A patient-specific fracture risk assessment tool for femoral bone metastases Using the Bone Strength Score in clinical practice

Florieke Eggermont, Esther Tanck and colleagues of the Radboudumc, together with Yvette van der Linden of the LUMC, developed the BOne Strength score (BOS score): an easy-to-use objective score based on patient-specific computer models. The BOS score helps assessing pathological fracture risk of patients with femoral bone metastases. The score is currently implemented at four hospitals. The first results were published in Cancers on 29 November 2022.

Patients with painful metastases in the femur are at risk of pathological fractures, which are important to prevent to maintain mobility and quality of life. Treatment is usually based on fracture risk: patients with a high risk of a fracture are considered for a preventive surgery, whereas patients with a low risk are treated conservatively with radiotherapy. However, in current clinical practice it appears to be challenging to estimate the fracture risk. The BOne Strength (BOS) score objectively calculates bone strength using a patient-specific computer model that uses CT scans as input. In December 2019, the BOS score was implemented at four radiotherapy centers (Radboudumc, LUMC, Verbeeten Instituut and Radiotherapeutisch Instituut Friesland). In this study, the researchers analyzed the added value of the BOS score for physicians and patients. They did this for the first 42 calculated BOS scores.

Physicians indicated that the BOS score 1) provided objective insight into fracture risk; 2) had an effect on treatment decisions; 3) was reassuring for physicians and patients, and 4) improved multidisciplinary discussions and shared decision making. We concluded that the BOS score is an objective tool to assess fracture risk in femoral bone metastases and aids physicians and patients in making a more informed decision regarding the most appropriate treatment.

Their ultimate goal is to have the BOS score adopted in clinical guidelines and to further implement the BOS score at national level to improve health care for patients with bone metastases.

Publication

Eggermont F, van der Linden Y, Verdonschot N, Dierselhuis E, Ligthert S, Bitter T, Westhoff P, Tanck E. A Patient-Specific Fracture Risk Assessment Tool for Femoral Bone Metastases: Using the Bone Strength (BOS) Score in Clinical Practice. Cancers. 2022; 14(23):5904.