Bone metastases in NSCLC: Modern paradigms in management and supportive care

Bone metastases (BoMs) are a frequent complication in advanced non-small-cell lung cancer (NSCLC), affecting approximately one third of patients at diagnosis and 35–60 % during the disease course. BoMs increase the risk of skeletal-related events (SREs), which have a detrimental impact on prognosis, performance status, and quality of life (QoL). Management of BoMs in NSCLC requires a multimodal approach. Although systemic anti-cancer therapies remain the cornerstone, the optimal management of BoMs in NSCLC also encompasses bone-targeted agents (BTAs) such as bisphosphonates and denosumab, local treatments including radiotherapy and surgical interventions, and supportive care strategies aimed at preventing SREs, alleviating pain, preserving mobility, and maintaining QoL. This review provides an updated overview of best practices for managing BoMs in NSCLC, covering diagnostic work‑up, therapeutic strategies, and the growing role of multidisciplinary care. It emphasizes the importance of supportive interventions, including nutrition and physical activity, to optimize outcomes in the era of targeted and immune-based therapies, alongside comprehensive simultaneous care.