In adults with destructive bone lesions, which etiology is most likely?

• A. Metastatic disease
• B. Primary bone sarcoma
• C. Osteomyelitis
• D. Infection

Answer: (A)

Destructive bone lesions in adults are most commonly due to metastatic cancer. Cancer cells spread through the bloodstream and often lodge in bone, especially in the spine, pelvis, ribs, and long bones, making metastases the leading cause of such lesions in adults. Primary bone sarcomas, like osteosarcoma or Ewing sarcoma, occur much more often in younger patients, so they’re less likely in an adult. Infections such as osteomyelitis can destroy bone too, but they typically come with signs of infection (fever, elevated inflammatory markers) and have particular imaging features like periosteal reaction, sequestra, or involucrum rather than a straightforward destructive lesion. So the most likely etiology in adults with destructive bone lesions is metastatic disease.