Distribution patterns of metastatic bone disease in 62 patients with soft-tissue cancers showed that 60% of bone lesions were located in the axial and 40% in the appendicular skeleton. Thirteen percent of the lesions were in appendicular regions not usually included in routine imaging studies. The majority of the metastatic skeletal lesions were clinically asymptomatic. The serum alkaline phosphatase level is a poor indicator of early bone metastases.
(JAMA 237:2504-2506, 1977)
Krishnamurthy GT, Tubis M, Hiss J, Blahd WH. Distribution Pattern of Metastatic Bone DiseaseA Need for Total Body Skeletal Image. JAMA. 1977;237(23):2504–2506. doi:10.1001/jama.1977.03270500056025