Signs That Metastatic Breast Cancer Has Spread to Your Bones

Metastatic breast cancer commonly spreads to the bones. Learn the signs and symptoms of bone metastasis — plus treatment options.

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When breast cancer spreads beyond the breast, it often lands in the bones, according to one review.

?(It also may spread to the lungs, liver, or brain, other research reported.)

Bone metastases, also known as “bone mets,” occur in roughly 70 percent of women with metastatic breast cancer, according to a study.

?While breast cancer can metastasize to any bone in the body, it most commonly spreads to the spine, according to the American Cancer Society (ACS), which reports other common sites include the hip bone, upper leg and arm bones, ribs, and skull.

While experts don’t know exactly why breast cancer spreads to the bones, they suspect our bone marrow may provide an excellent environment for cancer growth because of its rich blood supply and many available nutrients, says Steven Isakoff, MD, PhD, a medical oncologist and the director of breast cancer clinical research at Mass General Cancer Center in Boston.

Typically, bone pain is the first sign that cancer has spread to the bone. In some cases, however, bone metastases cause little or no symptoms, and it takes a routine scan or fracture from a minor fall or injury to uncover the lesion in the bone.

“A fracture is one of the worst case scenarios, and one we try to avoid,” says Alissa Huston Porter, MD, a breast cancer oncologist and an associate professor of medicine at the James P. Wilmot Cancer Institute at the University of Rochester in New York.

While these secondary cancers in the bone are not curable, many new and advanced treatments are available to reduce the complications, lessen the symptoms and lengthen a person’s life, according to a review.

?What’s more, finding and treating bone metastases early on can be critical in preventing problems later, per the ACS.

Bone mets can prove difficult to catch early, but according to one study, new advances in research point to a possible early-detection method: biomarkers. While these tests are not yet offered, methods to detect metastases early through bloodwork are under investigation.

doctors speaking with female patient about breast cancer progression to bones
Bone pain is typically the first sign that cancer has spread to the bone, experts say.
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Signs to Watch Out For

“Most aches and pains aren’t cancer,” stresses Dr. Huston. “But it’s important to keep an open and honest dialogue with your doctor about any unusual or persistent discomfort you may be having. He or she can determine if getting images is appropriate to rule out bone metastasis.” Here are the symptoms of bone metastasis to watch for.

Bone Pain

Pain is the most common symptom of bone metastasis. The pain may come and go at first, be worse at night, and feel better with movement. Later on, it may become constant and worsen during physical activity, according to the ACS.

Make sure to tell your healthcare provider about any new, unexplained pain that doesn’t resolve with rest, says Huston. If the pain is due to a tumor in the bone, that bone may be weak and at risk of fracture, which can be prevented if the metastasis is found and treated early.

Broken Bones

Because metastases can damage areas of bone or stimulate abnormal bone growth, they can cause the bones to be weak and unstable, making them more likely to fracture, according to StatPearls.

The most common sites of fracture are the spine and the long bones of the arms and legs, notes Huston. Long bones include the humerus (elbow to shoulder) and the femur (ankle to knee), and these hold a higher risk of fracture from bone mets.

A fracture can happen from a fall, trauma, or, if a bone is significantly weakened, everyday activities. Alert your doctor immediately if you experience sudden, severe bone pain, as this can be a sign of a fracture.

Spinal Cord Compression

When cancer spreads to the bones of the spine, it can squeeze or press on the spinal cord.

This can cause weakness in the legs, numbness in the belly or legs (or elsewhere in the body), difficulty urinating, and constipation, says Huston. Another symptom reported is band-like pain around the torso.

?If you have any of these symptoms, you should tell a doctor or nurse right away. Left untreated, spinal cord compression can lead to paralysis.

Extreme Thirst, Loss of Appetite, and Sluggishness

These are signs of hypercalcemia, or high levels of calcium in the blood, reports Cleveland Clinic.

Breast cancer and bone metastases can cause a release of calcium into the bloodstream, says Dr. Isakoff, who adds that, in addition to the symptoms above, hypercalcemia can cause bone pain, abdominal cramping, constipation, mood changes, and kidney stones. Left untreated, high calcium can lead to coma and abnormal heart rhythms.

“Hypercalcemia is treated with several approaches,” says Isakoff, including IV fluids and bisphosphonates (a medication used to treat bone mets). “But it's important to monitor the calcium level when treating with these medications to make sure the calcium level doesn’t go too low,” Isakoff adds.

“With a history of cancer, it’s probably best to let your oncologist know if you have any new medical symptoms that last more than a week, and certainly much sooner with any severe symptoms,” says Anne Peled, MD, a breast cancer surgeon in San Francisco.

If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam and blood tests, per Mayo Clinic. Depending on the results and where or how severe the bone pain is, he or she may also order an imaging test, such as an X-ray, PET scan, CT scan, bone scan, or MRI for further evaluation. In some cases, a tissue biopsy is also done to confirm the diagnosis.

Illustrative graphic titled, signs that metastatic breast cancer has spread to your bones, a woman is centered surrounded by icons of symptoms including spinal cord compression, thirst, loss of appetite, broken or fractured bone, bone pain
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How Bone Metastases Are Treated

Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself.

Systemic Cancer Treatment

“When breast cancer spreads to the bones, it is generally treated with the same therapies used to treat breast cancer that has spread to other parts of the body,” says Isakoff. Per the Mayo Clinic, systemic treatment for bone mets may include:

  • Chemotherapy?For bone mets, chemotherapy can be effective, says Isakoff. It may even decrease cancer pain.

    Side effects can vary from person to person but can include hair loss, nausea, and fatigue.

  • Endocrine Therapy?According to a review, treating breast cancer with estrogen-blocking therapy can also slow bone metastasis by interrupting a cycle in which breast cancer cells and bone cancer cells prompt each other’s growth.

    Some common side effects include hot flashes, decreased libido, and vaginal dryness or irritation, according to the ACS.

Bone-Modifying Medications

Bisphosphonates such as zoledronic acid are a class of drugs used to prevent and treat bone loss, reduce pain, and prevent hypercalcemia, says Isakoff. “Studies generally show that these medications can reduce the risk of skeletal events, including fractures and spinal cord compression, by 25 to 40 percent,” Isakoff adds.

According to one meta-analysis, bisphosphonates were typically prescribed once a month, but when taken over years, may cause side effects like kidney dysfunction, gastrointestinal disorders, and issues with the jaw bones. Study authors suggested decreasing bisphosphonate use over time may offer the same protection with fewer side effects and now the standard administration of bisphosphonate administration is once every three month.

Denosumab, a medication that prevents the breakdown of bone, can also be effective in treating bone metastases, according to a study of 247 people published in BMC Cancer, which found the treatment to be effective in delaying bone fractures from cancer metastasis. According to the prescribing label for denosumab, side effects can include jaw bone breakdown, atypical femur fracture, musculoskeletal pain, skin conditions like eczema, and low calcium levels.

?A meta-analysis published in Frontiers in Oncology, however, states that more research is needed to understand exactly how the medication works.


Surgery may be recommended to remove most of the tumor or stabilize the bone to prevent or manage a fracture, according to Mayo Clinic. “[However], unlike medications and radiation therapy, surgery is really not used to treat or remove bone metastases. It’s primarily used to manage impending bone fractures or fractures that have already happened as a result of the metastases,” says Dr. Peled.

Isakoff agrees, saying “In this situation, surgery can be highly effective to reduce pain and prevent or repair a fracture.” If a bone is weak or a fracture seems imminent, an orthopedic surgeon may insert a rod or pin to stabilize the bone, per Mayo Clinic. Spinal fractures are sometimes treated with an outpatient procedure called vertebroplasty, in which bone cement is injected into a collapsed vertebra to build it back up and improve back pain.

Decreased mobility is the most common side effect with surgery, according to one review. The surgeon must reconstruct areas which have been degraded by the cancer, which can make rehabilitation challenging.


Radiation therapy may be used to help prevent fractures and treat spinal cord compression to help alleviate symptoms of pain or numbness, says Huston.

A type of radiation called radiopharmaceuticals are given through an IV and contain radioactive material that homes in on your bones. Internal radiation can damage your bone marrow and cause decreased low blood cells.

The most common side effect of external beam radiation is skin irritation, but other side effects depend on the treatment area. For example, radiation to a joint can damage it, causing decreased range of motion and mobility.

Pain Medications

In most cases, providers start with NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen for pain control, says Isakoff, which blocks the production of prostaglandins, substances that the body releases in response to illness or injury.

“If additional pain medications are needed, opioid narcotics in conjunction with ibuprofen can be effective, and sometimes steroid anti-inflammatory medications can be added,” says Isakoff, who adds, if your pain is focused on a specific area, limited radiation therapy can be extremely effective and may help avoid the need for higher doses of other medications.

Opioids include medications like oxycodone (Oxycontin/Roxicodone), which can work effectively to reduce pain over a short period, but can cause side effects like drowsiness and constipation and can be addictive if misused, according to MedlinePlus.

Research is limited on opioid use for chronic pain (pain that extends past three months or beyond healing) and so its effectiveness over time is largely unknown, according to one study.

Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses; practicing relaxation methods like meditation, physical therapy, or yoga; and doing other gentle forms of exercise, according to a review.

Ask your healthcare team about programs that can keep you safely active.
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