Bone Metastases Management in Oncology
Summary
Bone metastases represent a common and debilitating stage in the progression of many solid tumours, notably breast, prostate and lung cancers. Tumour cells that home to the skeleton disrupt the normal balance of bone remodelling, leading to osteolytic, osteoblastic or mixed lesions. Clinically, this manifests as bone pain, pathological fractures, spinal cord compression and hypercalcaemia, collectively known as skeletal-related events. Early detection relies on a combination of biochemical markers and sensitive imaging techniques such as bone scintigraphy, magnetic resonance imaging and positron emission tomography. Management is inherently multidisciplinary, combining systemic antineoplastic therapies with bone-targeted agents—including bisphosphonates, denosumab and radiopharmaceuticals—to reduce morbidity and delay skeletal-related events. Local treatments, such as radiotherapy and orthopaedic surgery, are deployed to preserve structural integrity and relieve pain. Recent advances have focused on personalising bone-directed interventions, refining predictive models and integrating emerging targets within the bone microenvironment, all with the aim of improving quality of life and prolonging survival in a global patient population.
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Bone Metastases Management in Oncology publication trend
The graph below shows the total number of articles in bone metastases management in oncology across all publications each year (not limited to Nature Index journals).
Technical terms
Skeletal-related events (SREs): Clinical complications of bone metastases including pathological fractures, spinal cord compression, need for bone-directed interventions and hypercalcaemia.
Bisphosphonates: Synthetic analogues of pyrophosphate that inhibit osteoclast-mediated bone resorption, reducing skeletal morbidity.
Denosumab: A fully human monoclonal antibody against RANKL that prevents osteoclast formation, function and survival.
RANKL (Receptor activator of nuclear factor κB ligand): A cytokine essential for osteoclast differentiation and activation within the bone microenvironment.
Nomogram: A graphical predictive model that combines multiple clinical and pathological variables to estimate individual patient risk or prognosis.
References
- Bone metastasis and skeletal-related events in patients with solid cancer: A Korean nationwide health insurance database study. PLOS ONE (2020).
- Risk factors, prognostic factors, and nomograms for bone metastasis in patients with newly diagnosed infiltrating duct carcinoma of the breast: a population-based study. BMC Cancer (2020).
- Prognostic factors and survival according to tumour subtype in women presenting with breast cancer bone metastases at initial diagnosis: a SEER-based study. BMC Cancer (2020).
- SEOM Clinical Guideline for bone metastases from solid tumours (2016). Clinical and Translational Oncology (2016).
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