Instructional Course Lecture   |    
Contemporary Management of Metastatic Bone Disease: Tips and Tools of the Trade for General Practitioners
Robert H. Quinn, MD1; R. Lor Randall, MD2; Joseph Benevenia, MD3; Sigurd H. Berven, MD4; Kevin A. Raskin, MD5
1 Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, Mail Code 7774, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. E-mail address: quinnr@uthscsa.edu
2 Huntsman Cancer Institute, 2000 Circle of Hope Drive, Sarcoma Services, Suite 4260, Salt Lake City, UT 84112. E-mail address: r.lor.randall@hci.utah.edu
3 Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 140 Bergen Street, Room D-1610, Newark, NJ 07103. E-mail address: benevejo@umdnj.edu
4 Department of Orthopaedic Surgery, University of California at San Francisco, 500 Parnassus Avenue, MU320W, San Francisco, CA 94143-0728. E-mail address: BervenS@orthosurg.ucsf.edu
5 Yawkey Center for Outpatient Care, Massachusetts General Hospital, Suite 3700, Section 3B, 32 Fruit Street, Boston, MA 02114. E-mail address: KRaskin@partners.org
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy’s Annual Meeting, will be available in March 2014 in Instructional Course Lectures, Volume 63. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1887-1895
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Metastatic bone disease has a substantial impact on mortality and health-related quality of life. The aging of the population in the United States and the improved survival rate of patients with cancer have led to an increase in the prevalence of osseous metastatic lesions that are symptomatic and may require orthopaedic care. Skeletal related events in neoplastic disease include pain, pathologic fracture, hypercalcemia, and neural compression including spinal cord compression. Approximately 400,000 patients develop metastatic bone disease in the United States annually, and bone is the fourth most common metastatic site, after the lymphatic system, lung, and liver1-3. Seventy percent of patients with metastatic breast or prostate cancer compared with 20% to 30% of patients with metastatic lung or gastrointestinal cancers develop bone metastases2. Breast cancer patients experience a mean of 2.2 to 4.0 skeletal events annually, while prostate cancer patients experience a mean of 1.5 skeletal events3. The general orthopaedic practitioner is the primary evaluator and treating physician for an increasing population of patients with skeletal events. The purpose of this paper is to review contemporary strategies for the management of metastatic bone disease.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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