With multiple myeloma or bone metastases comes the risk of skeletal-related events (SREs).

Without early detection, the consequences of those SREs can be devastating.


Dr. Anil Kapoor and Dr. Alan So open up about counselling patients on the risk of SREs.


Dr. Wendy Lam discusses how fractures can affect a patient’s quality of life.


Dr. Andrew Loblaw and Dr. Neil Fleshner cover the importance of early bone health evaluation.

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The risk:
Who gets SREs and
when do they occur?

Bone metastases occur
in up to:
Bone lesions occur in up to:


90% of men with advanced prostate cancer1


75% of patients with advanced breast cancer2


40% of patients with advanced lung cancer2

Bone lesions occur
in up to:


100% of patients with multiple myeloma2

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In one study,* SREs were seen at
diagnosis of bone mets in:3

Within 24 months, the incidence
of SREs increased by more than:3

of prostate cancer patients
in prostate cancer patients
of breast cancer patients
in breast cancer patients
of lung cancer patients
in lung cancer patients
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The reality:
What SREs are common and
what complications can they

SREs may manifest in
various forms, such as:4–5

They can cause a range of potentially
devastating complications, including:4–8

Pathological fractures

  • Severe pain
  • Disability and loss of function
  • Reduced load-bearing capabilities

Spinal cord compression

  • Paralysis
  • Urinary retention/incontinence
  • Impotence

Radiation to the bone

  • Anorexia and fatigue
  • Myelosuppression
  • Vomiting and diarrhea

Surgery to the bone

  • Wound infection
  • Gastric bleeding
  • Risk of reoperation
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Your role:
Why does bone health matter and
how can you help your patients?

With cancer patients increasingly living longer,11
their quality of life is becoming increasingly important.

Assess your patient’s bone health before SREs occur,
using the below recommendations as a guide.

In prostate cancer patients, screen for bone mets using bone scans at a recommended frequency of:1

  • Every 3 to 6 months in patients with a rapid PSADT (<10 months).

  • Every 6 to 12 months in patients with a slower PSADT (>10 months).

– CUA-CUOG CRPC Guidelines

In breast cancer patients, screen for bone mets in:12

  • All patients with recurrent/Stage IV disease, using a bone scan or sodium fluoride PET/CT, as well as radiographs of any long or weight-bearing bones that are painful or appear abnormal on bone scan.

  • All other patients presenting with localized bone pain or elevated alkaline phosphatase, using a bone scan.

– NCCN Breast Cancer Guidelines

In patients with suspected multiple myeloma, screen for osteolytic bone lesions using:13

  • Whole-body imaging with low-dose CT or FDG PET/CT, as part of the diagnostic work-up.

  • Skeletal survey in certain circumstances.

  • Whole-body MRI without contrast, if initial CT or FDG PET/CT is negative.

– NCCN Multiple Myeloma Guidelines

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Cancer took so much.
Don’t let SREs take what’s left.

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