Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

Abstract

Pathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.