Bone Metastasis

Overview

Bone metastasis (also called bone secondary) is when cancer cells from another part of the body spread to the bones and grow there. It is not a new or different cancer — it is the same type of cancer you started with, now living in bone. These cells weaken healthy bone, which can cause pain and make the bone easier to break.

Yes. Bone metastasis is one of the most common complications of advanced cancer. It happens most often with certain cancers, including breast, prostate, lung, kidney, and thyroid cancer.

It can affect anyone who has had cancer, but it is most common in adults with advanced cancer. Children can develop it, but this is rare. The risk tends to increase with age because cancer itself is more common in older people.

Symptoms

Common symptoms

• A dull, deep pain in a bone that is there most of the time and may feel worse at night
• Pain that gets slowly worse over weeks or months
• Swelling or a tender spot over a bone
• A bone that breaks after a minor bump, twist, or fall
• Weakness in an arm or leg, or trouble moving a joint
• Feeling very tired or generally unwell

Symptoms in children

• Bone metastasis is rare in children. When it happens, a child may limp, avoid walking, or say a bone hurts without a clear reason.
• The pain may wake the child at night or be present while resting.
• Some children have trouble using an arm or leg, or have fever or unusual bruising if the bone marrow is affected.

Symptoms in older adults

• New back pain or hip pain that is not going away
• Stiffness that seems like arthritis but is more constant
• Easier falls due to weakness or unsteadiness
• Confusion or extreme sleepiness, which can happen if calcium from bones gets too high

Causes

Main causes

• Bone metastasis starts when cancer cells from the original tumor break away and travel through the blood or lymphatic system to the bone.
• Once in the bone, the cancer cells multiply and interfere with the normal cycle in which old bone is removed and new bone is formed.
• Why some cancers are more attracted to bone than others is still being studied.

Risk factors

• Having an advanced cancer that has already spread to nearby tissues or lymph nodes
• Having a type of cancer that is more likely to spread to bone, such as breast, prostate, lung, kidney, or thyroid cancer
• Having had cancer before — some cancers can return in bone many years later
• Not being able to receive or finish planned cancer treatment due to other health problems

When to see a doctor

See a doctor urgently if:

• If you have had cancer and new bone pain develops, call your GP or cancer team on the same day.
• If you cannot put weight on a leg, if an arm or leg becomes very weak, or if you have a sudden new bulge or swelling, seek medical care the same day.
• If you have a fever, especially during chemotherapy, contact your cancer team immediately.

Book a routine appointment if:

• Mention any new aches or pains — especially in the back, ribs, hips, or long bones — at your next cancer follow-up visit.
• If you are having trouble walking or keep losing your balance, ask your GP about a physiotherapy referral.

Diagnosis

To diagnose bone metastasis, the doctor asks about your symptoms, examines the painful area, and reviews your cancer history. If you have had cancer before, your GP will refer you to a cancer specialist. If not, the doctor will look for the source of the problem and may refer you for imaging tests.

Tests that may be done

• Blood tests to check calcium levels and other markers
• X-rays to look for changes in the bone
• A bone scan, which uses a small amount of radioactive tracer to highlight areas of bone activity
• CT scan, which gives detailed pictures of the bones and organs
• MRI, which gives very clear pictures of the spinal cord and tissues around bones
• A biopsy, in which a small piece of bone is removed and looked at under a microscope, if needed

What to expect at your appointment

Most tests are done in an outpatient department, so you do not usually stay in hospital overnight. A few different scans may be needed. Results can take a few days or up to a week. The team will explain what they find and what treatment options make sense. You can ask a friend or relative to come with you to appointments.

Treatment

Treatment for bone metastasis aims to control the cancer, reduce pain, keep the bone strong, and help you maintain your quality of life. The right plan depends on the original cancer, the areas of bone affected, your symptoms, and your general health. A team of specialists will work together with you to decide the best next steps.

Self-care at home

• Use a walking stick, frame, or brace if your care team recommends it.
• Avoid heavy lifting, sudden twisting, and high-impact activities.
• Make your home safer: clear wires and rugs, improve lighting, and keep a phone nearby.
• Ask for help with shopping, cleaning, and transport when you need it.
• Keep a simple pain diary to help your care team see what works.

Medical treatments

Treatment may include radiation therapy to shrink the tumor and relieve pain, chemotherapy to reach cancer cells throughout the body, hormone therapy if your original cancer is sensitive to hormones, targeted therapy or immunotherapy to block cancer cell growth, and medicines to strengthen bones or help normalize calcium levels. Your doctor will prescribe any medicines you need — never take new medicines, including over-the-counter ones, without checking with your cancer team.

When is surgery considered?

Surgery is sometimes used if a bone is already broken or looks likely to break. A metal rod, plate, or screw can hold the bone in place. In the spine, surgery can remove pressure from the spinal cord and protect your ability to move. This is not right for everyone, but it can greatly improve comfort and safety.

Living with this condition

Living with bone metastasis takes time to adjust to. Plan your day around the times when you feel strongest. Use rest when you need it, but also try to stay mobile. Ask for help with heavy tasks. Keep your appointments and give yourself credit for every step. You are allowed to enjoy good days and rest on difficult ones.

Lifestyle tips

• Keep your home free of clutter to reduce the risk of falls.
• Use handrails and shower chairs if balance feels unsteady.
• Try light activities like short walks or sitting outside when you feel able.
• If you smoke, ask your care team about reliable help to stop.
• Stay connected with people who make you feel supported and calm.

Diet and exercise

Aim for a balanced diet with enough protein, vegetables, fruit, and fluids — this helps your body cope with treatment. If your appetite is poor, small, frequent meals may work better than large ones. Before starting any exercise, ask your doctor or physiotherapist what is safe for your specific bones. Gentle stretching and short, flat walks are often fine, but avoid bending, twisting, or lifting until you know the risk to the affected bone.

Mental health and emotional wellbeing

It is completely normal to feel scared, sad, angry, or anxious after this diagnosis. These feelings can come and go. Talking to a counsellor, psychologist, or your GP can help you cope. You are more than your diagnosis. If you ever have thoughts of harming yourself or ending your life, call your local emergency number or crisis line right away — you deserve help and support.

Prevention

You cannot always prevent bone metastasis, especially once cancer has reached an advanced stage. However, following your cancer treatment plan, attending follow-up appointments, reporting new symptoms early, and keeping your general health as strong as possible may reduce the risk of serious problems like fractures.

Vaccines

There is currently no vaccine that prevents bone metastasis. Scientists are researching cancer vaccines, but they are not a routine part of care for this condition.

Screening programmes

There is no routine screening test for bone metastasis in the general population. If you have had cancer, your care team may use scans if you develop symptoms. Regular cancer follow-up gives the best chance of detecting problems early.

Complications

If left untreated

• Bones that break easily, causing pain and difficulty moving
• Spinal cord compression — pressure on the spinal cord that can cause leg weakness, numbness, or loss of bladder and bowel control
• Hypercalcemia — too much calcium in the blood, which can cause confusion, thirst, constipation, and kidney problems
• Chronic pain that affects sleep, appetite, and enjoyment of life
• Loss of independence and mobility if problems are not managed

Long-term outlook

Bone metastasis changes things, but it does not end hope. Although it is usually not completely curable, it is treatable, and treatment is better than ever. Many people live with bone metastasis for years, continuing to do things that matter to them. Your care team will focus on controlling pain, keeping you mobile, and supporting your quality of life. You can ask for help at any time, and you are allowed to hope.

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