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DISEASE
Metastatic bone disease is the most common
malignancy of bone, it is estimated that 70% of all
malignant bone tumors are metastatic in origin.
Testing
• Laboratory tests that can be used to aid in the diagnosis of
metastatic bone disease include the following:
• Serum alkaline phosphatase: Indirect reflection of bone
destruction
• Serum protein electrophoresis
• Urinalysis, urine protein electrophoresis
• N-telopeptide of type II collagen: Marker of bone resorption but
not widely used
Imaging studies
• The following radiologic studies may be used to evaluate metastatic
bone disease:
• Radiography: For the basic assessment of the extent of a tumor and
the degree of cortical erosion; can also be used for skeletal survey in
patients with multiple myeloma
• Computed tomography scanning: Most sensitive imaging modality to
detect bone destruction, providing the best assessment of the extent
of cortical destruction
• Magnetic resonance imaging: Most sensitive study for the assessment
of the anatomic (intramedullary and extraosseous) extent of a lesion
• Bone scanning: Very sensitive study for the detection of occult lesions
and the assessment of the biologic activity of lesions
• Angiography: Depicts devascularization of vascular metastases; may
also be used to assess pain palliation in patients with nonresectable
metastases
Procedures
• Biopsies should be obtained from any soft-tissue mass
or, if no soft-tissue mass is present, from the most
accessible bone in a mechanically safe area (eg,
metaphysis vs diaphysis, acetabulum vs
subtrochanteric femur).
Radiation therapy
• Radiation therapy remains a primary therapeutic modality for
the treatment of spinal metastasis, because nearly 95% of
patients who are ambulatory at the start of radiation therapy
remain so. Consequently, the possibility of regaining cord
function once it is lost as a result of spinal metastasis is
dismal. Therefore, such loss needs to be avoided by early
diagnosis, treatment, and, if indicated, surgical intervention.
Surgery
• The goals of surgical intervention for spinal surgery in
patients with metastatic bone disease includes
decreasing or eliminating pain, decompressing neural
elements to protect cord function, and mechanically
stabilizing the spine. [1, 2] Anterior or posterolateral
decompression, combined with anteroposterior
reconstruction, may be used in the following:
Pharmacotherapy
Medications used in the treatment of metastatic bone disease
include the following:
• Monoclonal antibody antineoplastic agents (eg, denosumab)
• Calcium metabolism modifiers/bisphosphonates (eg,
pamidronate, zoledronate, and ibandronate)