Bone metastases in patients with advanced cancer are very common and cause an increased risk of pathological fracture. Treatment is based on this fracture risk: patients with a low fracture risk are conservatively treated with local radiotherapy to relieve pain, whereas patients with a high fracture risk are considered for stabilizing prophylactic surgery. However, in present clinical practice, it appears to be difficult to differentiate between low and high fracture risk patients, causing a large number of over- and undertreated patients. Therefore, we want to improve the prediction of femoral fracture risk in patients with bone metastases with the use of patient-specific computer models, i.e. non-linear finite element (FE) models.

Our FE models have shown to be promising in an experimental setting (Thesis of Loes Derikx). In my PhD thesis, the computer simulations were validated in patients with cancer and bone metastases. Additionally, the computer simulations were further developed for large-scale clinical implementation. We are currently working on clinical implementation of the FE model, which we now call the BOneStrength score (or BOS score), see website and animation.