Pathologic Fracture Risk in Rehabilitation of Patients with Bony Metastases

Bunting, Robert; Lamont-Havers, Wendy; Schweon, Donna; Kliman, Allan

doi:10.1097/00003086-198501000-00031

Cited by 42 publications

(25 citation statements)

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“…The occurrence of the lesion resulted in the doubling of compressive strains compared to the control vertebrae with the development of stress concentration at the dorsal aspects of the vertebrae indicating increased structural instability. Retrospective clinical studies have identified defect geometry, destruction of the pedicles, pain, age, anatomic site, lesion type, activity levels and, for thoracic vertebrae, costovertebral joint destruction, as significant risk factors for impending vertebral collapse (Bunting, 1985;Coleman and Stanley, 1994;Fidler, 1981;Taneichi et al, 1997;Weber et al, 2011). Experimental (Whealan et al, 2000;Windhagen et al, 1997Windhagen et al, , 2000 and computational (Tschirhart et al, 2004(Tschirhart et al, , 2006Whyne et al, 2001Whyne et al, , 2003 studies have further established measures of defect size and geometry, defect location within the vertebral body and bone density, to be predictors of vertebral risk of fracture.…”

Section: Introductionmentioning

confidence: 99%

Effect of the metastatic defect on the structural response and failure process of human vertebrae: An experimental study

Alkalay

2015

Clinical Biomechanics

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Section: Introductionmentioning

confidence: 99%

Effect of the metastatic defect on the structural response and failure process of human vertebrae: An experimental study

Alkalay

2015

Clinical Biomechanics

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“…Anatomic site, lesion type (lytic, blastic, or mixed), size, geometry, presence of pain, patient age, and activity level have all been shown to be predictors of fracture risk in retrospective clinical studies (11)(12)(13). However, although pain is the most common presenting symptom of a skeletal metastasis, it is not always present (14), may be unrelated to the metastatic cancer (e.g., degenerative disc disease and facet arthropathy), and is not a reliable indicator of imminent vertebral fracture (15).…”

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confidence: 99%

Noninvasive Prediction of Fracture Risk in Patients with Metastatic Cancer to the Spine

Snyder

Cordio

Nazarian

et al. 2009

Clinical Cancer Research

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Purpose: Skeletal metastases affect up to 85% of breast cancer patients by the time of their death. This prospective in vivo study evaluated the diagnostic performance of computed tomography-based structural rigidity analysis (CTRA) to predict vertebral fracture risk in breast cancer patients with skeletal metastasis and in comparison with the current standard of care. Experimental Design: Torso CT scans of 94 women with vertebral metastatic breast cancer were obtained as part of routine screening for lung and liver metastases. The load-bearing capacity (LBC) and axial (EA) and bending (EI) rigidities of vertebrae T8 to L5 were calculated from CT images. The LBC was normalized by patient body mass index (BMI) to account for height and mass variations. Vertebral fracture risk was also calculated using the current radiographic-based criteria based on lesion size and location. The actual occurrence of a new vertebral fracture was assessed radiographically over the ensuing 4 months. Results: Eleven vertebral fractures occurred in 10 patients. The structural parameters EA, EI, LBC, and LBC/BMI were all 100% sensitive and 55%, 53%, 44%, and 70% specific to predict fracture risk, respectively. Although radiographic criteria correctly predicted all fracture cases (100% sensitive), only 48 of the 236 spinal segments that did not have a fracture were correctly predicted not to fracture (20% specific). Conclusions: CTRA, using CT scans as part of routine screening for lung and liver metastasis, is shown to be as sensitive as, and significantly more specific than, the current radiographic criteria for predicting vertebral fracture in breast cancer patients with skeletal metastasis. (Clin Cancer Res 2009;15(24):7676-83)

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“…Clinical Orthopaedics and Related Research S12 Mirels Bunting et al 2 reported a higher incidence of pathologic fracture occurring in younger patients. Neither Keene et al 9 nor the data from this study, using the scoring system, suggested any significant difference between the ages of the fracture (mean, 57.6 years) and the nonfracture (mean, 60.2 years) groups.…”

Section: Discussionmentioning

confidence: 99%

“…This information was obtained from the orthopedic, radiotherapy, and chemotherapy departments. The records of cancer patients treated at these departments were reviewed and the following criteria applied for sample collection: (1) a known metastatic lesion in a long bone; (2) no fracture or history of fracture through the bone; (3) no previous irradiation to the bone; (4) no prophylactic fixation of the bone; (5) records and roentgenograms available from the time of irradiation; and (6) outcome of the treatment at least six months following irradiation, or until the bone fractured.…”

Section: Methodsmentioning

confidence: 99%

The Classic: Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic Fractures

Mirels¹

2003

Clinical Orthopaedics and Related Research

364

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A weighted scoring system is proposed to quantify the risk of sustaining a pathologic fracture through a metastatic lesion in a long bone. This system objectively analyzes and combines four roentgenographic and clinical risk factors into a single score. Retrospective analysis of metastatic long bone lesions was completed in 78 lesions that had been irradiated without prophylactic surgical fixation. Clinical data and roentgenograms were scored prior to irradiation by independent observers. The outcome identified 51 lesions that did not fracture during the subsequent six months and 27 lesions that fractured within six months. A mean score of 7 was found in the nonfracture group, whereas the fracture group had a mean score of 10. The percentage risk of a lesion sustaining a pathologic fracture could be predicted for any given score. As the score increased above 7, so did the percentage risk of fracture. It is suggested that all metastatic lesions in long bones be evaluated prior to irradiation. Lesions with scores of 7 or lower can be safely irradiated without risk of fracture, while lesions with scores of 8 or higher require prophylactic internal fixation prior to irradiation.

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Pathologic Fracture Risk in Rehabilitation of Patients with Bony Metastases

Cited by 42 publications

References 0 publications

Effect of the metastatic defect on the structural response and failure process of human vertebrae: An experimental study

Effect of the metastatic defect on the structural response and failure process of human vertebrae: An experimental study

Noninvasive Prediction of Fracture Risk in Patients with Metastatic Cancer to the Spine

The Classic: Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic Fractures

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