Identifying Impending Pathologic Fractures And Treatment Considerations In Patients With Metastatic Bone Disease

Over a half million people succumb to cancer-related illness each year in the United States, well more than half of whom have evidence of metastatic bone disease on postmortem examination. The treatment of this disease is primarily palliative but can greatly increase a patient's quality of life. Although there are risks involved with surgery, the effects of a pathologic fracture on quality of life may outweigh the risks. Unrelenting pain, instability, impending fracture, or neurologic compression are indications for surgery; however, in patients in whom surgery is deemed inappropriate, options include the use of pharmaceuticals, radiation therapy, and radiofrequency ablation. This review focuses on the early identification of high-risk tumors before fracture occurs and discusses treatment options.