With recent advances in the management of cancer, the clinical
course of patients with metastatic bone disease is more likely to be
prolonged and accompanied by morbidity, including severe pain, hypercalcemia,
pathologic fracture, and spinal cord and/or nerve root compression.
The early identification of patients at higher risk for developing
bone metastases enables practitioners to be proactive in their diagnosis
and treatment. A multidisciplinary approach that integrates the diagnosis
and treatment of the cancer, symptom management, and rehabilitation
ensures optimal care. Bisphosphonates can reduce the number of
skeletal-related complications, delay the onset of progressive disease in
bone, and relieve metastatic bone pain caused by a variety of solid
tumors with a resulting enhanced quality of life. The complexity of the
clinical problem and the need to involve an array of health-care
providers present a logistical and clinical challenge. A strong argument
is made for a thematically integrated bone metastases program as part
of the primary care of patients with cancer.