ArticleJournal of the American Academy of Orthopaedic Surgeons. Global research & reviews2020
Mirels Scores in Patients Undergoing Prophylactic Stabilization for Femoral Metastatic Bone Disease in the Veterans Administration Healthcare System.
Article in Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 9 citations in OpenAlex.
- Conventional radiography for the assessment of focal bone lesions of the appendicular skeleton: fundamental concepts in the modern imaging era.Skeletal radiology · 2025Review
- Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025Article
- Physical therapist management and coordination of care to prevent pathological hip fracture from metastatic disease: a case report.Frontiers in rehabilitation sciences · 2024Article
- Denosumab administration for bone metastases from solid tumors: a retrospective cross-sectional study.BMC cancer · 2023Article
- Safety, Precautions, and Modalities in Cancer Rehabilitation: an Updated Review.Current physical medicine and rehabilitation reports · 2021Review
- Predicting Fracture Risk in Patients with Metastatic Bone Disease of the Femur: A Pictorial Review Using Three Different Techniques.Advances in orthopedics · 2021Article
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Authors and funding
5 authors at 1 institution in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
introductionA retrospective review was performed for patients in the Veterans Administration Healthcare System who underwent prophylactic stabilization of the femur for metastatic disease. The goal was to evaluate indications for prophylactic stabilization through Mirels criteria.
methodsAll veterans who underwent inpatient prophylactic femoral stabilization between October 2010 and September 2015 were identified. Procedure and demographic variables were collected by using chart review. Provider notes and radiographs were reviewed to calculate Mirels scores.
resultsNinety-two patients underwent confirmed prophylactic stabilization for metastatic bone disease. Lung cancer and multiple myeloma accounted for most lesions. The mean Mirels score was 10.3 (range 7 to 12). 3.2% of patients had a score of 7, and 6.5% had a score of 8. Most lesions were peritrochanteric (66%) and lytic (85%). There was more variability in size (mean 2.3), with 15% being under one third of bony width and 38% between one and two-thirds. The mean pain score was 2.5; 73% reported functional pain. Of lytic and peritrochanteric lesions (53% of all cases), 55% were less than two-thirds the cortical width and 31% lacked functional pain.
conclusionThis retrospective study of prophylactically stabilized metastatic lesions revealed that more than 90% of patients had Mirels scores greater than 8, suggesting a substantial risk of pathologic fracture. Over half of all stabilized lesions were peritrochanteric and lytic. These criteria alone achieve a minimum Mirels score of 8; however, one-third of these lacked functional pain. Notably, Mirels' original paper found location and type criteria to be the least predictive of impending fracture. Contrariwise, functional pain was the most accurate predictor. Multiple studies have found poor specificity of the Mirels criteria. The high scores achievable by the location and type criteria may represent an overrepresentation of their contribution to fracture risk. Reconsideration of the relative weights of each criterion warrants further examination.
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