Malignancies of the Bone



Initial workup of malignant skeletal lesions includes obtaining a thorough clinical history, physical exam, imaging, and laboratory testing. Key findings that suggest underlying malignant bone pathology include the presence of hypercalcemia, history of pathologic fracture associated with a skeletal lesion, and locally aggressive behavior of a bone tumor on imaging. The optimal approach to patients with primary or metastatic bone neoplasm or a hematologic malignancy includes a multidisciplinary approach with a variety of subspecialists. Bone-modifying therapy including bisphosphonates and denosumab plays an important role in the management of pain related to metastatic malignancy of bone and multiple myeloma.


Malignancy Skeletal metastases Multiple myeloma Pathologic fracture Bisphosphonates Denosumab Hypercalcemia 



American Society of Clinical Oncology


Bone-specific alkaline phosphatase


Body mass index


Beats per minute


Computed tomography


Carboxy-terminal telopeptide of type I collagen or C-telopeptide






Early Breast Cancer Trialists’ Collaborative Group


Erythrocyte sedimentation rate


Food and drug administration




Glomerular filtration rate




Insulin-like growth factor














    Monoclonal gammopathy of undetermined significance


    Millimeters of mercury




      Magnetic resonance imaging




       Amino-terminal telopeptide of type I collagen or N-telopeptide


        Osteonecrosis of the jaw


      Procollagen type I intact C-terminal propeptide


      Procollagen type I intact N-terminal propeptide


       Positron emission tomography




    Polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin findings


       Parathyroid hormone


     Parathyroid hormone-related peptide


   Receptor activator of nuclear factor κB ligand


   Response Evaluation Criteria in Solid Tumors


    Single-positron emission tomography


     Tumor growth factor-β


 Isoform 5b of the osteoclast enzyme tartrate-resistant acid phosphatase




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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Endocrinology, Diabetes and MetabolismCleveland Clinic FoundationClevelandUSA

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