CLINICAL PRESENTATION AND BIOCHEMICAL EVALUATION OF BONE SECONDARIES

Falih Waheed Hashim*

ABSTRACT

Background: The skeleton is one of the commonest sites for metastasis. Bone secondaries account for more than one third of the malignant disease of bone.

Objective: this study was carried out to: give idea about the incidence of bone secondaries in our locality, to study the modalities of clinical presentation in patients with bone secondaries, and to assess the biochemical changes associated with bone secondary.

Methods:  this is a prospective study was carried out over a period of about two years, was done on seventy-six patients with bone secondaries proved by histopathology and/or radiography. The biochemical changes were compared with those in fifty persons who had no apparent malignancy or musculoskeletal disease as a control group.

Results: the dominant sites of bone secondaries were spine, 60 patients (79%), and pelvis, 16 patients (21%). The common primary sites were breast, 19 patients (25%), and lung, 11 patients (15%); nine patients (11%) had undetected primary site. Pain was the dominant primary site. Late presentation was a major problem. Serum and urinary biochemical markers were significantly high in patients with bone secondaries than control group. Special interest with urinary hydroxyproline, it was significantly elevated in patients with bone secondaries; some of them had negative plain radiography.

Conclusion: bone metastases are frequently diagnosed in symptomatic patients, rarely seen incidentally on radiography. Patients with bone metastases often have marked morbidity and mortality. Biochemical markers could substitute for, or add significantly to other screening tools, to identify bone metastases in early stage. Lastly false positive and false negative results of biochemical markers had been documented, so always should correlate the results with patient's history and physical examination. 

^*Orthopedic surgeon, Department of Surgery, College of Medicine, University of Basrah, Iraq.

E-mail:  dr.falihalhasani@yahoo.com