Epidemiology of bone metastasis in France between 2009 and 2018

Bone is the third most frequent metastatic site, and bone metastases (BM) are responsible for severe skeletal complications requiring dedicated care. There is no recent BM epidemiology data. This study aimed to describe incident BM patients in France between 2009 and 2018. We accessed the general sample of beneficiaries from the French health insurance reimbursement database. The algorithm identified new adult BM patients through the BM hospitalization code or through codes reflecting the onset of a skeletal-related event (SRE): severe bone pain, pathologic fracture, spinal compression, or hypercalcemia, in patients with a diagnosis of cancer. Patients with primary sarcoma or with prevalent BM during the 3 yr preceding the inclusion date were excluded. A total of 6663 new BM patients over 10 yr, corresponding to 775 573 patients in the whole French population, were identified. The trend analysis of the overall crude rate of incident patients found a significant increase over the 2009-2018 period (average annual percent change of 8.6%, 95% CI [7.5; 9.7]). The most frequent primary cancer sites were breast (15.8%), prostate (13.4%), lung (12.6%), and digestive organs (10.6%). The median [IQR] follow-up was 1.3 yr [0.3-3.4] mainly interrupted by death (63.5%). Among BM patients, 4737 with SRE at inclusion or over the follow-up were identified. Over the period following the onset of an SRE, 66.4% received an opioid medication and 39.6% a nonsteroidal anti-inflammatory drug. Despite advances in oncology, BM concern a high number of patients. The burden of SRE is significant and preoccupant. Specific strategies to face this issue are urgent.