Metastatic Bone Disease

A 58-year-old man with a 3-year history of adenocarcinoma of the lung presents with progressive right hip pain and difficulty walking. Physical examination reveals tenderness over the right femoral neck and limited hip flexion. X-ray of the pelvis shows a lytic lesion in the right femoral neck with cortical disruption. Laboratory investigations reveal elevated alkaline phosphatase (120 U/L) and normal serum calcium (9.2 mg/dL). What is the most appropriate next step in management?

A 62-year-old woman with known breast cancer (hormone receptor-positive, HER2-negative) presents with severe mid-back pain for 2 weeks. MRI of the thoracic spine shows a sclerotic lesion at T7 vertebral body with 40% canal stenosis but no cord compression. Serum calcium is 8.8 mg/dL, alkaline phosphatase is 95 U/L, and hemoglobin is 11.2 g/dL. She is on aromatase inhibitor therapy. What is the most appropriate management?