The goals of the treatment for<unk>  include pain control, prevention and treatment of fractures, maintenance of patient function, and local tumor control. Optimal treatment requires a multidisciplinary team of physicians including medical and radiation oncologist, orthopedic surgeons, radiologist, nuclear medicine, palliative medicine specialists as well as general physicians. Assessment of treatment is determined by multiple factors, including performance status, pain score, impact on quality of life, and overall status of clinical disease. Important therapies include external-beam radiotherapy, targeted radioisotope therapy, image guided tumor ablation chemotherapy, and<unk> -targeting agents like Bisphosphonates and Denosumab. In addition, orthopedic interventions like internal fixation or spinal decompression may be necessary in the case of loss of structural stability due to<unk>  destruction. Pain management The World Health Organization's pain ladder was designed for the management of cancer-associated pain, and mainly involves various strengths of opioids. Other treatments include corticosteroids, radiotherapy, and radionucleotides. Percutaneous osteoplasty involves the use of<unk>  cement to reduce pain and improve mobility. In palliative therapy, the main options are external radiation and radiopharmaceuticals. Thermal ablation techniques are increasingly being used in the palliative treatment of painful metastatic<unk>  disease. Although the majority of patients experience complete or partial relief of pain following external radiation therapy, the effect is not immediate and has been shown in some studies to be transient in more than half of patients. For patients who are not eligible or do not respond to traditional therapies ( i.e. radiation therapy, chemotherapy, palliative surgery, bisphosphonates or analgesic medications), thermal ablation techniques have been explored as alternatives for pain reduction. Several multi-center clinical trials studying the efficacy of radiofrequency ablation in the treatment of moderate to severe pain in patients with metastatic<unk>  disease have shown significant decreases in patient reported pain after treatment. These studies are limited, however, to patients with one or two metastatic sites; pain from multiple tumors can be difficult to localize for directed therapy. More recently, cryoablation has also been explored as a potentially effective alternative as the area of destruction created by this technique can be monitored more effectively by CT than radiofrequency ablation, a potential advantage when treating tumors adjacent to critical structures. A Cochrane review of calcitonin for the treatment of metastatic<unk>  pain indicated no benefit in reduction of<unk>  pain, complications, or quality of life.<unk> -Targeted Agents<unk> -Targeted Agents (BTAs) including Bisphosphonates and Denosumab, can break the vicious cycle of osteoclast-mediated osteolysis. Osteoclast inhibitors, most frequently used in the treatment of osteoporosis, can allow for<unk>  healing and delay complications. BTAs have been shown to decrease the incidence of Skeletal Related Events (SREs) like pathological fractures, thus decreasing the need for surgical intervention or pain medication. These agents have been shown to prevent homing of tumor cells to<unk>  and may maintain the state of dormancy of tumor cells in<unk> .
Bone metastasis
Bone tumor
Bone sarcoma
Osteomyelitis
Osteoma
Osteopetrosis
Bone cyst
Tumoral calcinosis