Fracture Risk Evaluation of Bone Metastases: A Burning Issue

Simple Summary:& nbsp;Major progress has been achieved in stage-IV bone metastatic patients to control over the disease progression, thereby resulting in longer survival. Self-autonomy and return to physical activity are now frequent. Thus, assessment of the strength of tumoral bone has becoming an issue, especially with the rapid variations of bone tumoral aspect (from lytic to sclerosing and vice versa), that we can observe on treatment. This review will explain the current available imaging techniques, the limits of the existing fracture risk scores in bone metastasis and the new numerical simulation technics arising in biomechanics. 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.

Automated summary

Significant progress has been made in treating cancer patients and stage-IV bone metastatic patients, improving survival and focusing on fracture risk evaluation to guide physician decisions. Emerging tools like personalized numerical simulations are being developed for assessing bone tumoral strength and fracture risk, with the next generation expected to integrate multiple loadings and real-life conditions for personalized-medicine approaches.