Fast Five Quiz: Metastatic Bone Disease Management

Maurie Markman, MD


March 27, 2019

When evaluating patients with signs and symptoms suspicious for bone metastases, the role of the orthopedic surgeon is to determine the cause of the bony defect, predict the probability of fracture, and prophylactically fix a pathologic or impending fracture. In cases wherein radiographic imaging for other reasons reveals an incidental bony defect, the orthopedic surgeon will perform a needle biopsy to determine whether the defect represents metastatic disease or is the result of another etiology.

As part of the workup, the orthopedic surgeon assesses patients with MBD for fracture probability, which is defined as the presence of a bone defect that is likely to result in pathologic fracture with normal physiologic loading. Because MBD-related fractures are associated with increased morbidity and mortality, as well as a prolonged recovery time, surgical repair of pathologic and impending fractures is indicated.

Although the orthopedic surgeon helps to determine the primary cancer site by performing bone biopsy of suspected metastatic sites, the oncology team ultimately determines primary cancer type and staging.

Orthopedic surgeons do not inject chemotherapy agents into bone metastases after biopsy. The oncology team determines appropriate chemotherapeutic agents, manages pain control, and discusses prognosis with patients.

For more on the orthopedic surgeon's role in the treatment and management of patients with MBD, read here.


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