Bone metastases. Symptoms. Diagnostics. Therapeutic options in palliative care

Bone metastases are the most common cause of pain in patients with advanced cancer. The main reason of bone destruction is stimulation of osteoclast activity. Increased activity of osteoblasts is responsible for osteoblastic lesions. In most cases these two mechanisms are observed simultaneously. An essential part of diagnosis is imaging – plain radiography and skeletal scintygraphy. In selected cases computed tomography and magnetic resonance imaging is required. Clinical features of bone metastases include pain, pathological fractures, hypercalcemia, spinal cord compression and increased disability resulting in deterioration in quality of life, decreased performance status and survival time. The main aim of the treatment are pain relief and prevention of skeletal complications. Treatment include analgesics, palliative radiotherapy and in selected cases surgery procedures. Bisphosphonates are strong inhibitors of osteoclast activity and therefore play important role in treatment of metastatic bone disease. They produce significant pain relief and prevent skeletal morbidity. Bisphosphonates are the current standard of care in patients with malignant hypercalcemia. New treatment options are presented.