CLINICAL PRESENTATION AND BIOCHEMICAL EVALUATION OF BONE SECONDARIES

The skeleton is one of the commonest sites for metastasis. Bone secondaries account for more than one third of the malignant disease of bone. Seventy-six patients with bone secondaries were admitted in the orthopaedic department of Basrah Teaching Hospital from February 2000 to June 2002, age range 14-86 years; 34 were males and 42 were females. The dominant sites of bone metastases were spine, 60 patients (79%) and pelvis, 16 patients (21%). The common primary sites were breast, 19 patients (25%) and lung, 11 patients (14.4%); 9 patients (11.2%) had undetected primary site. Most secondaries (90%) were osteolytic in type and the most common histopathological type was adenocarcinoma, 47 patients (63%). In 63 patients (83%), pain was the dominant presenting feature. Late presentation was a major problem; it ranges between 4-8 months. Another problem was lack of clinical awareness in the early stage of the illness. Serum and urinary biochemical markers of bone metabolism were significantly high in patients with bone secondaries than control group, no difference whether the metastasis was single or multiple and whichever the primary site or histopathological subtype. Special interest with urinary hydroxyproline, it was significantly elevated in patients with bone secondaries, some of them had negative radiography. Prognosis was poor with short life expectancy.