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Metastatic Bone Disease: A Review of Literature

Issue: Vol.8, No.4 - October 2009

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Article Type: Manuscript

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  1. Dr Vijayakumar Narayanan
    St.Gregorios Medical Mission Hospital
  2. Cherian Koshy

Growth of aging population is a recognized feature all over the world. Better living standards, availability of good medical facilities, and awareness among people are contributory to it. Many of the communicable diseases are under control now, but the incidence of chronic illnesses like cancer is going up. Most of the cancers tend to metastasize to bone. Contrary to the belief that the prognosis of patients with metastatic bone disease (MBD) as bad, the literature showed good quality life span to these group of patients. Survival up to 10 yrs in patients with exclusive bone secondaries has been reported. The question whether this result can be duplicated among patients from developing countries is debatable, as the cost of interventions designed in each series were prohibitive, still, among those patients who can afford the treatment and with excellent supportive structure, an attempt can be made. Several authors had described the skeletal related events (SREs) in metastatic bone disease and the impact on the quality of life. Severe bone pain, pathological fractures, humoral hypercalcemia of malignancy (HHM), spinal cord compression (SCC) and bone marrow suppression are identified as the major SREs. Considerable morbidity is associated with these problems. The resorption and formative processes within the bone are dynamic and always remain coupled. When this is uncoupled in tumors, lesions do appear, depending on the predominant mode, either lytic /blastic or both. The micro environment of the bone and a variety of other factors like adolescent growth spurt, disease states, hormones, medications, age, nutritional status, also influences the skeletal turn over. The multifaceted cancer syndrome per se has a deleterious effect on bone. Once a SRE is suspected in a patient, the process of establishing a diagnosis for proper management has to be carried out. Investigations fall into two main categories, radiological and biochemical. They are useful in four ways. Screening, diagnosis, assessment of severity and monitoring response. Treatment modalities include pharmacotherapy, external beam radiotherapy, radio-pharmaceutical therapy, biphosphonates, surgery, chemotherapy and non conventional measures. Better understanding of the pain pathways and effective pharmacological interventions can result in the patient a qualitative life. Unraveling of the molecular mechanisms of bone metastasis will lead to better therapeutic options in the future. Bio engineering approaches for bone reconstruction are also in the offing. Optimal utilization of available resources for tackling the issue depends on a multi-disciplinary approach. The economic impact on the National exchequer due to SRE is yet to be studied world wide as the burden is universal. The economic strain for tackling this particular issue is simply huge.

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