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Preventing Fractures in the Bone Mets Population


Preventing fractures in patients with bone metastasis improves mobility and quality of life and for some, it means prolonged survival as well, according to recent studies. While not all cancer patients have access to an orthopedic oncologic specialist, it’s important that medical and radiation oncologists prioritize the referral of those with bone mets for a skeletal evaluation early in their diagnosis, says Juan Pretell, M.D., chief of musculoskeletal oncology surgery at Baptist Health Miami Cancer Institute.

Dr. Juan Pretell

Juan Pretell, M.D.

“We have treatments for impending fracture, but many patients don’t reach me in time,” Dr. Pretell says. “Surgery after the fact is much more involved for the patient, and if a fracture occurs after they received radiation, the bone often doesn’t heal. We want to help patients before this happens.”

Some 400,000 new cases of bone metastasis are diagnosed each year in the U.S., and the numbers are increasing as improved treatments for primary cancers are leading to longer survival, according to the American Cancer Society. Every cancer patient is at risk, but bone metastasis is most common in patients with prostate, breast, lung, thyroid and renal cancer. There is also a high incidence in multiple myeloma patients.

While the spine is frequently the site of metastasis, it’s the long bones in the extremities, which is Dr. Pretell’s area of expertise, that most often fracture. The femur and the humerus are particularly vulnerable, he says.

Before a fracture occurs, some patients experience bone pain, but many patients are asymptomatic. “It’s all the more reason for an evaluation,” says Dr. Pretell, who sees patients at Miami Cancer Institute’s Plantation office. “Many fractures are preventable.”

Today’s treatments include newer, less-invasive procedures to strengthen the bone, such as intramedullary devices, which involve the insertion of a balloon catheter through a tiny incision. Once in the canal of the compromised bone, a cement-like material is introduced and then exposed to blue light, which allows it to harden.

“For the upper extremities, it is amazing,” Dr. Pretell says. “Patients usually stay in the hospital one night for observation because of their fragile medical condition. If they were experiencing bone pain, their pain is controlled. Their functionality is improved. They heal very quickly.”

When implants are necessary, Dr. Pretell says newer carbon-fiber options have numerous advantages over the more traditional metallic implants used to repair fractures. In addition to being very lightweight, their radiolucency means that there is less artifact seen on images, an important benefit for those facing radiation therapy and additional imaging studies.

Most of Dr. Pretell’s work is done to improve a patient’s quality of life rather than to cure an already very advanced cancer, yet research continues to show a correlation between fracture prevention and extended survival. In a study of more than 14,000 patients with multiple myeloma, those who developed a fracture were twice as likely to die than those who did not have a fracture. Another study by Massachusetts General Hospital researchers found prophylactic stabilization of an impending fracture led to significantly longer survival in comparison with patients who had surgery after a fracture occurred.

To refer a patient or for more information on orthopedic oncology, contact Dr. Pretell at

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