Selected Instructional Course Lecture   |    
Metastatic Bone Disease: Diagnosis, Evaluation, and Treatment
J. Sybil Biermann, MD1; Ginger E. Holt, MD2; Valerae O. Lewis, MD3; Herbert S. Schwartz, MD2; Michael J. Yaszemski, MD, PhD4
1 University of Michigan Hospitals, 1500 East Medical Center Drive, CC 7304/5946, Ann Arbor, MI 48109-5946. E-mail address: biermann@med.umich.edu
2 Vanderbilt Orthopaedic Institute, Medical Center East, South Tower Suite 4200, 1215 21st Avenue South, Nashville, TN 37232-8774. E-mail address for G.E. Holt: ginger.e.holt@vanderbilt.edu. E-mail address for H.S. Schwartz: herbert.s.schwartz@vanderbilt.edu
3 MD Anderson Cancer Center, P.O. Box 301402, Unit 444, Houston, TX 77230-1402. E-mail address: volewis@mdanderson.org
4 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address: yaszemski.michael@mayo.edu
View Disclosures and Other Information
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 2010 in Instructional Course Lectures, Volume 59. 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: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jun 01;91(6):1518-1530
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Metastatic bone disease is a major health-care issue, affecting 4.9 million individuals in the United States. The cost of bone metastasis from cancer was estimated to be thirteen billion dollars per year in the United States in 20051, and the annual incident number of cancer cases in the United States is expected to double over the next fifty years2. With improved medical treatment of many cancers, patients are living longer, which places them at increased risk for the development of metastatic disease3,4. The skeleton is the third most common target of metastatic cancer and can be one of the earliest sites affected, especially in individuals with breast or prostate cancer. Ultimately, 60% to 84% of all cases of metastatic disease invade bone, and approximately 70% of patients with metastatic bone disease experience bone pain5. Patients with metastatic cancer involving bone are also at increased risk for fractures, spinal cord compression, hypercalcemia, and immobility resulting in substantial medical-associated morbidities.
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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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