Published 3 November 2008, doi:10.1136/bmj.a2041
Cite this as: BMJ 2008;337:a2041

Clinical Review

Managing skeletal related events resulting from bone metastases

Anna N Wilkinson, general practitioner in oncology1, Raymond Viola, palliative care physician, assistant professor2,2, Michael D Brundage, professor (oncology), community health and epidemiology principal investigator3,3

1 Department of Oncology, Ottawa Hospital Cancer Centre, 503 Smyth Road, Ottawa, ON, Canada K1H 1C4, 2 Palliative Care Medicine Program, Department of Medicine, Queen’s University, 34 Barrie Street, Kingston, ON, Canada K7L 3J7, 3 Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, ON, Canada K7L 3N6

Correspondence to: A N Wilkinson anwilkinson@toh.on.ca

The first 150 words of the full text of this article appear below.


  • Bone is an extremely common site of cancer metastases, and bone metastases frequently results in pain
  • Bone metastases can be detected on a bone scan, computed tomogram, and magnetic resonance imaging; plain x ray films will show abnormalities only when at least half of the bone is involved
  • Pathological fracture and spinal cord compression should always be ruled out
  • Treatment of metastatic bone pain should comprise analgesics, non-steroidal anti-inflammatory drugs, and bisphosphonates. Systemic chemotherapy, hormonal therapy, and surgery can play a role in some cases
  • Radiation therapy, as a single fraction, half body treatment, or as a systemic radiopharmaceutical, can provide effective pain relief with minimal side effects


Pain is one of the most common symptoms managed in a palliative setting, and over half of all metastatic cancers will be associated with pain originating from bone metastases. Breast, lung, and prostate cancers account for about 80% of all bone metastases.1 . . . [Full text of this article]


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