Search Our Scientific Publications & Authors

Med Clin North Am 2020 May 14;104(3):525-538. Epub 2020 Feb 14.

Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: https://twitter.com/ctsinclair.

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Read More

Am J Emerg Med 2020 11 10;38(11):2477-2481. Epub 2020 Mar 10.

Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.

J Nippon Med Sch 2019 ;86(3):159-164

Department of Orthopaedic Surgery, Nippon Medical School.

Background: Early diagnosis of bone metastasis is difficult. The aim of the present study was to determine whether symptoms related to skeletal-related events (SREs) can be used for the diagnosis of bone metastasis in the absence of screening tests.

Methods: We reviewed 81 patients with bone metastasis to evaluate their SREs at diagnosis. Read More

Praxis (Bern 1994) 2018 Jul;107(14):749-754

1 Universitätsspital, Klinik für Innere Medizin, Basel.

CME: Multiple Myeloma - a Review Abstract. Multiple myeloma accounts for 1 % of all malignancies, and its incidence increases with age. Both the symptoms and the course of the disease are heterogeneous. Read More

BMJ Case Rep 2018 Jun 11;2018. Epub 2018 Jun 11.

Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Osteoporosis is the most common metabolic bone disorder worldwide, especially in women. Postmenopausal status is the most common risk factor for osteoporosis in elderly women. The operational diagnosis of osteoporosis is usually made with the help of central dual energy X-ray absorptiometry scan. Read More

Medicine (Baltimore) 2017 Dec;96(51):e9327

The Second Affiliated Hospital of Harbin Medical University The Tumor Hospital Affiliated to Harbin Medical University, Harbin, China.

Because of improving treatments and survival, 40% to 58% of patients with bone metastases from nonsmall cell lung cancer (NSCLC) will suffer from at least one skeletal-related event (SRE), affecting their quality of life, but the natural history of SRE is poorly understood. The study aimed to examine the factors involved in SRE-free survival (SRS) and overall survival (OS) of patients with NSCLC and bone metastases.This was a retrospective study of 211 patients with bone metastasis from NSCLC and treated at the Tumor Hospital Affiliated to Harbin Medical University between January 2007 and January 2012. Read More

Bratisl Lek Listy 2017 ;118(9):529-534

Neuroendocrine tumors arise from various cells that form a part of the endocrine system and account for a small number of cases encountered by oncologists in clinical practice. The clinical incidence of these tumors used to be low, and newer imaging modalities have now begun to be used for detecting bone metastases at an earlier stage. Bone metastases arising from neuroendocrine tumors are a well-recognized complication. Read More

Curr Osteoporos Rep 2017 10;15(5):483-498

Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Professional Office Building 216, 55 Fruit Street, Boston, MA, 02114, USA.

Purpose Of Review: Bone disease is a defining characteristic of multiple myeloma (MM) and the major cause of morbidity. It manifests as lytic lesions or osteopenia and is often associated with severe pain, pathological fracture, spinal cord compression, vertebral collapse, and hypercalcemia. Here, we have reviewed recent data on understanding its biology and treatment. Read More

Spinal Cord Ser Cases 2017 13;3:17010. Epub 2017 Apr 13.

Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Introduction: Immobilisation-induced hypercalcemia following SCI affecting the kidney function, is a rare but potentially serious condition. We report immobilisation-induced hypercalcemia affecting the kidney function in two young native Greenlanders with spinal cord injury (SCI).

Case Presentations: Two 15- and 24-year-old male native Greenlanders, both with traumatic C5 SCI were admitted to our spinal cord unit. Read More

Cochrane Database Syst Rev 2017 03 23;3:CD003347. Epub 2017 Mar 23.

Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Sant Antoni Maria Claret 171 - Edifici Casa de Convalescencia, Barcelona, Catalunya, Spain, 08041.

Background: This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates. Read More

Int J Clin Oncol 2017 Jun 2;22(3):548-553. Epub 2017 Jan 2.

Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan.

Background: The aim of the present study was to elucidate the details of bone metastasis (BM) and the resulting skeletal-related events (SREs), and survival and prognostic factors, in urothelial cancer (UC) patients with BM.

Methods: A total of 48 UC patients with BM who were treated at our institution between 1994 and 2013 were enrolled. Details of BM and SREs were investigated. Read More

Clin Ther 2016 Aug 29;38(8):1880-9. Epub 2016 Jul 29.

Xcenda, Palm Harbor, Florida. Electronic address:

Purpose: The development of skeletal-related events (SREs) (pathologic fracture, need for surgery and/or radiation to bone, spinal cord compression, and hypercalcemia of malignancy) in metastatic prostate cancer (MPC) is associated with worsened pain and compromised quality of life. Opioids are frequently used throughout the course of SRE treatment. This study describes the treatment patterns and incremental use of opioids in MPC patients diagnosed with SREs. Read More

Eur J Cancer Care (Engl) 2017 Nov 19;26(6). Epub 2016 Jul 19.

Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.

The purpose of this meta-analysis was to evaluate the efficacy of denosumab, compared with zoledronic acid (ZA), in delaying skeletal-related events (SREs) and enhancing overall survival in patients with advanced solid tumours and bone metastases. A systematic literature search of several electronic databases, including PubMed, Medline, Embase, the Cochrane Library, CKNI and Web of Science with Conference Proceedings, was performed. Only randomised controlled trials assessing denosumab in comparison with ZA, in patients with advanced solid tumours and metastatic-stage disease, were included. Read More

Oncology 2016 20;90(2):103-11. Epub 2016 Jan 20.

Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.

Background/objective: The aim of this study was to evaluate the characteristics and prognostic factors of small cell lung cancer (SCLC) with bone metastases. We also investigated the characteristics and predictive factors of skeletal-related events (SREs) in these patients.

Materials And Methods: Sixty-one patients who were first diagnosed with SCLC with bone metastases at our institution were included in this retrospective analysis. Read More

J Med Econ 2016 22;19(5):477-86. Epub 2016 Jan 22.

a Eli Lilly and Company , Indianapolis , IN , USA.

Objective: A potential complication for all new multiple myeloma (MM) patients is the clinical presentation of osteolytic lesions which increase the risk for skeletal-related events (SREs). However, the contribution of SREs to the overall economic impact of MM is unclear. The impact of SREs on healthcare resource utilization (HCRU) and costs for US patients with MM was analyzed in Truven Health Marketscan Commercial Claims and Medicare Supplemental Databases. Read More

Medicina (B Aires) 2014 ;74(6):457-61

Instituto de Investigaciones Metabólicas (IDIM), Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador (USAL), Buenos Aires, Argentina. E-mail:

This report shows our conclusions on the clinical, biochemical and densitometry characteristics of 35 normocalcemic primary hyperparathyroidism (PHPT) patients. This condition is defined by a high level of intact parathyroid hormone (iPTHI) with persistently normal serum and ionized calcium in the absence of secondary hyperparathyroidism. Our selection consisted of 30 women (90%) and 5 men (10%). Read More

Support Care Cancer 2015 Jan 2;23(1):237-47. Epub 2014 Oct 2.

Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA, 90212, USA.

Purpose: Up to 75% of patients with prostate cancer experience metastatic bone disease, which leads to an increased risk for skeletal-related events (SREs) including pathological bone fracture, spinal cord compression, and hypercalcemia of malignancy. Our objective was to systematically review the literature on the impact of SREs on quality of life (QOL), morbidity, and survival with a primary focus on the impact of SREs on pain in prostate cancer patients.

Methods: We searched PubMed, limiting to peer-reviewed English-language human studies published in 2000-2010. Read More

J Thorac Oncol 2014 Feb;9(2):231-8

*Institute of Biomedical Research and Innovation, Kobe, Japan; †Yokohama Municipal Citizen's Hospital, Yokohama, Japan; ‡Osaka City General Hospital, Osaka, Japan; §Kyushu University Hospital, Fukuoka, Japan; ‖Gifu Municipal Hospital, Gifu, Japan; ¶Aichi Cancer Center Aichi Hospital, Okazaki, Japan; #National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; **Toneyama National Hospital, Toyonaka, Japan; ††Tokai University School of Medicine, University Hospital, Isehara, Japan; ‡‡Shizuoka Cancer Center, Shizuoka, Japan; §§The University of Tokyo, Tokyo, Japan; and ‖‖Teikyo University School of Medicine, Tokyo, Japan.

Background: Bone metastasis (BM) is a frequent complication in patients with advanced lung cancer and it causes skeletal-related events (SREs). Our study aim is to prospectively investigate the incidence of BM, incidence and types of SRE, and predictive factors of BM and SREs.

Methods: Newly diagnosed, advanced non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) patients were enrolled into the study. Read More

Bull Cancer 2013 Nov;100(11):1073-81

Institut Curie, hôpital René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.

The actual improvement of epidemiologic database collection concerning bone metastases of solid tumors allows us to better understand the seriousness of this evolution, its human, social and financial burden. A renewal of interest appeared with a better screening of the asymptomatic forms and by the therapeutic advances obtained by bone resorption inhibitors. They were developed in clinical trials with a specific and original methodology evaluating their efficacy on the skeletal-related events (SRE) (pain, fracture, spinal cord compression, pathologic fracture and hypercalcemia). Read More

Hematol Oncol 2014 Mar 1;32(1):52-5. Epub 2013 Sep 1.

Clinical Haematology, University College Hospital, London, UK.

Orthop Nurs 2013 Jul-Aug;32(4):209-14; quiz 215-6

University Hospitals Case Medical Center, Seidman Cancer Center, Cleveland, OH, USA.

Bone is the third most common site of cancer metastasis resulting in pain and other serious morbidities that can affect one's quality of life. The orthopaedic patient with bone metastasis faces many challenges and has complex nursing care needs. Managing care involves astute assessment skills, knowledge of treatments including medication, surgery, and radiation therapy, and recognition of serious complications such as fracture, spinal cord compression, and hypercalcemia. Read More

Expert Rev Pharmacoecon Outcomes Res 2013 Aug 18;13(4):483-96. Epub 2013 Jul 18.

Pharmerit International, Bethesda, MD 20814, USA.

Despite effective skeletal-related event (SRE)-limiting therapies such as zoledronic acid and denosumab, SREs continue to place a meaningful burden on patients, providers and payers. However, studies of SRE-related effects on clinical (i.e. Read More

Asian Pac J Cancer Prev 2013 ;14(5):3357-62

Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Read More

J Oral Maxillofac Surg 2013 Sep 1;71(9):1532-40. Epub 2013 May 1.

Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To investigate the efficacy and safety of zoledronic acid (ZA) combined with targeted therapy (TT).

Materials And Methods: A retrospective study was performed in patients with metastatic renal cell carcinoma treated with ZA and TT.

Results: Twenty-one patients received ZA and TT to prevent skeletal-related events and no pretherapy oral and maxillofacial (OM) examination (cohort A). Read More

Tumori 2013 Jan-Feb;99(1):1-9

Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy.

Advances in the diagnosis and treatment of tumors by surgery, chemotherapy, biotherapy, radiotherapy and other modalities have increased the survival of cancer patients over the last 20 years. As a consequence, bone now represents the third most common site of metastatic involvement after the lung and liver. Approximately 20-25% of patients with neoplastic disease develop clinically evident bone metastases (BMs) during the natural course of their illness, with a further 50% of such lesions being identified during autopsy. Read More

J Am Vet Med Assoc 2013 Mar;242(6):803-6

Carolina Veterinary Specialists, 1600 Hanes Mall Blvd, Winston-Salem, NC 27103, USA.

Case Description: An 11-year-old spayed female Siberian Husky was evaluated because of a 2-week history of progressive paraparesis.

Clinical Findings: Results of neurologic examination were consistent with a T3-L3 myelopathy. There were no abnormalities on CBC, and hypercalcemia was noted on serum biochemical analysis. Read More

J Clin Endocrinol Metab 2013 Apr 22;98(4):1492-7. Epub 2013 Feb 22.

Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.

Context: Bone metastases (BM) can cause severe pain, spinal cord compression, pathological fractures, and/or hypercalcemia. These skeletal-related events (SREs) may cause immobilization, loss of independence, poor quality of life, and reduced survival. There is limited information on the clinical effects of BM and SREs in patients with malignant pheochromocytoma or sympathetic paraganglioma (PHEO/sPGL). Read More

Nurs Stand 2013 Jan 9-15;27(19):48-56; quiz 57

King's College Hospital NHS Foundation Trust, London.

A diagnosis of bone metastases may be devastating for patients with cancer because it suggests that the cancer is incurable and that patients are at increased risk of developing skeletal-related events. The optimal goal for these patients should be to maintain quality of life. Nurses have an important role in the care of patients with cancer-induced bone disease and need to have a good understanding of the effects of bone metastases to ensure prompt management of this condition. Read More

Support Care Cancer 2013 Jun 19;21(6):1557-60. Epub 2013 Jan 19.

Medical School, Memorial University, Newfoundland, Newfoundland and Labrador, Canada.

Purpose: Bone metastases occur in 65-75% of patients with metastatic breast cancer. These patients are at risk of developing skeletal-related events (SREs). SREs are defined as any pathological fracture, spinal cord compression, hypercalcemia, and surgery or radiation required for treatment of bone metastases. Read More

J Palliat Med 2013 Jan 20;16(1):9-19. Epub 2012 Nov 20.

University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA.

Abstract The spine is a common site of involvement in patients with bone metastases. Apart from pain, hypercalcemia, and pathologic fracture, progressive tumor can result in neurologic deterioration caused by spinal cord compression or cauda equina involvement. The treatment of spinal bone metastases depends on histology, site of disease, extent of epidural disease, extent of metastases elsewhere, and neurologic status. Read More