# Bone metastases and skeletal-related events

Source: https://onco.cc/terms/bone-metastases/  
OnCo record `bone-metastases` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer spread to the bones, most common in prostate, breast, lung, kidney and thyroid cancer and myeloma. It causes pain, fractures and high calcium, and the complications are counted in trials as 'skeletal-related events'.

## Summary

Skeletal-related events (fracture, need for radiotherapy or surgery to bone, spinal cord compression, hypercalcaemia) are reduced 30-40% by bone-modifying agents (zoledronic acid, denosumab). Single-fraction 8 Gy radiotherapy relieves pain as well as longer courses; SBRT gives more durable relief for spine metastases. Bone-seeking radiopharmaceuticals (radium-223, strontium-89) treat bone-predominant prostate cancer, and bone-only disease has a better prognosis than visceral spread in breast cancer. Spinal cord compression is an emergency needing steroids and urgent radiotherapy or surgery.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: bone metastasis; skeletal metastases; skeletal-related events; skeletal-related event; SRE; bone-only; bone-predominant; osseous metastases; pathological fracture; spinal cord compression

## Notes

- Lung cancer: NICE NG122 (1.17.1) says to offer single-fraction radiotherapy to people with bone metastasis who need palliation and for whom standard pain relief is inadequate, and points to its guideline on spinal metastases and metastatic spinal cord compression. NG234 lists the pain that should prompt a call within 24 hours (severe unremitting back pain, progressive back pain, pain aggravated by standing, sitting, moving, coughing, sneezing or straining, night-time pain disturbing sleep, localised tenderness) and the symptoms treated as an oncological emergency (bladder or bowel problems, difficulty walking, limb weakness, numbness or altered sensation, radicular pain).
- Prostate cancer: Prostate Cancer UK says about 4 in 100 people with prostate cancer develop metastatic spinal cord compression, that the risk is highest where the cancer has already spread to the spine, and that at its worst cord compression can cause nerve damage and paralysis, so treatment straight away lowers the risk of that being permanent. NICE NG234 (1.3.2) treats new symptoms or signs of cord compression in anyone with a past or current cancer diagnosis as an oncological emergency, and (1.5.2) asks for an MRI as soon as possible and always within 24 hours.
- Protecting the skeleton: NICE NG131 (1.5.19) says to consider zoledronic acid to prevent or reduce skeletal-related events in hormone-relapsed metastatic disease, and (1.5.20) oral or intravenous bisphosphonates for pain relief where analgesics and palliative radiotherapy have not been enough. NG131 (1.3.35) says not to offer bisphosphonates to prevent bone metastases in the first place, and (1.4.12) not to offer them routinely to prevent osteoporosis on hormone therapy, which are three different questions with three different answers.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Bone_metastasis
- Wikipedia: https://en.wikipedia.org/wiki/Bone_metastasis
- NICE NG122: lung cancer, palliative interventions and supportive and palliative care: https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care
- NICE NG234: spinal metastases and metastatic spinal cord compression, recommendations: https://www.nice.org.uk/guidance/ng234/chapter/Recommendations
- Prostate Cancer UK: metastatic spinal cord compression (MSCC): https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/metastatic-spinal-cord-compression-mscc
- NICE NG131: prostate cancer, diagnosis and management: https://www.nice.org.uk/guidance/ng131/chapter/Recommendations

## Connected records

- terms: [Hypofractionation (fewer, larger radiotherapy doses)](https://onco.cc/terms/hypofractionation/), [Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life](https://onco.cc/terms/tnbc-symptom-control-palliation/), [Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain](https://onco.cc/terms/lung-palliation-breathlessness-effusion-obstruction/), [Radiographic progression-free survival (rPFS)](https://onco.cc/terms/radiographic-progression-free-survival/), [Stereotactic body radiotherapy (SBRT / SABR)](https://onco.cc/terms/sbrt-term/), [What androgen deprivation costs: the side of hormone therapy the survival curves do not show](https://onco.cc/terms/prostate-adt-burden/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Metastatic cancer (cancer that has spread)](https://onco.cc/cancers/metastatic-cancer/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Renal cell carcinoma](https://onco.cc/cancers/rcc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Bone-modifying agents (bisphosphonates, denosumab)](https://onco.cc/technologies/bone-modifying-agents/), [FLASH research accelerators (Oriatron, Mobetron FLASH, ProBeam FLASH)](https://onco.cc/technologies/flash-research-accelerators/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/)
- drugs: [Atrasentan](https://onco.cc/drugs/atrasentan/), [Denosumab](https://onco.cc/drugs/denosumab/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Radium-223 dichloride](https://onco.cc/drugs/radium-223/), [Zibotentan](https://onco.cc/drugs/zibotentan/), [Zoledronic acid](https://onco.cc/drugs/zoledronic-acid/)
- trials: [10TASQ10](https://onco.cc/trials/tasquinimod-10tasq10/), [CA184-043](https://onco.cc/trials/ca184-043-ipilimumab/), [COMET-1](https://onco.cc/trials/comet-1/), [Dutch Bone Metastasis Study](https://onco.cc/trials/dutch-bone-metastasis-study/), [ENTHUSE M1](https://onco.cc/trials/enthuse-m1-zibotentan/), [ERA 223](https://onco.cc/trials/era-223/), [PEACE-3 (EORTC 1333)](https://onco.cc/trials/peace-3/), [READY](https://onco.cc/trials/ready-dasatinib/), [SWOG S0421](https://onco.cc/trials/swog-s0421-atrasentan/)
- key papers: [STOpCaP: docetaxel or bisphosphonates added to standard of care in hormone-sensitive prostate cancer, a systematic review and meta-analysis](https://onco.cc/key-papers/paper-vale-stopcap-docetaxel-bisphosphonates-lancet-oncol-2016/), [The evolutionary history of lethal metastatic prostate cancer](https://onco.cc/key-papers/paper-gundem-evolutionary-history-lethal-metastatic-prostate-nature-2015/)
- institutions: [Weston Park Cancer Centre, Sheffield Teaching Hospitals](https://onco.cc/institutions/weston-park-sheffield/)

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JSON: https://onco.cc/api/v1/entities/bone-metastases.json