OSSEOUS METASTASES: š“ can appear non-aggressive or aggressive š“ lung cancer most common primary overall š“ breast cancer in women, often osteoblastic metastases š“ prostate in men most common cause of osteoblastic metastases š“ distribution matches red marrow, rare beyond elbow and knees š“ fractures that should make you think underlying lesion such as metastasis: -- subtrochanteric femur or humerus transverse fracture -- lesser trochanter avulsion fracture in adult š“ beware diffuse increased bone density in extensive osteosclerotic metastases - easy to miss š“ expansile "blow out" lytic metastases; think renal cell carcinoma or thyroid carcinoma š“ absent pedicle "winking owl sign" on frontal spine radiographs in lytic posterior element involvement.