Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 6;18(1):44.
doi: 10.1186/s12885-017-3922-0.

Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States

Rohini K Hernandez  1 , Sally W Wade  2 , Adam Reich  3 , Melissa Pirolli  3 , Alexander Liede  4 , Gary H Lyman  5
Affiliations

Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States

Rohini K Hernandez et al. BMC Cancer. .

Abstract

Background: Bone metastases commonly occur in conjunction with solid tumors, and are associated with serious bone complications. Population-based estimates of bone metastasis incidence are limited, often based on autopsy data, and may not reflect current treatment patterns.

Methods: Electronic medical records (OSCER, Oncology Services Comprehensive Electronic Records, 569,000 patients, 52 US cancer centers) were used to identify patients ≥18 years with a solid tumor diagnosis recorded between 1/1/2004 and 12/31/2013, excluding patients with hematologic tumors or multiple primaries. Each patient's index date was set to the date of his or her first solid tumor diagnosis in the selection period. Kaplan-Meier analyses were used to quantify the cumulative incidence of bone metastasis with follow-up for each patient from the index date to the earliest of the following events: last clinic visit in the OSCER database, occurrence of a new primary tumor or bone metastasis, end of study (12/31/2014). Incidence estimates and associated 95% confidence intervals (CI) are provided for up to 10 years of follow-up for all tumor types combined and stratified by tumor type and stage at diagnosis.

Results: Among 382,733 study patients (mean age 64 years; mean follow-up 940 days), breast (36%), lung (16), and colorectal (12%) tumors were most common. Mean time to bone metastasis was 400 days (1.1 years). Cumulative incidence of bone metastasis was 2.9% (2.9-3.0) at 30 days, 4.8% (4.7-4.8) at one year, 5.6% (5.5-5.6) at two years, 6.9% (6.8-7.0) at five years, and 8.4% (8.3-8.5) at ten years. Incidence varied substantially by tumor type with prostate cancer patients at highest risk (18% - 29%) followed by lung, renal or breast cancer. Cumulative incidence of bone metastasis increased by stage at diagnosis, with markedly higher incidence among patients diagnosed at Stage IV of whom11% had bone metastases diagnosed within 30 days.

Conclusions: These estimates of bone metastasis incidence represent the experience of a population with longer follow-up than previously published, and represent experience in the recent treatment landscape. Underestimation is possible given reliance on coded diagnoses but the clinical detail available in electronic medical records contributes to the accuracy of these estimates.

Keywords: Bone metastasis; Epidemiology; Incidence; Solid tumor.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Board of each oncology practice approved collaboration to contribute data to a large longitudinal electronic health records database; informed patient consent was waived per the US framework for retrospective noninterventional studies. Individual patient-level data were protected against breach of confidentiality consistent with the final Health Insurance Portability and Accountability Act (HIPAA) Security Rule from the US Department of Health and Human Services.

Consent for publication

Not applicable.

Competing interests

RKH and AL are employees and stockholders of Amgen Inc. SW is employed by Wade Outcomes Research and Consulting which has conducted paid work for Amgen Inc. AR and MP are employees of IMS Health which has conducted paid work for Amgen Inc. GL is Principal Investigator on a research grant to the Fred Hutchinson Cancer Research Center from Amgen to study Febrile Neutropenia.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Selection of Study Patients
Fig. 2
Fig. 2
Cumulative bone metastasis incidence in 10-year follow-up of patients with solid tumors
Fig. 3
Fig. 3
Cumulative bone metastasis incidence by stage at diagnosis for all solid tumors combined
Fig. 4
Fig. 4
Country-specific cumulative bone metastasis incidence estimates for women with breast cancer
See this image and copyright information in PMC

References

    1. Coleman RE, Lipton A, Roodman GD, Guise TA, Boyce BF, Brufsky AM, Clezardin P, Croucher PI, Gralow JR, Hadji P, et al. Metastasis and bone loss: advancing treatment and prevention. Cancer Treat Rev. 2010;36(8):615–620. doi: 10.1016/j.ctrv.2010.04.003. - DOI - PMC - PubMed
    1. Li S, Peng Y, Weinhandl ED, Blaes AH, Cetin K, Chia VM, Stryker S, Pinzone JJ, Acquavella JF, Arneson TJ. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012;4:87–93. - PMC - PubMed
    1. Norgaard M, Jensen AO, Jacobsen JB, Cetin K, Fryzek JP, Sorensen HT. Skeletal related events, bone metastasis and survival of prostate cancer: a population based cohort study in Denmark (1999 to 2007) J Urol. 2010;184(1):162–167. doi: 10.1016/j.juro.2010.03.034. - DOI - PubMed
    1. Sathiakumar N, Delzell E, Morrisey MA, Falkson C, Yong M, Chia V, Blackburn J, Arora T, Brill I, Kilgore ML. Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999-2006. Breast Cancer Res Treat. 2012;131(1):231–238. doi: 10.1007/s10549-011-1721-x. - DOI - PubMed
    1. Sathiakumar N, Delzell E, Morrisey MA, Falkson C, Yong M, Chia V, Blackburn J, Arora T, Kilgore ML. Mortality following bone metastasis and skeletal-related events among men with prostate cancer: a population-based analysis of US Medicare beneficiaries, 1999-2006. Prostate Cancer Prostatic Dis. 2011;14(2):177–183. doi: 10.1038/pcan.2011.7. - DOI - PubMed

Publication types

MeSH terms