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Baldwin Breast Cancer Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R01 AR065419"],"award-info":[{"award-number":["R01 AR065419"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Metastatic breast, prostate, lung, and other cancers often affect bone, causing pain, increasing fracture risk, and decreasing function. Management of metastatic bone disease (MBD) is clinically challenging when there is potential but uncertain risk of pathological fracture. Management of MBD has become a major focus within orthopedic oncology with respect to fracture and impending fracture care. If impending skeletal\u2010related events (SREs), particularly pathologic fracture, could be predicted, increasing evidence suggests that prophylactic surgical treatment improves patient outcomes. However, current fracture risk assessment and radiographic metrics do not have high accuracy and have not been combined with relevant patient survival tools. This review first explores the prevalence, incidence, and morbidity of MBD and associated SREs for different cancer types. Strengths and limitations of current fracture risk scoring systems for spinal stability and long bone fracture are highlighted. More recent computed tomography (CT)\u2010based structural rigidity analysis (CTRA) and finite element (FE) analysis methods offer advantages of increased specificity (true negative rate), but are limited in availability. Other fracture prediction approaches including parametric response mapping and positron emission tomography\/computed tomography measures show early promise. Substantial new information to inform clinical decision\u2010making includes measures of survival, clinical benefits, and economic analysis of prophylactic treatment compared to after\u2010fracture stabilization. Areas of future research include use of big data and machine learning to predict SREs, greater access and refinement of CTRA\/FE approaches, combination of clinical survival prediction tools with radiographically based fracture risk assessment, and net benefit analysis for fracture risk assessment and prophylactic treatment.<\/jats:p>","DOI":"10.1002\/jor.24660","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T06:32:01Z","timestamp":1583994721000},"page":"1175-1190","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["Fracture risk assessment and clinical decision making for patients with metastatic bone disease"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9403-4030","authenticated-orcid":false,"given":"Timothy A.","family":"Damron","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Institute for Human Performance SUNY Upstate Medical University  Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1150-0740","authenticated-orcid":false,"given":"Kenneth A.","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute for Human Performance SUNY Upstate Medical University  Syracuse New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"AAOS.2019.Metastatic Bone Disease.orthoinfo.aaos.org."},{"key":"e_1_2_10_3_1","first-page":"87","article-title":"Estimated number of prevalent cases of metastatic bone disease in the US adult population","volume":"4","author":"Li S","year":"2012","journal-title":"Clin Epidemiol"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28990"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2017.08.012"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2005.03.011"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2017.04.008"},{"key":"e_1_2_10_8_1","unstructured":"Surgeons ACo.2019. 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