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DISEASE
DEFINITION
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)