Bone metastases; Clinical aspects

Metastasis to the skeleton represents a serious and, currently irreversible, step in the progression of solid and hematological malignancies. Bone metastases are especially prevalent in breast cancer and prostate cancer and patients may live for years with the consequent high risk of skeletal morbidity. Complications include severe bone pain, pathological fracture and the possibility of spinal cord compression. In recent years, systemically administered bone targeted agents such as bisphosphonates, denosumab and Radium-223 have led to reduction in skeletal morbidity and, in the case of Radium-223 in prostate cancer, improved survival. The use of bone-targeted agents in the prevention of bone metastasis is a key goal of current research, with the recent practice-changing demonstration in postmenopausal patients with early breast cancer that adjuvant bisphosphonates can reduce the risk of future bone metastasis. Molecular biomarkers to assess individual risk of future development of bone metastasis and response to bone-targeted therapy are also being developed. This article focuses on these recent developments, as well as the diagnosis of metastatic bone disease and its treatment.