Abstract
➢ The differential diagnosis of an aggressive bone lesion includes metastatic disease, multiple myeloma, lymphoma, and primary sarcoma of bone. Evaluation includes radiographs of the entire bone; laboratory tests; computed tomography (CT) scanning of the chest, abdomen, and pelvis; bone scintigraphy; and biopsy.➢ Except in rare circumstances, the treatment of skeletal metastasis is palliative and the goals of care center around pain relief and the maintenance of function.➢ Nonoperative interventions include chemotherapy, bone-modulating agents such as bisphosphonates and denosumab, radiation therapy, and ablation with cementoplasty.➢ When prophylactic operative stabilization is indicated to prevent pathological fracture, a cephalomedullary nail is preferred for femoral diaphyseal lesions. Postoperative external-beam radiation is indicated for local disease control.➢ High-quality treatment of these patients relies on the close coordination of multiple different specialists.
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