Osteoid Osteoma

  • What is osteoid osteoma?

    Osteoid osteoma is a common benign tumor that can occur in any bone, but tends to affect hips and legs more than other bones. In 7-20 percent of cases, osteoid osteoma occurs in the spine.

    The non-cancerous tumor usually affects patients between the ages of 10 and 30. Boys are twice as likely as girls to develop osteoid osteomas, which can cause extreme pain.

    Your child’s doctor will need to perform several tests to ensure an accurate diagnosis. Osteoid osteoma is often confused with other diseases such as osteomyelitis, Langerhans cell histiocytosis, aneurysmal bone cyst and unicameral bone cyst.

  • Causes

    It is not known what causes osteoid osteoma.

  • Signs and symptoms

    Symptoms of osteoid osteoma include:

    • Sharp pain that is worse at night, when your child is at rest, but is commonly relieved with nonsteroidal anti-inflammatory medications
    • Tenderness
    • A limp
    • Scoliosis

    Osteoid osteoma usually resolves on its own, but it may take time. The disease normally has two long stages:

    • Stage I: lasts 18-36 months and includes acute pain requiring regular analgesics (i.e. aspirin, Tylenol®, ibuprofen).
    • Stage II/recovery stage: lasts three to seven years and includes occasional pain requiring analgesics.

    Drinking alcohol can increase the pain of osteoid osteoma.

  • Testing and diagnosis

    At The Children’s Hospital of Philadelphia, our clinical experts use a variety of diagnostic tests to diagnose osteoid osteoma in children, including:

    • X-rays, which produce images of bones on film.
    • Radioisotope bone scan, which can help located areas of abnormal bone growth.
    • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
    • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to produce cross-sectional images ("slices") of the body.
    • EOS imaging, an imaging technology that creates 3-dimensional models from two planar images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.
  • Treatments

    The pain associated with osteoid osteomas can often be treated with over-the-counter pain relievers such as ibuprofen.

    However, if the pain does not respond to pain relievers, or the patient does not want to reduce his or her normal activities, surgery is the next option.

    Intralesional curettage is generally the recommended treatment for osteoid osteoma. Curettage involves scraping out the bone to completely remove the tumor and filling the space with bone graft material.

    In rare cases where the osteoid osteoma is affecting a bone in or near the spine, surgeons may need to insert a growing rod or other fixation device to stabilize the spine.

    Though surgery for osteoid osteoma is highly effective, we understand any surgery can be a stressful experience for your child and family. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

    Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. See safety in surgery for details about safety protocols at The Children's Hospital of Philadelphia.

  • Follow-up care

    Whether your child had surgical treatment for osteoid osteoma or simply used analgesics and had monitoring, regular follow-up care is important. Ongoing care is recommended until healing has occurred and your child no longer experiences symptoms related to osteoid osteoma. Your child’s doctor will set up a schedule for follow-up visits.

    Follow-up care and ongoing support and services are available at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and referring physicians to provide the most current, comprehensive and specialized care possible for your child.

  • Outlook

    Children with osteoid osteoma have positive long-term outcomes. These tumors generally do not lead to malignant tumors. The recurrence rate is about 10 percent.

Reviewed by John P. Dormans, MD, FACS on May 19, 2014