Context and Approach to Metastatic Bone Disease

Metastatic bone disease (MBD) commonly heralds the final progression of many cancers. Skeletal-related events (SRE) represent symptomatic bone metastases and usually present as pain, fracture, spinal cord compression, and hypercalcemia of malignancy. As patients with advanced disease live longer due to therapeutic advances, the number of patients with metastatic bone disease is increasing. The optimal management of MBD and SRE requires a coordinated team effort including specialists from surgical and nonsurgical disciplines. MBD management is far from a one-size-fits-all approach. Each patient must be evaluated within the context of their expectations and disease status. An appreciation of the underlying tumor biology combined with life expectancy estimates helps guide appropriate treatment. This article attempts to provide a framework in which to evaluate and treat patients with metastatic bone disease. In addition, an ask is made for orthopedic surgeons to develop an awareness for the need of an integrated multidisciplinary approach and consider assuming the lead role of the musculoskeletal team.