This 2020 Nature Reviews Disease Primers article surveys the epidemiology, pathophysiology, diagnosis, and multidisciplinary management of bone metastases from solid tumors and multiple myeloma. It addresses how tumors colonize bone, what skeletal morbidity results, and what treatments prevent or mitigate it. The paper synthesizes evidence across imaging, bone-targeted agents, radiotherapy, and surgery to provide a comprehensive clinical framework.
As an orthopedic surgeon, you will be consulted on pathological fractures and impending fractures in patients whose primary oncologists are deciding on systemic therapy. This paper gives you the framework to understand why those decisions matter for bone healing.
In myeloma specifically: do not expect lytic lesions to heal after fixation even when the hematologist achieves complete remission. The DKK1/sclerostin-mediated suppression of osteoblast activity persists. Plan your fixation accordingly — intramedullary stabilization that bypasses the entire bone, not just the lesion.
When a postmenopausal breast cancer patient asks whether a bone medication helps her survive (not just prevent fractures), the answer is yes. Bisphosphonates reduce 10-year breast cancer mortality by approximately one-fifth. This is not true for premenopausal women and is not true for denosumab.
When bone scintigraphy shows two equivocal lesions in a prostate cancer patient being staged for surgery or radiation, remember that scintigraphy misses roughly 40% of individual lesions. If the staging result will change management, push for PSMA-PET–CT or whole-body MRI before committing to a treatment plan.
This 2020 Nature Reviews Disease Primers article surveys the epidemiology, pathophysiology, diagnosis, and multidisciplinary management of bone metastases from solid tumors and multiple myeloma. It addresses how tumors colonize bone, what skeletal morbidity results, and what treatments prevent or mitigate it. The paper synthesizes evidence across imaging, bone-targeted agents, radiotherapy, and surgery to provide a comprehensive clinical framework.
As an orthopedic surgeon, you will be consulted on pathological fractures and impending fractures in patients whose primary oncologists are deciding on systemic therapy. This paper gives you the framework to understand why those decisions matter for bone healing.
In myeloma specifically: do not expect lytic lesions to heal after fixation even when the hematologist achieves complete remission. The DKK1/sclerostin-mediated suppression of osteoblast activity persists. Plan your fixation accordingly — intramedullary stabilization that bypasses the entire bone, not just the lesion.
When a postmenopausal breast cancer patient asks whether a bone medication helps her survive (not just prevent fractures), the answer is yes. Bisphosphonates reduce 10-year breast cancer mortality by approximately one-fifth. This is not true for premenopausal women and is not true for denosumab.
When bone scintigraphy shows two equivocal lesions in a prostate cancer patient being staged for surgery or radiation, remember that scintigraphy misses roughly 40% of individual lesions. If the staging result will change management, push for PSMA-PET–CT or whole-body MRI before committing to a treatment plan.