[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Bones, joints and soft tissue](https://durgical.com/en/general-pathology/areas/bone-soft/) › Bone metastases

# Bone metastases

- Lesion

Most cancers in bone came from somewhere else, usually prostate, breast, lung, kidney or thyroid; they eat or build bone.

Updated Nov 12, 2026

## Key points

- Most common sources in adults: prostate, breast, kidney, lung, thyroid.
- Lytic: kidney, lung, thyroid, myeloma, GI tract, melanoma; blastic: prostate (and some breast); mixed: breast often.
- Axial skeleton first; spread through the Batson vertebral venous plexus explains spinal metastases from prostate and breast.
- Lytic mechanism: tumour PTHrP raises osteoblast RANKL, osteoclasts dissolve bone and release growth factors that feed the tumour (vicious cycle).
- Complications: pain, pathologic fracture, spinal cord compression and hypercalcaemia.
- Renal cell and thyroid metastases are very vascular and bleed at biopsy.

## What it is

Metastases are by far the commonest malignant tumours in bone. In adults, about four of every five come from the prostate, breast, kidney, lung or thyroid; in children, neuroblastoma, Wilms tumour, osteosarcoma, Ewing sarcoma and rhabdomyosarcoma. They favour the red-marrow axial skeleton: vertebrae, pelvis, ribs, skull and proximal femur, partly through the valveless vertebral venous plexus. Tumour cells alter local remodelling: most metastases are lytic, by recruiting osteoclasts through PTHrP and RANKL, while prostate cancer is typically blastic.

## Structure

- Lytic metastasis: tumour nests in the marrow with active osteoclasts and lost trabeculae.
- Blastic metastasis: tumour cells with dense reactive woven bone laid down by osteoblasts.
- Immunohistochemistry identifies the primary: PSA and NKX3.1 for prostate, GATA3 for breast, TTF-1 for lung, PAX8 for kidney and thyroid, thyroglobulin for thyroid.
- Bone scan is often positive in blastic disease and may miss purely lytic myeloma.

## Step by step

- Tumour cells enter veins and reach the marrow sinusoids, especially through the vertebral venous plexus.
- They adhere to bone matrix and marrow niche cells.
- Tumour PTHrP, IL-6 and other factors raise RANKL on osteoblasts; osteoclasts resorb bone.
- Resorbed matrix releases TGF-β and IGFs, which stimulate the tumour further: the vicious cycle.
- In blastic metastases, tumour endothelin-1 and Wnt signals drive osteoblasts to build disorganized bone.

## Common primaries and their bone lesions

| Primary | Usual pattern | Clue |
| --- | --- | --- |
| [Prostate](https://durgical.com/en/conditions/prostate-cancer/) | Blastic | High PSA; lumbar spine and pelvis |
| [Breast](https://durgical.com/en/conditions/breast-cancer/) | Lytic or mixed | GATA3, oestrogen receptor; spine, pelvis, ribs |
| [Lung](https://durgical.com/en/conditions/lung-cancer/) | Lytic | TTF-1; may also go to hands and feet |
| [Kidney (renal cell carcinoma)](https://durgical.com/en/conditions/renal-cell-carcinoma/) | Lytic, expansile, vascular | PAX8; bleeds at biopsy |
| [Thyroid](https://durgical.com/en/conditions/thyroid-cancer/) | Lytic, vascular | Thyroglobulin; follicular type |
| [Myeloma (not a metastasis)](https://durgical.com/en/conditions/multiple-myeloma/) | Punched-out lytic | Monoclonal protein; bone scan may be negative |

## Clinical notes

- New back pain in a patient with a history of cancer is metastasis until proven otherwise; weakness or bladder problems point to cord compression and are an emergency.
- Hypercalcaemia of malignancy causes confusion, constipation, polyuria and dehydration.
- Antiresorptive drugs reduce skeletal events in bone metastases.

## Memory aid

Bones are fed by Prostate, Breast, Lung, Kidney and Thyroid; only the prostate builds, the rest mostly break.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common malignant tumour in bone?

Metastatic carcinoma.

## Which primary typically causes blastic metastases?

Prostate carcinoma.

## How do lytic metastases destroy bone?

Tumour PTHrP and cytokines raise osteoblast RANKL, activating osteoclasts; released matrix factors feed the tumour.

## Why are spinal metastases common from prostate and breast?

Tumour cells reach the spine through the valveless vertebral venous plexus (Batson plexus).

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/bone-metastases/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Connections

## Related 7

- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Prostatic adenocarcinoma: Gleason and grade groups](https://durgical.com/en/general-pathology/prostatic-adenocarcinoma-gleason-and-grade-groups/)
- [Invasive breast carcinoma of no special type](https://durgical.com/en/general-pathology/invasive-breast-carcinoma-of-no-special-type/)
- [Lung carcinoma: histologic types](https://durgical.com/en/general-pathology/lung-carcinoma-histologic-types/)
- [Clear cell renal cell carcinoma](https://durgical.com/en/general-pathology/clear-cell-renal-cell-carcinoma/)
- [Multiple myeloma](https://durgical.com/en/general-pathology/multiple-myeloma/)

## Related conditions 7

- [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/)
- [Hypercalcaemia of malignancy](https://durgical.com/en/conditions/hypercalcaemia-of-malignancy/)
- [Malignant spinal cord compression](https://durgical.com/en/conditions/malignant-spinal-cord-compression/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Prostate Cancer](https://www.ncbi.nlm.nih.gov/books/NBK470550/) (StatPearls (NCBI Bookshelf), 2025); [Breast Cancer](https://www.ncbi.nlm.nih.gov/books/NBK482286/) (StatPearls (NCBI Bookshelf), 2025); [Bone Cancer | MedlinePlus](https://medlineplus.gov/bonecancer.html) (MedlinePlus, US National Library of Medicine, 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/general-pathology/bone-metastases/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/bone-metastases/