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Direct resorption of bone by tumor cells
2%
31/1295
Neoangiogenesis of the vertebral body
1%
17/1295
Macrophage-mediated bony destruction
6%
84/1295
Tumor induced activation of osteoclasts
88%
1143/1295
Necrosis of the vertebral body
11/1295
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Metastatic tumors are thought to induce osteolysis not by direct resorption of bone (remember only osteoclasts can destroy bone) but rather by releasing osteoclastogenic inflammatory cytokines. Okeefe et al present a Level 5 review that states TNFa, RANKL, IL-1b, and IL-6 are osteoclastogenic inflammatory cytokins. Among these, RANKL is the most notable and important cytokine. It binds to RANK, a surface receptor, and initiates osteoclastogenesis. Goltzman presents a Level 5 review of the skeletal manifestations of malignancy. They report that by binding and neutralizing RANKL, osteoprotegrin (OPG) can diminish the production of functioning osteoclasts, and this factor has been shown to block bone resorption that is associated with malignancy. Illustration A is a schematic representation of tumor-cell induced osteolysis.
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