Skeletal Metastases — RACP Adult Medicine MCQ

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EasyEndocrinologySkeletal MetastasesRACP Adult Medicine

A 65-year-old woman with a history of breast cancer treated 10 years ago presents with unexplained weight loss, new back pain, and hypercalcaemia (calcium 3.2 mmol/L). ALP is 320 U/L. PTH is suppressed (<0.5 pmol/L). CT shows multiple lytic lesions throughout the spine with pathological fracture of L2. What is the most likely diagnosis?

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Correct answer: B — Bone metastases

Hypercalcaemia with suppressed PTH, elevated ALP, multiple lytic bone lesions, and history of breast cancer is metastatic breast cancer to bone. Breast cancer commonly metastasises to bone (along with lung, liver, and brain). Treatment includes bisphosphonates/denosumab for skeletal events, radiotherapy for painful lesions, hormonal therapy or chemotherapy for systemic disease.

Reference: Cancer Council Australia – 2024 – Breast Cancer Guidelines