Fracture Risk Evaluation of Bone Metastases: A Burning Issue

Abstract

Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.

Impact of Bone Metastases on Patients with Renal Cell Carcinoma or Melanoma Treated with Combotherapy Ipilimumab Plus Nivolumab

“…Furthermore, with the current available data on the absence of a significant difference between BM and non-BM, no specific restriction in terms of combo-ICI prescription should be applied in BM patients. On the contrary, these patients should additionally benefit from a modern dedicated approach to BM to optimize fracture risk evaluation, care, and skeletal event prevention [ 9 , 10 , 13 ].…”

Ten-year retrospect of the investigation of proximal limbs metastasis in cancer: A multi-center study on survival outcome, limb function status and surgical procedures analysis

“…With the development of bone target therapy and comprehensive treatment on primary cancer, the aim of the treatment in cancer patients with limbs metastasis has been turning into the integration of symptom palliation and function improvement [23]. Patients with limbs metastasis usually suffered from refractory pain, pathological fracture, limited mobility and emotion damage, which signi cantly reduced patients' quality of life and increased patients' medical costs [24].…”

Osteolytic vs. Osteoblastic Metastatic Lesion: Computational Modeling of the Mechanical Behavior in the Human Vertebra after Screws Fixation Procedure

“…The vertebra is one of the most common sites that can be affected by metastasis [ 1 , 2 ], and nearly 5% to 10% of patients with tumors develop vertebral metastases [ 3 ]. The presence of vertebral metastasis can induce a vertebral fracture (10–30% of all cancer patients [ 4 ]) that causes pain, instability, limited mobility, and neurological alterations significantly affecting the quality of life [ 5 ]. A vertebral fracture is mainly related to the mechanical changes that metastasis induces in the vertebral environment.…”

“…In clinical practice, fracture risk assessment is still not so accurate. The clinical scoring systems [ 4 ] used to estimate a vertebral failure do not account for mechanical determinants of fracture (i.e., geometry, material properties, loading acting on the bone) that are key to evaluating its occurrence [ 6 ]. In the last decade, due to the need to improve the fracture risk assessment, mechanics-based computational tools such as image-based finite element (FE) modeling [ 7 , 8 , 9 , 10 ] were developed to better understand the mechanical behavior of vertebra with tumoral lesions.…”