Bone Metastases: Pain, Fractures, and Treatment

This page is for people whose cancer has spread to the bone, and their families. It covers the warning signs that need help right away, how bone metastases are found, and how they are treated.

Bone metastases are areas of cancer that started somewhere else in the body and spread to bone. They are not a new, separate bone cancer. The National Cancer Institute (NCI) explains that metastatic cancer keeps the name of the cancer where it started. So breast cancer that has spread to a rib is still breast cancer.

NCI says bone, liver, and lung are the most common places for cancer to spread. The American Cancer Society (ACS) says almost any cancer can spread to bone. Cancers that often do include breast, lung, prostate, kidney, thyroid, and ovarian cancer, and melanoma.

The spine is the most common site. Other common sites are the pelvis (hip bone), the thigh bone, the upper arm bone, the ribs, and the skull.

Healthy bone is always being broken down and rebuilt. ACS explains that cancer in bone can speed up or block this cycle. Either too much bone is broken down, or too much new bone is made. Both make bones break more easily.

Spinal cord compression. Cancer in the spine can press on the spinal cord. ACS calls this an emergency. If it is not treated right away, it can cause paralysis. Signs include:

• Back or neck pain, sometimes with pain going down one or both legs.
• Numbness in the legs or belly.
• Weak legs, or trouble moving your legs.
• Losing control of urine or stool, or trouble passing urine.

ACS says that if you notice signs like these, call your doctor right away or go to the emergency room. Tell them about the cancer and that you are worried about spinal cord compression. Call 911 if you cannot get there safely.

High calcium in the blood (hypercalcemia). When cancer breaks down bone, calcium can leak into the blood. ACS says this can be life-threatening if it is not found and treated early. Signs include:

• Feeling very thirsty and passing urine often.
• Constipation or belly pain.
• Feeling sluggish or sleepy, or muscle weakness.
• Confusion or trouble thinking.

Call your care team the same day about these. Call 911 for passing out, a seizure, or someone who is very hard to wake.

A broken bone. ACS says a weak bone can break during normal activities, not only after a fall. A break often causes sudden, severe pain. Sudden pain in the middle of the back may mean a bone in the spine has broken. Call your care team right away, or go to the emergency room, for sudden severe bone pain.

Fever. If you are having chemotherapy, CDC says to call your doctor right away for a temperature of 100.4°F (38°C) or higher.

ACS says bone metastases may be seen on imaging tests. These include an X-ray, a CT scan, an MRI, a PET scan, or a bone scan. They may be found because of pain, or when doctors check whether the cancer has spread. Sometimes a small sample of bone, called a biopsy, is taken.

Blood tests can check your calcium level and how well your kidneys are working.

ACS says bone pain is often the first sign that cancer has spread to bone. At first, the pain may come and go. It is often worse at night and may get better with movement. Later it can become constant and worse with activity.

Tell your care team about any new bone pain, or pain that is getting worse. ACS says finding bone metastases early can help prevent problems later, such as a break.

Your treatment depends on your type of cancer and how many bone areas are affected, and where they are. Your care team will talk with you about the options that fit you.

Treating the cancer itself. Treatments for the cancer, such as hormone therapy, chemotherapy, or targeted drugs, can shrink the cancer in bone.

Radiation therapy. NCI says radiation can relieve pain from cancer that has spread to bone. It may be given in a single dose or in several smaller doses over time. Some people have a short-lived pain flare after treatment.

Radiopharmaceuticals. These are drugs that carry a radioactive substance. NCI says a single dose into a vein may relieve pain when cancer has spread to several areas of bone.

Bone-strengthening drugs. ACS lists bisphosphonates, such as pamidronate and zoledronic acid, and denosumab. They are given into a vein or under the skin, often monthly at first. They can help prevent fractures, high calcium, and spinal cord compression.

These drugs have a rare but serious side effect in the jaw, where part of the jawbone dies. ACS says your doctor will probably suggest a dental checkup before you start. Good mouth care and regular dental visits help. You may also be told to take calcium and vitamin D.

Surgery. ACS says that if a bone in an arm or leg is likely to break, surgery may put a metal rod in the weak part. If a bone in the spine has broken, bone cement may be injected to support it. This is called vertebroplasty or kyphoplasty.

Treatment for spinal cord compression. ACS says radiation is often used, sometimes with a steroid medicine, and is often started within 12 to 24 hours. If the spinal cord already shows signs of damage, such as leg weakness, surgery followed by radiation may be best for some people.

Pain medicine. Pain medicines can be given as pills, liquids, patches, or pumps. Ask your care team for a pain plan that works for you.

Ask which bones are affected, and whether any of them limit what you should do. Ask whether a hip or thigh bone needs checking before you keep walking on it.

Keep a simple pain diary. Note where the pain is, how bad it is out of ten, and what makes it better or worse. Share it with your team.

ACS suggests asking your care team about safety equipment at home, such as shower chairs, walkers, or handrails, if you feel weak, dizzy, or confused.

• National Cancer Institute — Metastatic Cancer: When Cancer Spreads
• National Cancer Institute — Cancer Pain (PDQ), Patient Version
• American Cancer Society — Bone Metastases
• American Cancer Society — Hypercalcemia (High Calcium Levels)
• Centers for Disease Control and Prevention — Fever and Cancer Treatment