Osteoid Osteoma Treatment Options
Understating what is Osteoid osteoma and learning about its characteristics, symptoms, treatment options and management strategies.
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Last updated on 3rd Jul, 2025
Introduction
Osteoid osteoma is a non-cancerous bone tumour that primarily affects younger individuals, causing chronic, dull pain, especially during the night. These tumours do not spread to other areas of the body. It is typically smaller than 1 inch in diameter. In many cases, osteoid osteomas may improve on their own or with conservative treatments such as NSAIDs.
Osteoid osteomas are most commonly found in the long bones, such as the tibia (shin bone) and femur (thigh bone). They can also occur in other parts of the body, including the arms, hands or fingers, feet or ankles, and spine.
What are the Characteristics of Osteoid Osteoma?
The tumour may cause discomfort but does not spread to other areas of the body.
In younger children, it may cause bone deformities or encourage abnormal bone growth, resulting in a larger or longer bone.
It is commonly seen among teenagers and young adults.
The exact cause of osteoid osteomas is still unknown.
Osteoid osteomas typically affect individuals aged 5 to 25 and are more prevalent in men and they are three times more likely to develop the condition than women. However, osteoid osteomas can occur in people of any gender, ethnicity, or race. These tumours represent approximately 10% of all benign bone tumours.
Common Symptoms of Osteoid Osteoma
The primary symptom of an osteoid osteoma is a persistent, dull pain that tends to worsen at night. This pain is not affected by physical activity.
Other potential symptoms include:
Bone deformities
Issues with walking or gait
Joint discomfort and stiffness
Muscle atrophy (loss of muscle mass)
A difference in leg length (especially if the tumour is in the thigh or shin)
Sciatica and scoliosis (if the tumour is located in the spine)
Swelling
If the tumour is near a joint, additional signs may include:
Swelling of the joint (joint effusion)
Osteoarthritis
Joint contractures (tightening and stiffness in the joint)
Diagnosis of Osteoid Osteoma
To diagnose an osteoid osteoma, your doctor will begin by discussing your symptoms and conducting a physical examination. They may ask questions about the pain, such as:
The duration of the pain
How severe the pain is
What, if anything, helps relieve it
Whether you've had any injuries to the affected area
If an osteoid osteoma is suspected, your doctor may recommend several diagnostic tests, including:
X-ray: This imaging test provides detailed images of your bones. An osteoid osteoma usually appears as a thickened area of bone with a small central core.
Three-phase bone scan: This test involves the injection of a radiotracer into your vein. A camera detects the radiation and takes images of the radiotracer in your bones:
The first set of images captures the blood flow in the bone and surrounding tissues.
After two to three hours, another set of images is taken to locate the tumour precisely.
CT scan or MRI: A CT scan provides high-resolution images of the bones and is useful for identifying osteoid osteomas. Although an MRI is less effective at detecting osteoid osteomas, it can help rule out other conditions, such as cancer.
Biopsy: In this procedure, a sample of the tumour is taken for microscopic examination to confirm the diagnosis and exclude other potential conditions.
Blood tests: These tests can help rule out infections that might mimic the symptoms of an osteoid osteoma.
Treatment for Osteoid Osteoma
Osteoid osteomas may sometimes resolve without intervention, although this process can take a considerable amount of time.
For managing symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or naproxen—either over-the-counter or prescription—are commonly used. These drugs help to reduce pain and may also aid in the shrinking of the tumour. Typically, symptoms subside within approximately 30-35 months using this conservative approach. If the tumour persists or causes significant problems, surgical options may be considered.
Surgical Treatment Options for Osteoid Osteoma
While many individuals find relief through NSAIDs, some may continue to experience persistent pain or may not wish to wait for the tumour to shrink naturally. In such cases, surgery could be considered, though it comes with potential risks, including complications from general anaesthesia, infection, bleeding, or injury to nearby tissues.
Surgical intervention is typically advised when other treatments fail to alleviate symptoms or if higher doses of medication are required to control pain. Traditionally, the surgical approach of choice has been open en bloc resection, with reported success rates ranging from 88% to 100%. The aim of the procedure is to remove the entire tumour and surrounding tissue, along with performing local bone curettage.
Radiofrequency Ablation (RFA) for Osteoid Osteoma
Radiofrequency ablation (RFA) is a minimally invasive treatment for osteoid osteomas (OO) and remains the most effective approach. The procedure uses a CT scan to locate the tumour, after which a radiofrequency probe is inserted to deliver high-frequency electrical currents. This heats and destroys the tumour tissue with minimal impact on surrounding tissues. Typically, only one session is needed. The procedure takes about two hours, followed by a short recovery period before the patient can go home with mild pain relief.
Cryoablation Therapy for Osteoid Osteoma
Cryoablation is a treatment that uses extreme cold to destroy tumour tissue. The procedure involves a cryoprobe through which argon gas circulates, forming an ice ball at the tip, which freezes the tumour. After freezing, helium gas is circulated to thaw the ice. Temperatures below -40°C effectively destroy the osteoid osteoma cells. This technique has proven effective for treating osteoid osteomas and osteoblastomas, though larger tumours may need multiple probes to target the entire tumour mass.
Emerging Therapies and Research for Osteoid Osteoma
Transcutaneous High-Intensity Focused Ultrasound (HIFU) is an innovative treatment option for osteoid osteomas. This technique utilises ultrasound waves, typically between 4 and 400 MHz, delivered through an external probe placed on the skin. These waves generate heat, causing the targeted area to reach temperatures between 65 and 85°C. The heat leads to thermal ablation, which destroys tumour tissue and results in coagulative necrosis. This not only alleviates pain but also causes the death of cancerous cells within the tumour.
MRI-guided HIFU has shown success in treating tumours in various organs, including the bladder, prostate, and uterus, by offering real-time imaging for precise targeting. This method presents a promising, minimally invasive approach for treating osteoid osteomas, minimising the need for surgery and offering a more focused, targeted therapy.
Potential Complications of Osteoid Osteoma
Osteoid osteomas, while typically benign, can lead to a range of complications, particularly due to the location of the tumour and associated swelling. These complications may include:
1. Scoliosis: When the osteoid osteoma is located in the spine, it can lead to an abnormal curvature of the spine, known as scoliosis. This condition can affect posture and movement.
2. Bone Enlargement or Deformity: If the osteoid osteoma is present in a smaller bone, it can cause the bone to enlarge or become deformed over time. This can affect the bone's normal function.
3. Joint Stiffness or Deformity: When the osteoid osteoma occurs near a joint, it may lead to joint stiffness or deformity, restricting movement and causing discomfort, particularly when using the affected joint.
Treatment options such as surgery or minimally invasive procedures like radiofrequency ablation can help manage these risks and reduce complications.
Key take away points:
Osteoid osteomas are benign and do not spread to other tissues.
A common symptom is persistent, dull pain, which tends to worsen at night.
The origin of these cancers is not yet well understood.
Some osteoid osteomas may resolve naturally or with NSAIDs.
If necessary, minimally invasive procedures like CT-guided resection and radiofrequency ablation are commonly used to treat this condition.
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