• Andrea Piccioli, Maria Silvia Spinelli, and Giulio Maccauro.
• Orthopedics Oncology, "Palazzo Baleani", Teaching Hospital Policlinico Umberto I, Rome, Italy.
• Injury. 2014 Dec 1;45 Suppl 6:S138-41.

IntroductionThe concept of impending fracture has been developed to help address this difficult skeletal-related problem. There is no consensus on the subject in the literature and a specific definition of impending fracture has not been outlined.DiscussionThere is disagreement in the literature on the best criteria for the diagnosis of impending fracture. A method of discrimination for patients who need preventative treatment for a metastatic lesion has not yet been established.ConclusionsCurrent score systems consider variables like size, location and treatment response and are easy to remember. However, these score systems have never been evaluated prospectively and rigorously, their sensitivity is low and they do not take into account potentially relevant factors that can influence patient prognosis. A consistent tool to evaluate impending fractures would be of great value to guide the treatment of metastatic bone disease.Copyright © 2014 Elsevier Ltd. All rights reserved.

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