Bone is the most common site of distant
metastases from
breast carcinoma. The presence of bone
metastases affects a patient's prognosis, quality of life, and the planning of their treatment. We discuss recent innovations in bone imaging and present algorithms, based on the strengths and weaknesses of each technique, to facilitate the most successful and cost-effective choice of imaging studies for the detection of osseous
metastases. Skeletal scintigraphy (bone scan) is very sensitive in the detection of osseous
metastases and is recommended as the first imaging study in patients who are asymptomatic. Radiographs are recommended for the assessment of abnormal
radionuclide uptake or the risk of
pathological fracture and as initial imaging studies in patients with bone
pain. MRI or PET-CT can be considered for cases of abnormal
radionuclide uptake that are not addressed by radiography. Osseous
metastases can lead to emergent situations, such as
spinal-cord compression or impending fracture of a weight-bearing bone, and imaging guidelines are essential for early detection and initiation of appropriate
therapy. The imaging method used in non-emergent situations, such as assessment of the ribs, sternum, pelvis, hips, and joints, should be guided by the strengths and limitations of each technique.