Cancer and Spinal Fractures

Bone metastasis and multiple myeloma

Written by Jason M. Highsmith, MD

Spinal compression fractures can be caused by many things. While osteoporosis is the most common cause, certain types of cancer that either originate in the spine or spread from another part of your body (eg, lung, breast) can cause a spinal bone to break or fracture. Two types of cancer that may cause spinal compression fracture are (1) bone metastasis and (2) multiple myeloma.

Another term for bone metastasis is osseous metastatic disease. “Osseous” means bone. This type of cancer originates in a primary tumor that spreads to bone. Multiple myeloma is the third most common type of blood cancer affecting the plasma, the white blood cells.

Below you can read about how each of these cancers weakens your spinal bones, leaving them vulnerable to fractures.
First: A Word on Diagnosing Spinal Tumors
A foremost symptom of any spinal fracture is pain, and cancer-related spine bone fractures are no different. In addition to a physical and neurological examination, your doctor will order tests necessary to determine the source of pain. He/she may start with one or more Imaging tests, such as x-ray, CT scan, and/or MRI to find if a primary cancer has spread to the spine. These tests can reveal important information about the tumor, including its size, shape and location.

To confirm the type and stage of the cancer, your doctor may order blood tests, needle biopsies, and/or surgical bone biopsies. During a biopsy, your doctor removes a sample of the tumor. Surgical bone biopsies are often carried out at the same time if/when vertebral augmentation is performed, such as vertebroplasty or kyphoplasty.

How Bone Metastasis Weakens Your Bones
Bone metastasis is cancer that spreads to your bones from another site (most commonly from the breasts, lungs, and prostate). Because the spine is a central structure in the body, the bones of the spine are the top site for bone metastasis.

Bone metastasis can lead to spinal fractures because it prevents the 2 main types of bone cells—osteoblasts and osteoclasts—from working properly. Osteoblasts build new bone, while osteoclasts break down old bone.
This type of cancer produces 2 kinds of lesions, and the type of lesion associated with fractures is known as an osteolytic lesion. Osteolytic lesions occur when the cancer triggers the osteoclasts to break down too much bone. This type of lesion causes your bones to weaken and lose density, making them prone to fractures.

Bone pain is typically the earliest symptom, but some patients may not realize they have bone metastasis until they develop a fracture.

Multiple Myeloma Makes Spinal Bones Vulnerable to Fracture
Multiple myeloma is a cancer of your plasma cells, which are white blood cells that live in your bone marrow. White blood cells are part of your body’s immune system. As with bone metastasis, multiple myeloma wears away at your bones’ mass.

Like bone metastasis, multiple myeloma interferes with the healthy balance of activity between osteoblasts and osteoclasts. This type of cancer triggers the osteoclasts to work harder—so they wear away bone quicker than they normally should. Plus, multiple myeloma inhibits the osteoblasts from rebuilding new bone, so spinal bones become weakened and vulnerable to fracture.

Spinal bone pain is a commonly reported symptom of people who have multiple myeloma.

Get More Information About Spinal Cancer
Though osteoporosis is the leading cause of spinal compression fractures, spinal tumors can also wear away bones and make them susceptible to fracture. If you or a loved one has recently been diagnosed with multiple myeloma, bone metastasis, or another type of spinal cancer, we have detailed resources to help you explore more about the disease and therapeutic options:

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