Fracture prediction in femoral bone metastases

Accurate fracture risk prediction is important, because it is difficult for clinicians to differentiate between high and low fracture risk lesions.

Patients with advanced cancer often develop bone metastases, and in approximately ten percent, these lesions occur in the femur. Femoral metastases may cause pain and can lead to pathological fractures, which severely affect the quality of life. Local treatment of patients with femoral metastases is based on the expected fracture risk: patients with a low fracture risk are treated conservatively with for example radiotherapy to decrease pain, whereas patients with a high fracture risk are considered for stabilizing surgery to prevent a fracture from occurring. Therefore, accurate fracture risk prediction is important. However, it is difficult for clinicians to differentiate between high and low fracture risk lesions, leading to considerable numbers of under and over treatment. To improve fracture risk prediction, we developed the BOne Strength score, or BOS score; a patient-specific finite element (FE) computer model that calculates bone strength based on patient-specific anatomy and bone quality, obtained from CT scans.

Previously, we demonstrated that the BOS score improved fracture risk prediction in patients, compared to current clinical guidelines. The goal of this project is to initiate clinical implementation of the BOS score by determining whether the BOS score aids in fracture risk prediction and treatment decision making for patients with bone metastases in the femur.

Researcher for this project: Florieke Eggermont.