In fact, this topic is quite difficult to answer, because once a patient has lung cancer and bone metastasis, it means that the patient’s condition has reached the fourth stage of clinical stage, at this time we actually have to deal with it from many aspects. On the one hand, we have to treat the lung cancer itself, including radiotherapy, targeted therapy, Chinese herbal medicine and immunotherapy, which can play a certain role in certain types of tumors. In addition, the treatment of the metastasis itself, such as pain relief, is the first priority. If a patient is always in a state of pain, the patient’s quality of life and the patient’s psychological state will be very bad. If the metastasis is in certain specific areas, such as the spinal metastasis that leads to spinal cord compression, we may need to take some surgical treatment to release the spinal cord compression, so that the patient can stand up again, or even walk, and of course, some other related help, such as giving him a certain amount of psychological guidance and so on, through these comprehensive means to enable the patient’s quality of life to be improved. The quality of life of the patient can be improved through these comprehensive measures. How to choose radiotherapy and chemotherapy for bone metastasis? In fact, we may have some bias towards radiotherapy in the treatment of lung cancer in the past, because we always think that radiotherapy has a lot of side effects and is only a local treatment, but now we find that simultaneous radiotherapy and chemotherapy is actually a very good choice for lung cancer itself. Firstly, simultaneous radiotherapy is given to the primary lung cancer; secondly, radiotherapy is given to the metastases, such as inside the mediastinum; thirdly, if the patient already has bone metastases, radiotherapy to the metastases is a pretty good choice. If surgery is possible, of course, it can be lifted by surgery, and if drug therapy is possible, drug therapy is also a good choice. In short, whether it is for lung cancer itself, for the primary focus or for the metastases, simultaneous radiotherapy and chemotherapy is a better choice. What is the recommended treatment plan for a patient diagnosed with advanced lung cancer bone metastasis? Firstly, there is lung cancer, and secondly, bone metastasis has already appeared, of course, this treatment is mainly dealt with from two major aspects. First, the treatment of lung cancer itself. If lung cancer has metastases, it means that lung cancer itself has lost the chance of surgery, so conservative treatment for lung cancer itself is adopted, including chemotherapy, radiotherapy, Chinese herbal medicine, immunotherapy, etc. The second is the means of treatment for metastases. For example, we can talk about the use of pain-relieving drugs, including the use of zoledronic acid. Can bisphosphonates prevent bone metastases from lung cancer? To prevent bone metastasis of lung cancer, it is necessary to do the work in advance, to actively detect lung cancer as early as possible and then actively treat lung cancer in order to prevent or slow down the probability of bone metastasis. Can bone-related markers be used as predictors of the efficacy of bisphosphonates in lung cancer treatment? There are many ways to determine the effectiveness of a drug treatment, first of all, whether it can relieve the symptoms, and if it can relieve the symptoms, then the drug should be effective. However, some studies have found that there are some markers of bone biochemistry, such as inorganic components, such as calcium in urine, and organic components, including peptide-bound collagen, or NTX, and some cross-linked collagen and parathyroid hormones. Although there are some studies suggesting that bone-related markers may change during bone metabolism, the use of biochemical indicators of bone metabolism to monitor drug use cannot be recommended at this time, so it is not very valuable for determining the efficacy of drugs at this time. What are the side effects of bisphosphonates and what are the precautions in their use? Bisphosphonates work by inhibiting bone destruction to inhibit bone osteogenesis, which may lead to renal effects, so we must pay attention to monitoring creatinine during use and may need to delay once creatinine is significantly elevated. Another aspect is that some patients may experience damage to the jawbone during use, so we should discontinue the use of bisphosphonates once the jawbone has been damaged during use. Are there any best choices among the first to third generation bisphosphonates? The first, second and third generation bisphosphonates are available for any tumor-related bone events such as advanced age, hypercalcemia, breast cancer, arterial myeloma. However, for lung cancer, zoledronic acid is preferred, which means that zoledronic acid is the best drug for bone metastases caused by lung cancer, and of course, zoledronic acid is also preferred for bone metastases caused by prostate cancer. In addition, as mentioned earlier, general phosphoric acid can be used for patients with severe bone pain, so there are still some different options for different tumors and different bone-related events.