Skeletal Issues

In addition to the direct effects of primary tumors in bone, bone complications in cancer patients occur from metastasis to bone and through the effects of cancer-related treatments and conditions. Bone is a very common metastatic site for many cancers, including myeloma, melanoma, and breast, prostate, thyroid, lung, bladder, and kidney cancers.

Over 40 million men and women in the United States have osteoporosis and low bone mineral density (BMD), placing them at risk for adverse skeletal events such as fractures and their sequelae. There are over 12 million cancer survivors in this country.

Bone renewal is essential for bone strength. During childhood and early adulthood, bone formation prevails over bone resorption, as bones increase in size and strength. Peak bone mass is achieved during the third decade in life, with a higher peak bone mass being protective against osteoporosis later in life.

Despite the significant progress that has occurred in recent decades in the treatment of many advanced malignancies, skeletal morbidity remains a major problem for patients affected by cancers that metastasize to or grow primarily within bone.

More than 50% of patients with advanced breast or prostate cancer have identifiable bone metastasis, and 30% to 40% of patients with non–small-cell lung cancer ultimately develop metastases to bone. Most tumors preferentially metastasize to the axial skeleton, targeting the vertebrae, pelvis, proximal ends of long bones, and skull.