Patients are usually over 40, and the average age is around 55.
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. An occasional patient may have hypertesion from the tumor affecting the renin-angiotensin pathway. Hematuria is also a common sign, but small amounts of blood in the urine cannot be detected without a urinalysis When a patient has a metastasis and no site of origin can be found (a metastasis of unknown origin) the most likely site is the lung or kidney.
Lesions may be large and appear as a "blowout" of the particular bone involved.
I believe all patients should be started and maintained on bisphosphonates as soon as a diagnosis of metastasis to bone is confirmed.