Many patients suffer from osteoporosis in the bones that weaken them and increase the risk of fracture.

Amir Sternheim

22.09.2017
Many cancer patients suffer from bone metastases that weakens the bones and increases the risk of fracture.

Research
An Israeli doctor has tested software that may help in early identification of this risk:
A 41 year old mother of two small children, contracted cancer that metastasized to the right hip joint, which caused pain in the area. CT imaging showed significant bone loss and increased risk of fracture. She had an appointment for surgery to stabilize the bone, but it broke before the surgery. The woman was hospitalized and the hip replaced by surgery. Four weeks later, the woman returned with news of new pains in her left hip joint. Clinical examination and scans showed that there was also a metastasis that involves the bone and increases the risk of fracture.  Another date for surgery's set.  Two weeks later, on the eve of Purim, the woman came to the hospital and said that the pain had greatly diminished. Clinical examination showed that there was indeed a significant improvement in her condition (the range of movement of the joint was greater and limp diminished), but the scan showed no change. We took a difficult decision and postponed the date of the operation. Four years later, and the left thigh was not broken.

Many cancer patients suffer from bone metastases that weaken the bones and increase the risk of fracture. These are cancerous cells that have disengaged from the tumor and migrated with the circulatory system or the lymphatic system to a distant site, such as the hip bone.  The cancerous cells multiply, grow, and cause bone destruction due to their rapid multiplication.  The weakening of the bone is manifested in pain, impaired functioning, and injury.

Quality of life suffers due to the bones weakness.  The bone may break in everyday activities such as climbing stairs or getting out of bed.  Doctors are now looking for some signs that indicate a high fracture risk:

Where it is a pain that appears every time you put weight on your leg, for example standing and walking.

Risk of fracture increases when the location of the metastasis is in the long bones of the legs, especially in the thigh area, where the loads while walking are very large.

High fracture risk allows for preventive analysis planning (which involves creating a structure that stabilizes the bone). Its purpose is to reduce
pain and return the patient to full function. Patients at low risk for fracture receive pharmacological or radiation treatment.
Today, the decision on preventive surgery is based on clinical testing and visual examination of CT images. However, in many cases, preventive surgery is not performed when necessary or is performed unnecessarily.
For address this problem, custom software was developed (by Prof. Zohar Yosibash and Dr. Nir Trabelsi), that automatically generates a model of the femur from CT scans and assesses the risk of fracture. This software (Simfini) simulates the load on the femur based on the weight of the patient. Using scientific analysis and software contract
Exactly higher the femur strength with metastasis (even compared to the hip bone creation) and consequently the
Risk of fracture. This can save the patient a possible fracture or prevent unnecessary surgery. Similarly, for simulations of structural strength, the patient's bone is treated as a structure with variable material properties.
Loads that simulate daily activities are applied (vertical force, "pressure") on the femoral head, for example, walking down stairs. The information is then assigned to one of four risk levels for fracture, and the report is then given to the surgeon.

The Tel Aviv Medical Center recently completed the first phase of retrospective clinical research, which examined the efficacy of the system on 50 patients; Most of the patients suffered from metastases and received surgery recommendations to prevent fractures in the femur:
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A few have already been operated on as a result of a fracture; In 11 out of 45 patients diagnosed as requiring surgery, the risk of fracture was low and surgery was unnecessary.  In 12 of the 45 patients who refused surgery the software did predict a low risk of fracture in nine of them. In five patients who broke the bone, the hip software did recognize that the risk was increased. This was after initially mistakenly diagnosed as having low risk of break. Now the prospective phase of the study is about to begin using the system in real time as a tool to help make the decision on preventive surgery.

This year, encouraging results of the first clinical trial were presented in the system at two international conferences
(EMSOS), the European company for muscle and skeletal growth
. (ISOLS)
Dr. Amir Sternheim is an expert in orthopedic oncology and head of surgical treatment bone metastases in the National Unit of Orthopedic Oncology at the Tel Aviv Medical Center