Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis, problems to be considered include the following:

Paget sarcoma
Primary bone sarcoma - Malignant fibrous histiocytoma and others

Differential Diagnoses

Workup

British Orthopaedic Oncology Society and British Orthopaedic Association. Metastatic bone disease: a guide to good practice (2015 revision). British Association for Surgical Oncology. Available at https://baso.org.uk/media/61543/boos_mbd_2016_boa.pdf. 2015; Accessed: February 23, 2022.
Zeng L, Chow E, Bedard G, Zhang L, Fairchild A, Vassiliou V, et al. Quality of life after palliative radiation therapy for patients with painful bone metastases: results of an international study validating the EORTC QLQ-BM22. Int J Radiat Oncol Biol Phys. 2012 Nov 1. 84 (3):e337-42. [QxMD MEDLINE Link].
Frankel BM, Jones T, Wang C. Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery. 2007 Sep. 61 (3):531-7; discussion 537-8. [QxMD MEDLINE Link].
Harrington KD. Orthopaedic management of extremity and pelvic lesions. Clin Orthop Relat Res. 1995 Mar. (312):136-47. [QxMD MEDLINE Link].
Keene JS, Sellinger DS, McBeath AA, Engber WD. Metastatic breast cancer in the femur. A search for the lesion at risk of fracture. Clin Orthop Relat Res. 1986 Feb. (203):282-8. [QxMD MEDLINE Link].
Quattrocchi CC, Piciucchi S, Sammarra M, Santini D, Vincenzi B, Tonini G, et al. Bone metastases in breast cancer: higher prevalence of osteosclerotic lesions. Radiol Med. 2007 Oct. 112 (7):1049-59. [QxMD MEDLINE Link].
Alarmo EL, Kallioniemi A. Bone morphogenetic proteins in breast cancer: dual role in tumourigenesis?. Endocr Relat Cancer. 2010 Jun. 17 (2):R123-39. [QxMD MEDLINE Link].
Doot RK, Muzi M, Peterson LM, Schubert EK, Gralow JR, Specht JM, et al. Kinetic analysis of 18F-fluoride PET images of breast cancer bone metastases. J Nucl Med. 2010 Apr. 51 (4):521-7. [QxMD MEDLINE Link].
Hung JJ, Jeng WJ, Hsu WH, Wu KJ, Chou TY, Hsieh CC, et al. Prognostic factors of postrecurrence survival in completely resected stage I non-small cell lung cancer with distant metastasis. Thorax. 2010 Mar. 65 (3):241-5. [QxMD MEDLINE Link].
Edwards J. Src kinase inhibitors: an emerging therapeutic treatment option for prostate cancer. Expert Opin Investig Drugs. 2010 May. 19 (5):605-14. [QxMD MEDLINE Link].
Byttner M, Wedin R, Bauer H, Tsagozis P. Outcome of surgical treatment for bone metastases caused by colorectal cancer. J Gastrointest Oncol. 2021 Oct. 12 (5):2150-2156. [QxMD MEDLINE Link]. [Full Text].
Mundy GR, Yoneda T. Facilitation and suppression of bone metastasis. Clin Orthop Relat Res. 1995 Mar. (312):34-44. [QxMD MEDLINE Link].
Guise TA, Yin JJ, Taylor SD, Kumagai Y, Dallas M, Boyce BF, et al. Evidence for a causal role of parathyroid hormone-related protein in the pathogenesis of human breast cancer-mediated osteolysis. J Clin Invest. 1996 Oct 1. 98 (7):1544-9. [QxMD MEDLINE Link]. [Full Text].
Cancer statistics. National Cancer Institute. Available at https://www.cancer.gov/about-cancer/understanding/statistics. September 25, 2020; Accessed: February 23, 2022.
Turpin A, Duterque-Coquillaud M, Vieillard MH. Bone Metastasis: Current State of Play. Transl Oncol. 2019 Dec 23. 13 (2):308-320. [QxMD MEDLINE Link]. [Full Text].
Key statistics about bone cancer. American Cancer Society. Available at https://www.cancer.org/cancer/bone-cancer/about/key-statistics.html. January 12, 2022; Accessed: February 23, 2022.
Jawad MU, Pollock BH, Wise BL, Zeitlinger LN, O' Donnell EF, Carr-Ascher JR, et al. Sex, racial/ethnic and socioeconomic disparities in patients with metastatic bone disease. J Surg Oncol. 2022 Mar. 125 (4):766-774. [QxMD MEDLINE Link].
Harrington KD. Orthopedic surgical management of skeletal complications of malignancy. Cancer. 1997 Oct 15. 80 (8 Suppl):1614-27. [QxMD MEDLINE Link]. [Full Text].
Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC. Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res. 1990 Feb. (251):213-9. [QxMD MEDLINE Link].
Hirbe AC, Morgan EA, Weilbaecher KN. The CXCR4/SDF-1 chemokine axis: a potential therapeutic target for bone metastases?. Curr Pharm Des. 2010. 16 (11):1284-90. [QxMD MEDLINE Link].
Kirkinis MN, Spelman T, May D, Choong PFM. Metastatic bone disease of the pelvis and extremities: rationalizing orthopaedic treatment. ANZ J Surg. 2017 Nov. 87 (11):940-944. [QxMD MEDLINE Link].
Baumber R, Gerrand C, Cooper M, Aston W. Development of a scoring system for survival following surgery for metastatic bone disease. Bone Joint J. 2021 Nov. 103-B (11):1725-1730. [QxMD MEDLINE Link].
Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989 Dec. (249):256-64. [QxMD MEDLINE Link].
Hipp JA, Springfield DS, Hayes WC. Predicting pathologic fracture risk in the management of metastatic bone defects. Clin Orthop Relat Res. 1995 Mar. (312):120-35. [QxMD MEDLINE Link].
Kawaguchi M, Tateishi U, Shizukuishi K, Suzuki A, Inoue T. 18F-fluoride uptake in bone metastasis: morphologic and metabolic analysis on integrated PET/CT. Ann Nucl Med. 2010 May. 24 (4):241-7. [QxMD MEDLINE Link].
Freedland SJ, Richhariya A, Wang H, Chung K, Shore ND. Treatment patterns in patients with prostate cancer and bone metastasis among US community-based urology group practices. Urology. 2012 Aug. 80 (2):293-8. [QxMD MEDLINE Link].
Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer. 2013 Mar 1. 119 (5):1033-41. [QxMD MEDLINE Link].
Haider MT, Smit DJ, Taipaleenmäki H. MicroRNAs: Emerging Regulators of Metastatic Bone Disease in Breast Cancer. Cancers (Basel). 2022 Jan 30. 14 (3):[QxMD MEDLINE Link]. [Full Text].
Raje N, Terpos E, Willenbacher W, Shimizu K, García-Sanz R, Durie B, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncol. 2018 Mar. 19 (3):370-381. [QxMD MEDLINE Link].
Barrett-Lee P, Casbard A, Abraham J, Hood K, Coleman R, Simmonds P, et al. Oral ibandronic acid versus intravenous zoledronic acid in treatment of bone metastases from breast cancer: a randomised, open label, non-inferiority phase 3 trial. Lancet Oncol. 2014 Jan. 15 (1):114-22. [QxMD MEDLINE Link].
Wong MH, Stockler MR, Pavlakis N. Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev. 2012 Feb 15. 2:CD003474. [QxMD MEDLINE Link].
Irelli A, Cocciolone V, Cannita K, Zugaro L, Di Staso M, Lanfiuti Baldi P, et al. Bone targeted therapy for preventing skeletal-related events in metastatic breast cancer. Bone. 2016 Jun. 87:169-75. [QxMD MEDLINE Link].
Errani C, Bazzocchi A, Spinnato P, Facchini G, Campanacci L, Rossi G, et al. What's new in management of bone metastases?. Eur J Orthop Surg Traumatol. 2019 Oct. 29 (7):1367-1375. [QxMD MEDLINE Link].
Zaikova O, Fosså SD, Bruland OS, Giercksky KE, Sandstad B, Skjeldal S. Radiotherapy or surgery for spine metastases?. Acta Orthop. 2011 Jun. 82 (3):365-71. [QxMD MEDLINE Link].
Orita Y, Sugitani I, Matsuura M, Ushijima M, Tsukahara K, Fujimoto Y, et al. Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma. Surgery. 2010 Mar. 147 (3):424-31. [QxMD MEDLINE Link].
Sebghati J, Khalili P, Tsagkozis P. Surgical treatment of metastatic bone disease of the distal extremities. World J Orthop. 2021 Oct 18. 12 (10):743-750. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Redmond KJ, Lo SS, Soltys SG, Yamada Y, Barani IJ, Brown PD, et al. Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey. J Neurosurg Spine. 2017 Mar. 26 (3):299-306. [QxMD MEDLINE Link]. [Full Text].
Clayer MT, Tang X. Low risk of cardiac events during intramedullary instrumentation of lung cancer metastases. Acta Orthop. 2007 Aug. 78 (4):547-50. [QxMD MEDLINE Link]. [Full Text].
Camnasio F, Scotti C, Peretti GM, Fontana F, Fraschini G. Prosthetic joint replacement for long bone metastases: analysis of 154 cases. Arch Orthop Trauma Surg. 2008 Aug. 128 (8):787-93. [QxMD MEDLINE Link].
Forauer AR, Kent E, Cwikiel W, Esper P, Redman B. Selective palliative transcatheter embolization of bony metastases from renal cell carcinoma. Acta Oncol. 2007. 46 (7):1012-8. [QxMD MEDLINE Link].
Chow E, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, et al. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol. 2014 Feb. 15 (2):164-71. [QxMD MEDLINE Link].
Nieder C. Repeat palliative radiotherapy for painful bone metastases. Lancet Oncol. 2014 Feb. 15 (2):126-8. [QxMD MEDLINE Link].
[Guideline] Lutz S, Balboni T, Jones J, Lo S, Petit J, Rich SE, et al. Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017 Jan - Feb. 7 (1):4-12. [QxMD MEDLINE Link].

Media Gallery

Lateral view of the femur of a 70-year-old man with metastatic prostate carcinoma, the most common cause of osteoblastic metastases in men.
Radiograph of a patient with severe rest- and activity-related pain at the time of presentation.
Pathologic fracture. Radiograph shows a displaced fracture through an osteolytic lesion in the distal femur of a 53-year-old woman with lung carcinoma.
Radiograph shows osteolytic metastasis in the distal femur of a 51-year-old woman with breast carcinoma.
Lateral radiograph shows sclerotic metastasis of the L2 vertebra in a 54-year-old man with prostatic carcinoma.
Axial computed tomography scan shows 2 rounded, mixed osteolytic-sclerotic lesions in the thoracic vertebral body of a 44-year-old woman with lung carcinoma.
Axial computed tomography scan shows a destructive osteolytic lesion in the left acetabulum of a woman with vulval carcinoma. Soft-tissue extension into the pelvic cavity is present.
Sagittal spin-echo T2-weighted magnetic resonance image shows hypointense lesions in the T10 and L3 vertebrae in a 66-year-old man with lung carcinoma. The tumor involves the T10 pedicle. See also the next image.
Sagittal short-tau inversion recovery magnetic resonance (MRI) from a 66-year-old man with lung carcinoma. This MRI shows hyperintense lesions in the T10 and L3 vertebrae, with T10 pedicular involvement.
Sagittal short-tau inversion recovery (STIR) magnetic resonance image (MRI) in a 68-year-old man with thyroid carcinoma. This MRI shows severe compression of the L1 vertebra with retropulsion. Affected T11-L2 vertebrae show signal hyperintensity, posterior vertebral body marginal bulging, and spinal canal narrowing. See also the next image.
Sagittal gadolinium-enhanced spin-echo T1-weighted magnetic resonance image from a 68-year-old man with thyroid carcinoma. This image shows heterogeneous enhancement of the T11-L2 vertebrae, with prominent epidural component enhancement and spinal canal compromise. See also the next image.
Axial spin-echo T1-weighted magnetic resonance image (MRI) in a 68-year-old man with thyroid carcinoma. This MRI shows tumor extension from the L1 vertebral body and left pedicle into the left psoas muscle and epidural space, with resultant spinal cord compression. See also the next image.
Axial gadolinium-enhanced spin-echo T1-weighted magnetic resonance image from a 68-year-old man with thyroid carcinoma. This image shows heterogeneous enhancement of the soft tissue component of the L1 vertebral metastatic tumor.
Typical scintigraphic pattern of bone metastases in a 60-year-old man with nasopharyngeal carcinoma. This posterior technetium-99m bone scintiscan shows multiple randomly distributed focal lesions scattered throughout the skeleton, particularly the spine, ribs, and pelvis.

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Metastatic Bone Disease Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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