Management of Bone Spurs and Bone Hypertrophy

Introduction to Bone Hypertrophy

Pathological bone hypertrophy may occur in metastatic disease, leading to skeletal-related events (SRE) including pain, fractures, and neurological complications 1

Evaluation should include assessment of pain, neurological risk, and bone instability 1
CT scan is the first-line investigation for bone abnormalities, with MRI recommended when neurological complications are suspected 1
For spinal lesions, the Spinal Instability Neoplastic Score (SINS) helps determine instability risk, classifying lesions as stable (≤6), potentially unstable (7-12), or unstable (≥13) 2
For long bones, the Mirels' score helps assess fracture risk, with scores ≥9 indicating high risk 2, 3

For bone metastases with hypertrophy, antiresorptive treatments (bisphosphonates or denosumab) may be indicated to prevent skeletal-related events 3
Systemic oncological treatments based on primary tumor type should be considered for bone metastases with hypertrophy 1

Persistent pain despite conservative treatment is an indication for surgery 3
Mechanical instability or high fracture risk is an indication for surgery 5
Neurological compromise is an indication for surgery 2
Surgical stabilization for unstable lesions or those at high risk of fracture is recommended 2
Prophylactic stabilization of impending fractures is preferred over fixation after fracture 3

Radiotherapy may be beneficial for bone metastases causing pain or at risk of fracture 2
Cementoplasty for spine metastases provides rapid analgesic effect (within 24-48 hours) 2
Radiofrequency ablation, often paired with cementoplasty, can provide significant pain relief 2

For bone metastases, treatment should be guided by a multidisciplinary tumor board 1

Monitoring for complications of treatment, particularly with surgical interventions, is crucial 3