Metastatic Bone Tumors

  • Theofanis Kalathas
  • Nikolaos K. Paschos
Part of the Orthopaedic Study Guide Series book series (ORTHSTUDY)


  • Most common sites affected by metastatic disease in general:
    • Lung.

    • Liver.

    • Bone.

  • Most common bones affected by metastatic disease:
    • Spine (70%).

    • Pelvis (40%).

    • Proximal femur (25%).

    • Humerus.

  • Most common site affected:
    • Thoracic spine.

  • Most common site of fracture secondary to metastasis:
    • Proximal femur.

  • Most common tumors metastasized to bones:
    • Prostate (32%)—90% osteoblastic lesions.

    • Breast (22%)—60% osteoblastic, 40% osteolytic lesions.

    • Kidney (16%)—Mainly osteolytic.

    • Lung—Mainly osteolytic.

    • Thyroid—Mainly osteolytic.

  • Multiple metastatic bone lesions typically present.

  • Vascular spread through:
    • Batson’s vertebral plexus: responsible for metastases to axial structure (skull, vertebral bodies, pelvis, proximal limbs).

    • Arterial tree metastases: responsible for metastases to distal extremities (mainly in lung and renal cancer).

  • Most common and dominant symptom:
    • Pain—more than 3/4 of patients.
      • Mechanical due to bone destruction or.

      • Tumorigenic—worst at night.

  • Other symptoms.
    • Pathological fracture (8–30% at presentation).

    • Malignant hypercalcemia symptoms—confusion, muscle weakness, polyuria and polydipsia, nausea/vomiting.

    • Neurologic abnormalities (due to compression of the spinal cord in case of disease to the spine).


  1. 1.
    Himelstein AL, Foster JC, Khatcheressian JL, Roberts JD, Seisler DK, Novotny PJ, Qin R, Go RS, Grubbs SS, O’Connor T, Velasco MR Jr, Weckstein D, O’Mara A, Loprinzi CL, Shapiro CL. Effect of longer-interval vs standard dosing of zoledronic acid on skeletal events in patients with bone metastases: a randomized clinical trial. JAMA. 2017;317(1):48–58. Scholar
  2. 2.
    Hosaka S, Katagiri H, Honda Y, Wasa J, Murata H, Takahashi M. Clinical outcome for patients of solitary bone only metastasis. J Orthop Sci. 2016;21(2):226–9. Scholar
  3. 3.
    Torres C, Hammond I. Computed tomography and magnetic resonance imaging in the differentiation of osteoporotic fractures from neoplastic metastatic fractures. J Clin Densitom. 2016;19(1):63–9. Scholar
  4. 4.
    Guzik G. Results of the treatment of bone metastases with modular prosthetic replacement—analysis of 67 patients. J Orthop Surg Res. 2016;11:20. Scholar

Sources for Additional Studying

  1. European Surgical Orthopaedics and Traumatology- The EFORT Textbook Editors: Bentley, George, DOI,746-7, Springer, EFORT 2014 Bone Metastases of Long Bones and Pelvis Johnny Keller. p. 4282–4293.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Theofanis Kalathas
    • 1
  • Nikolaos K. Paschos
    • 2
  1. 1.Department of Internal MedicineBoston Medical CenterBostonUSA
  2. 2.Division of Sports Medicine, Department of Orthopedic SurgeryBoston Children’s Hospital, Harvard Medical SchoolBostonUSA

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