An update on the nonoperative treatment of patients with metastastic bone disease

Bone metastases constitute a major problem in oncology because of their fre quency and the therapeutic problems they present. Treatment indications dep end on accurate diagnosis including histologic type, number, location, and sensitivity to treatment. New findings in the pathophysiology of bone metas tases, new staging procedures, new treatment modalities, and better guideli nes improve therapeutic effectiveness and the quality of life of patients. There are biologic and biomechanical indications for treatment. The goals o f treatment are pain relief, restoration and maintenance of function, and t he prevention of complications. The non-surgical treatment of patients with metastatic bone disease includes analgesics, hormones, radiation therapy, cytotoxic drugs, radiopharmaceuticals, chemoablation, vertebroplasty, and b isphosphonates. The future of the treatment of patients with metastatic bon e disease may involve the identification of biochemical markers. The author presents an overview of the current scientific concepts of metastatic bone disease and indications and specific strategies for non-operative treatmen t of patients with tumor-induced osteolysis from metastatic bone disease.