It most commonly occurs in women over age 40.
Pain is the most common presenting symptom. Pathological fracture rarely occurs without a history of a few weeks or months of increasingly severe pain. In some cases the patient has tried to ignore or deny the symptoms. Sometimes a painful bone lesion is thought to be a "muscle pull" or a "sprain" and strong pain medicines are prescribed, allowing the patient to continue to tolerate very severe pain before the true nature of the problem is discovered. Systemic symptoms may also occur, such as hypercalcemia.
The lesions can often be blastic but may also appear purely lytic, with poor margination, no matrix and cortical destruction.
One of the most exiting new developments is a class of drugs knows as bisphosphonates (Aredia, Fosamax, Didronel, and others). There is virtually no role for curative surgery. Orthopedic stabilization of weakened bones should be done promptly, before fractures can occur.