This narrative review by Weber (Johns Hopkins) addresses the systematic evaluation of adults over 40 who present with a destructive bone lesion — a common orthopedic scenario given that >50% of cancer patients develop bone metastases. It walks through history, physical exam, laboratory workup, imaging strategy, biopsy principles, and staging, with specific guidance for four common clinical scenarios.
When any adult over 40 presents with a destructive bone lesion, work it up as metastatic disease until proven otherwise: get plain films in two planes, CT chest/abdomen/pelvis, bone scan, and targeted labs (SPEP/UPEP if myeloma is possible, PSA, urinalysis) — and biopsy before you nail or replace anything, because misidentifying a chondrosarcoma as a metastasis can cost the patient their limb.
This narrative review by Weber (Johns Hopkins) addresses the systematic evaluation of adults over 40 who present with a destructive bone lesion — a common orthopedic scenario given that >50% of cancer patients develop bone metastases. It walks through history, physical exam, laboratory workup, imaging strategy, biopsy principles, and staging, with specific guidance for four common clinical scenarios.
When any adult over 40 presents with a destructive bone lesion, work it up as metastatic disease until proven otherwise: get plain films in two planes, CT chest/abdomen/pelvis, bone scan, and targeted labs (SPEP/UPEP if myeloma is possible, PSA, urinalysis) — and biopsy before you nail or replace anything, because misidentifying a chondrosarcoma as a metastasis can cost the patient their limb.