation in time to therapy based on insurance type warrants further investigation in a larger cohort of patients to better understand how it might lead to disparities in care. Although limited to a single institution, our study reveals a prominent gap in the care of newly diagnosed MM patients that may be applicable to many institutions. Ongoing efforts are currently underway to improve the prescription & time to therapy of anti-resorptive agents.