{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:07:28Z","timestamp":1791515248025,"version":"4.3.4"},"reference-count":129,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.<\/jats:p>","DOI":"10.3390\/cancers13225711","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:19:20Z","timestamp":1636964360000},"page":"5711","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Fracture Risk Evaluation of Bone Metastases: A Burning Issue"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9318-6785","authenticated-orcid":false,"given":"Cyrille B.","family":"Confavreux","sequence":"first","affiliation":[{"name":"Centre Expert des M\u00e9tastases Osseuses (CEMOS), D\u00e9partement de Rhumatologie, Institut de Canc\u00e9rologie des Hospices Civils de Lyon (IC-HCL), H\u00f4pital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre B\u00e9nite, France"},{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, 69100 Villeurbanne, France"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale INSERM, LYOS UMR1033, 69008 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3290-2899","authenticated-orcid":false,"given":"Helene","family":"Follet","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, 69100 Villeurbanne, France"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale INSERM, LYOS UMR1033, 69008 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-0916","authenticated-orcid":false,"given":"David","family":"Mitton","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Gustave Eiffel, Universit\u00e9 Claude Bernard Lyon 1, LBMC, UMR_T 9406, 69622 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6038-7540","authenticated-orcid":false,"given":"Jean Baptiste","family":"Pialat","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, 69100 Villeurbanne, France"},{"name":"CREATIS, CNRS UMR 5220, INSERM U1294, INSA Lyon, Universit\u00e9 Jean Monnet Saint-Etienne, 42000 Saint-Etienne, France"},{"name":"Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre B\u00e9nite, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4463","authenticated-orcid":false,"given":"Philippe","family":"Cl\u00e9zardin","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lyon, Universit\u00e9 Claude Bernard Lyon 1, 69100 Villeurbanne, France"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale INSERM, LYOS UMR1033, 69008 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.1056\/NEJMra0805239","article-title":"Molecular Basis of Metastasis","volume":"359","author":"Chiang","year":"2008","journal-title":"N. 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