Question 1

What are bone metastases?

Accepted Answer

Bone metastases (also called bone mets) occur when cancer cells from a tumor in another organ (breast, prostate, lung, kidney, thyroid) travel through the bloodstream and grow in the bones. This is different from primary bone cancers (osteosarcoma, chondrosarcoma) that start in the bone itself. Bone metastases are MUCH more common than primary bone cancers. About 70% of patients with advanced breast or prostate cancer develop bone metastases. The cancer weakens bone structure, causing pain and fracture risk. Most common sites: spine (60-70%), pelvis/hip (40%), ribs (30%), skull (25%), long bones of arms/legs (20%).

Question 2

Does having bone metastases mean my cancer is incurable?

Accepted Answer

Bone metastases indicate Stage IV (metastatic) cancer, which is generally not curable with current treatments. However, 'not curable' does NOT mean 'untreatable' or 'terminal immediately'. Many patients with bone metastases live for years with good quality of life, especially with breast and prostate cancer. Median survival varies greatly: Prostate cancer with bone mets: 2-5+ years, Breast cancer: 2-4 years, Lung cancer: 6-12 months, Kidney cancer: 1-2 years. These are medians - many patients live longer with modern treatments. Focus shifts from cure to: controlling cancer, preventing complications (fractures, cord compression), maintaining quality of life.

Question 3

Will I definitely break a bone?

Accepted Answer

Not necessarily. Without treatment, about 50% of patients with bone metastases develop pathological fractures. However, with modern management - bone-modifying agents (bisphosphonates/denosumab), radiotherapy to high-risk areas, and prophylactic surgical stabilization when needed - fracture risk reduced to 20-30%. Fracture risk varies by: location (femur/humerus high risk, pelvis/ribs lower), size of metastasis (greater than 50% cortical destruction = high risk), type (lytic 'holes' higher risk than sclerotic 'dense' lesions), cancer type (kidney cancer higher risk). Mirels scoring system assesses risk - score greater than 8 warrants preventive surgery.

Question 4

What is the Mirels score?

Accepted Answer

The Mirels score is a tool doctors use to assess fracture risk in long bones (femur, humerus). Four factors scored 1-3 points each: 1) Location (upper limb=1, lower limb=2, trochanteric hip=3), 2) Pain (mild=1, moderate=2, functional pain=3), 3) Type (sclerotic/dense=1, mixed=2, lytic/holes=3), 4) Size (less than 1/3 bone width=1, 1/3-2/3=2, greater than 2/3=3). Total score: 4-12 points. Score less than 7: low fracture risk, manage with radiotherapy and observation. Score 8: intermediate risk, consider prophylactic surgery. Score 9+: high fracture risk (15-35%), prophylactic surgery strongly recommended. The score helps decide whether to do preventive surgery or watch and wait.

Question 5

Should I have preventive surgery if my doctor recommends it?

Accepted Answer

Usually yes, if you're fit enough for surgery. Studies clearly show prophylactic stabilization (surgery BEFORE fracture) has better outcomes than waiting for fracture then fixing it: Better pain relief (80% vs 50%), shorter hospital stay (3 vs 7 days), faster recovery (6 weeks vs 12 weeks), lower complication rates (10% vs 30%), better function (90% vs 60% regain mobility). Waiting for fracture means: emergency surgery (higher risk), displaced fracture harder to fix, delays cancer treatment (radiotherapy), worse functional outcomes. However, surgery only worthwhile if life expectancy at least 6-8 weeks. Discussion with oncologist about prognosis essential.

Medical Disclaimer

Bone Metastases (Cancer Spread to Bones)

📖What is Bone Metastases (Cancer Spread to Bones)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention