Metastatic Bone Disease

Metastatic bone disease is cancer that starts in one part of the body and moves to your skeleton. The disease can lead to pain, broken bones, and serious health problems.

There's no cure for metastatic bone disease, but treatments like radiation therapy and surgery can improve your quality of life.

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On this page

• What Is Metastatic Bone Disease?
• What Are the Symptoms of Metastatic Bone Disease?
• How Do You Diagnose Metastatic Bone Disease?
• How Do You Treat Metastatic Bone Disease?

What Is Metastatic Bone Disease?

Doctors define metastatic bone disease as cancer that spreads from one part of the body into a bone. The tumor may begin in an organ, gland, or connective tissue, and the cancer cells move through the blood or lymph system into the skeleton.

Doctors also refer to metastatic bone disease as osseous metastatic disease or bone metastases.   

Common sites for metastatic bone disease include the:

• Pelvis. 
• Ribs.
• Skull.
• Spine.
• Upper arm bone.
• Upper leg bone.

Metastatic bone disease is a serious condition and having it means your cancer is advanced. At this point, treatment typically focuses on stopping the spread of cancer instead of curing it. But new advances in medicine and other treatments can help you manage pain and improve your quality of life.

How common is metastatic bone disease?

Bones are the third most common place for cancer to spread. (The lungs and liver are the most common.) Cancer that moves into a bone from another organ is much more common than cancer that originates in a bone.

Around 350,000 people die each year in the U.S. from metastatic bone disease, according to the National Center for Biotechnology Information. 

What are the types of metastatic bone disease?

In healthy bone tissue, new bone is always forming while old bone is breaking down. Cells called osteoblasts form the new bone and cells called osteoclasts break down old bone.

But cancer cells slow down or speed up this process, so that too much bone is being made or too much is being broken down. Either change can make a bone weaker and more prone to breaking.

Bone tumors may be:

• Osteoblastic, if there are too many new bone cells.
• Osteolytic, if too much bone gets destroyed.

What causes metastatic bone disease?

Doctors aren’t sure what causes cancer to spread from one part of the body to a bone.

What are metastatic bone disease risk factors and complications?

Metastatic bone disease is serious. If you have a primary cancer in another organ, you'll be monitored for any spread of the disease.

Metastatic bone disease risk factors

The main risk factor for metastatic bone disease is having cancer in another organ. About half of the cancers that start in other organs can spread to a bone, according to the American Academy of Orthopaedic Surgeons.

Some types of cancers are more likely to spread to the skeleton, including:

• Breast
• Kidney
• Lung
• Melanoma
• Ovarian
• Prostate
• Thyroid

Complications of metastatic bone disease

Metastatic bone disease can lead to serious complications, including bone fractures, paralysis, and death. 

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What Are the Signs and Symptoms of Metastatic Bone Disease?

The signs and symptoms of metastatic bone disease include:

• Anemia. Metastatic tumors often grow in the large bones that produce many of the body’s red blood cells, which carry oxygen to the rest of the body. Anemia or not enough red blood cells can lead to fatigue, weakness, and shortness of breath.
• Bone pain. The most common symptom of metastatic bone disease, bone pain may get worse at night.
• Fractures. Minor injuries or normal activities can cause fractures when you have metastatic bone disease.  
• Hypercalcemia (high calcium levels). Tumors can cause too much calcium to be released into the bloodstream. High calcium levels can lead to muscle aches, weakness, constipation, and kidney failure.
• Spinal cord compression. If cancer grows in the spine, it can press on the spinal cord and cause neck or back pain. It can also lead to numbness of the legs or abdomen, leg weakness, incontinence, or paralysis.

When should I see a doctor about my metastatic bone disease symptoms?

If you have cancer or had cancer in the past, you should see an oncologist right away if you’re having any of the symptoms of metastatic bone disease. If they can identify and begin to treat metastatic bone disease early, they can help you maintain function and quality of life. 

Even if you’ve never had cancer but develop bone pain, call your doctor. Some people don’t realize they have a primary cancer (such as breast or prostate cancer) until it spreads into the bone.

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How Do You Diagnose Metastatic Bone Disease?

If your doctor suspects you have metastatic bone disease, they'll take a detailed medical history and ask you questions about your symptoms. They'll also ask about your history of cancer, medications you take, and treatments you’ve had.

Tests to diagnose metastatic bone disease

Your doctor may order imaging tests, including: 

• CT or MRI scans, which are especially helpful for locating tumors on the spine or pelvis.
• Whole body scan, to determine if the cancer has spread to any other bones in your body.
• X-rays, which allow doctors to see if there is a tumor on a bone, and how much of the bone is involved.

You may need a biopsy to diagnose metastatic bone disease. Your doctor will take a small piece of tissue from the tumor and examine it under a microscope. The biopsy may be done with a needle, or by a small surgical procedure.

If you have cancer, there are tests you should have regularly to identify any spread of the disease. These tests include:

• Blood chemistries. Levels of electrolytes, calcium, and other substances can be abnormal in people with metastatic bone disease.
• Complete blood count (CBD). A low red blood count can be a sign of metastatic bone disease.
• Serum and urine protein tests. These tests can rule out multiple myeloma, a blood cancer with symptoms similar to metastatic bone disease.
• Thyroid function tests. Your thyroid may not function well if you have certain tumors.
• Urine tests. Blood in the urine can be a sign of some cancers (like kidney cancer) that move into the bone.

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How Do You Treat Metastatic Bone Disease?

Metastatic bone disease can't usually be cured. But with proper treatment, doctors can ease your symptoms and improve your quality of life. 

Your treatment team may include:

• Medical oncologists.
• Orthopaedic oncology surgeons.
• Pain management specialists.
• Radiation oncologists.
• Social workers.

Your treatment options will depend on where the cancer is and how far it has progressed. Your team may also use a combination of treatments.

Radiation therapy for metastatic bone disease

Radiation is one of the most common treatments for the symptoms of metastatic bone disease. It can kill cancer cells, relieve pain, and stop the tumor from growing.

Different types of radiation include:

• Local field radiation. This is the most common type of radiation used on metastatic bone disease. Radiation is directed at the tumor and nearby tissue. It relieves pain with minimal side effects.
• Hemibody irradiation. This type of radiation is used for people with widespread cancer because it targets large areas of the body instead of specific bones. Doctors may use it in addition to local field radiation.
• Radioisotope radiation. Doctors inject a radioactive material into a vein and the diseased area absorbs the medicine, which kills the cancer cells. Many people find radioisotope radiation easier to tolerate than hemibody irradiation. 

Medicine to treat metastatic bone disease

Medication treatments for metastatic bone disease include:

• Bisphosphonate drugs. These drugs interfere with osteoclasts, the cells that break down bone. They can help prevent fractures, treat bone pain, and lower too-high calcium levels in the blood.
• Chemotherapy. Chemo uses combinations of drugs to kill cancer cells. These medications affect the whole body, so healthy cells may be damaged along with cancer cells. Doctors will prescribe chemotherapy in cycles with rest periods in between to let your body recover.
• Endocrine (hormone) therapy. Hormones are chemicals produced in glands, tissues, and organs that send messages to various parts of the body to control metabolism, growth and development, sexual function, and more. Hormones can help cancer cells grow or prevent their growth, so treatment involves increasing or blocking certain hormone levels.

Surgery for metastatic bone disease

Surgery can prevent or treat broken bones. Surgeons may remove the tumor and stabilize the bone with wires, plates, or screws. They may also use bone cement to fill the gap left by the tumor.

Surgery can help strengthen your bones and make them less painful. You may be able to be more active following surgery.

How effective is treatment?

There's no cure for metastatic bone disease. Your doctor will focus on managing your symptoms, relieving your pain, and improving your quality of life.

Survival rates for metastatic bone disease vary greatly, depending on where the cancer originated, when it was detected, and how far it spread.

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