-Original-

Symptoms Related to Moderate Skeletal-Related Events as Clues for the Diagnosis of Bone Metastasis

Yasuyuki Kitagawa, Toshihiko Ito, Yoshihiro Mizuno, Yoshihiro Sudo, Yong Kim, Ryu Tsunoda and Shinro Takai

Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan

Background: Early diagnosis of bone metastasis is difficult. The aim of the present study was to determine whether symptoms related to skeletal-related events (SREs) can be used for the diagnosis of bone metastasis in the absence of screening tests.
Methods: We reviewed 81 patients with bone metastasis to evaluate their SREs at diagnosis. SREs were arbitrarily classified as moderate or severe. Moderate SREs included radiation to the bone before pathological fracture or paralysis, bone surgery before pathological fracture or paralysis, and hypercalcemia without dialysis. Severe SREs included pathological fracture, spinal cord compression, and hypercalcemia necessitating dialysis.
Results: The complication rates of SREs at the time the bone metastasis was diagnosed were 59.3% and 24.7% for severe and moderate SREs, respectively, and only 16.0% of cases were uncomplicated. The clinical factors that showed a significant relationship with the severity of SREs were age and history of malignancy. However, there was no significant relationship between the complication rate of total SREs and the presence or absence of a malignancy history (83.3% vs. 85.2%, respectively, p=0.83).
Conclusion: The results of the present study suggest that symptoms related to SREs can be used to diagnose bone metastasis in the absence of a screening test. Bone metastasis should be diagnosed as often as possible based on symptoms related to moderate SREs and should be treated as soon as possible before patients develop severe SREs.

J Nippon Med Sch 2019; 86: 159-164

Keywords
skeletal-related events, diagnosis, bone metastasis, pathological fracture, spinal cord compression

Correspondence to
Yasuyuki Kitagawa, MD, Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kitayasu@nms.ac.jp

Received, October 3, 2018
Accepted, February 8, 2019