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 and hypertrophic pulmonary osteoarthropathy (painful thickening of the long and short tubular bones and clubbing of the fingers).
Lung cancer metastases normally appear purely lytic, with poor margination, no matrix and cortical destruction. Lung lesions in bone may also be blastic. When you see a smoker over age 40 with multiple bone lesions, think lung cancer.
There is virtually no role of curative surgery. Orthopedic stabilization of weakened bones should be done promptly, before fractures can occur.