Pathophysiology of Bone Metastases

  • G. David. Roodman
Part of the Cancer Metastasis – Biology and Treatment book series (CMBT, volume 12)


Bone is a very common site for cancer metastasis and may be the only site of metastasis in patients with breast cancer or prostate cancer. The exact incidence of bone metastasis is unknown, but it has been estimated that approximately 300,000–400,000 people in the United States die from bone metastasis each year. Bone metastasis can involve any bone but has a predilection for areas of red bone marrow. Bone lesions are characterized as either osteolytic or osteoblastic, but this classification actually represents extremes of a continuum in which normal bone remodeling, where bone destruction and formation are balanced, is unbalanced. Increased bone destruction is characteristic of osteolytic metastasis and markedly increased bone formation results in osteoblastic metastasis. However, patients can have both osteolytic and osteoblastic metastasis as well as mixed lesions containing both elements. Bone is a frequent site of involvement in patients with prostate cancer, breast cancer and multiple myeloma (MM) because the propensity of these tumors to home to bone and the capacity of bone marrow to support the growth of the tumor. In patients with osteolytic and osteoblastic bone metastasis, both osteoclast formation and activity are increased. In osteoblastic bone metastasis osteoblast is also increased by tumor derived factors. However, the factors which enhance osteoclast or osteoblast activity differ among different tumor types. The identification and characterization of the pathophysiologic mechanisms and factors that underlying bone metastasis have provided important new therapeutic targets for treating these patients, who are currently incurable, and are reviewed in this chapter.


Metastasis Bone Pathogenesis of Bone Metastasis Osteoclast Osteoblast 


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© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Medicine/Hematology-OncologyUniversity of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, Research and Development 151-U, University Drive C, Rm. 2E113PittsburghUSA

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