[Basic principles of the diagnostics and treatment of malignant bone tumors in old age]

Abnormal X‑ray images and magnetic resonance imaging (MRI) findings in older patients are common and require prompt evaluation to distinguish malignant diseases from harmless incidental findings. A thorough medical history, including pre-existing diseases and previous imaging, is essential. Conventional X‑ray images provide initial indications of lesion dignity using the Lodwick classification. The diagnostics are supplemented by contrast-enhanced MRI and, if necessary, additional CT scans. The most common malignant bone tumors in old age are metastases, followed by lymphomas, plasmacytomas and, less frequently, primary bone tumors. The fracture risk of the extremities can be assessed using the Mirels score and using the spinal instability neoplastic score (SINS) regarding the spine. In cases of unclear findings, a biopsy is necessary for further evaluation and should be performed at a specialized tumor center. The treatment depends on the tumor entity and staging and includes surgical procedures, radiotherapy and chemotherapy. The most important indicator of a pathological fracture is an inadequate trauma mechanism.