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Malignancies of the Bone

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Abstract

Initial workup of malignant skeletal lesions includes obtaining a thorough clinical history, physical exam, imaging, and laboratory testing. Key findings that suggest underlying malignant bone pathology include the presence of hypercalcemia, history of pathologic fracture associated with a skeletal lesion, and locally aggressive behavior of a bone tumor on imaging. The optimal approach to patients with primary or metastatic bone neoplasm or a hematologic malignancy includes a multidisciplinary approach with a variety of subspecialists. Bone-modifying therapy including bisphosphonates and denosumab plays an important role in the management of pain related to metastatic malignancy of bone and multiple myeloma.

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Abbreviations

ASCO:

American Society of Clinical Oncology

BAP:

Bone-specific alkaline phosphatase

BMI:

Body mass index

Bpm:

Beats per minute

CT:

Computed tomography

CTX:

Carboxy-terminal telopeptide of type I collagen or C-telopeptide

dL:

Deciliter

DPD:

Deoxypyridinoline

EBCTCG:

Early Breast Cancer Trialists’ Collaborative Group

ESR:

Erythrocyte sedimentation rate

FDA:

Food and drug administration

G:

Gram

GFR:

Glomerular filtration rate

h:

Hour

IGF:

Insulin-like growth factor

IL:

Interleukin

IV:

Intravenous

K:

     Thousand

L:

     Liter

Lb:

    Pounds

mg:

        Milligram

MGUS:

    Monoclonal gammopathy of undetermined significance

mmHg:

    Millimeters of mercury

mmol:

      Millimoles

MRI:

      Magnetic resonance imaging

Ng:

       Nanogram

NTX:

       Amino-terminal telopeptide of type I collagen or N-telopeptide

ONJ:

        Osteonecrosis of the jaw

P1CP:

      Procollagen type I intact C-terminal propeptide

P1NP:

      Procollagen type I intact N-terminal propeptide

PET:

       Positron emission tomography

Pg:

        Picogram

POEMS:

    Polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins, and skin findings

PTH:

       Parathyroid hormone

PTHrP:

     Parathyroid hormone-related peptide

RANKL:

   Receptor activator of nuclear factor κB ligand

RECIST:

   Response Evaluation Criteria in Solid Tumors

SPECT:

    Single-positron emission tomography

TGF-β:

     Tumor growth factor-β

TRACP5b:

 Isoform 5b of the osteoclast enzyme tartrate-resistant acid phosphatase

U:

         Unit

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, OH, USA

    Megan R. Crawford, Susan E. Williams, Leila Khan & Angelo Licata

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  2. Susan E. Williams
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Correspondence to Angelo Licata .

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  1. Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA

    Pauline M. Camacho

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Crawford, M.R., Williams, S.E., Khan, L., Licata, A. (2019). Malignancies of the Bone. In: Camacho, P. (eds) Metabolic Bone Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-03694-2_15

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