Osteoid osteoma is a benign tumor that consists of osteblastic mass called a nidus that is surrounded by a distinct zone of reactive bone sclerosis. The zone of sclerosis represents a secondary reversible change that gradually disappears after the removal of the nidus.
The nidus tissue has a limited local growth potential and usually is less than 1 cm in diameter.
Osteoid osteomas account for about 10 percent to 12 percent of all benign bone tumors. The males are three times more commonly affected than females. More than 80 percent of the patients are between 5 and 25 years age, and the peak incidence is in the second decade of life. Half all osteoid osteomas occur in the long bones of the lower extremities.
The femoral neck is the single most frequently affected site anatomically.
In the long bones, osteoid osteoma is usually located near the end of the shaft, are often present in the small bones of the hands and feet.
In vertebrae, they are nearly exclusively located in the posterior arch. The primary location in the vertebral body is very rare. Osteoid osteomas occur very rarely in flat bones and almost never occur in craniofacial bones.
Clinical Profile
The most frequently reported symptom is pain of increasing severity that is worse at night, relieved by aspirin and other nonsteroidal anti-inflammatory agents.
If the involved bone is superficial, painful swelling of the adjacent soft tissue may be present. This often occurs in the small bones of the hands and feet.
Scoliosis may occur with vertebral osteoid osteoma.
Imaging
The radiographic features of osteoid osteoma are characteristic and diagnostic. Conventional radiographs reveal a well-demarcated lytic lesion (nidus) surrounded by a distinct zone of sclerosis. A zone of central opacity that represnts a more sclerosis. A zone of central opacity that represents a more slecrotic portion of the nidus and is surrounded by a lucent halo may be present within the nidus.
The intracortical lesions of long bones produce extensive fusiform thickening of the cortex with dense radiopacity that sometimes obscures the nidus.
In many cases, nidus may not be visible, so additional imaging techniques, such as computed tomography, radioisotope scanning, and magnetic resonance imaging, may be necessary to document the lesions.
In vertebral locations, conventional radiographs show increased density of the pedicle, loss of a distinct contour, or both features. The nidus is often not seen on conventional radiographs. Exact anatomic localization of the nidus usually requires computed tomography. Most frequently, the nidus is present in the area of the posterior arch or at the base of a pedicle. In very unusual instances, it is present within the transverse or spinous process.
Different Diagnoses
- Chronic and acute osteomyelits
- Bone abscess
- Intracortical hemangioma
- Bone island
- Stress fracture
- Ewing’s sarcoma
- Intracortical osteosarcoma.
Treatment
Osteoid osteomas has limited growth potential. The majority of lesions are about 0.5 cm in diameter. Some may even spontaneously regress.
The primary treatment is surgical removal of the nidus and some of the surrounding bone by enbloc excision after precise localization of the nidus.
Some of these patients can be managed with prolonged treatment with nonsteroidal anti-inflammatory durgs.
Ablation of the nidus with a percutaneously placed radiofrequency electrode has also been advocated as an alternative approach. This could prove to be valuable where it is difficult to surgically remove the tumor.
13 old male with medial side thigh pain since 6 to 8 months, pt have pain off and on,pain more in nigth, nasid relifed pain , but last 2 mo pian was continue in nigth and morning , xray shoe medial side sclerosis leison near LT, serum alk po4 234. s ca 8.3, other inv normal limit,
@sachin,
MRI?
CT?
ESR?
Hi
my father in law is about 60 years old he is suffering from Osteoid Osteoma with so much pain. please tell me what can we do for treatment of this disease.
thanking you
ARADHANA
@aradhana,
Did you go through the article. I think the article covers the outline of the treatment well.
If yu want to inquire further please let me know.
I suffered from an Osteoid Osteoma on the end of my femur within the hip joint. The pain was unbelievable , especially at night. Surgery would have required a lengthy recovery. I searched all over the internet to find an alternative. Ultimately I discovered that Radiofrequency Ablation was being done at Mass General. I pursued this option and I have been pain free ever since. It was an outpatient procedure and I actually walked out of the Hospital under my own power!
This was 7 years ago and I remain grateful that this option was available.
I searched this topic today out of curiosity to see if there have been any improvements to the availability of this option for treatment and I am disappointed that it is not referenced in more widely available information. Its a shame. It makes me wonder what other medical options have been developed and still remain a virtual "secret"
@Jeffrey Spalt,
There is no secret. Things happen painstakingly slowly when the treatment aspect is a concern.
Good to know it worked for you.
Hi,
I am 26, generally fit and healthy. I was playing basketball and pulled back my middle finger, ring finger and baby finger. At the a@e, they said I fractured my 4th metacarpal, was referred to fracture clinic who then said no fracture but an osteoid osteoma. This is quite painful and a very slow process and the waiting is ridiculous! I'm being referred for an MRI, is this normal? Also can an osteoma be caused by trauma?
Thanks in advance, Joy.
@Joy,
Trauma results in tissue injury. Osteoma is a kind of tumor. Both are entirely different.
Has MRI been done. Can you send me the xray and MRI pictures to contact [at] boneandspine dot com
Dear Sir/Madam,
I am 39years old.Long time back i got pain by heating heavy iron stick.Now i have continious pain on my right thigh middle shaft.Night time it is giving more pain and i went to doctor and did CT Scan,MRI,And X-ray,they are telling it is an osteod osteoma.I did an RFA but still have same pain.My question is it possible to occure this osteod osteoma by heating something?.they are telling i have to do same RFA again.Am I now right way to my treatment?What i can do please tell me.
Thanks
Santo
@Santo,
Yes! Your treatment appears on the right line. If RFA des not work another option is removal by surgery.
my child also suffer in ostiod osteoma inleft leg shaft. he has sever pain in day two to three time. i consult various ortho surgeom. All surgeon advise me take aspirin in two to three time in day.after three month i asked doctor how many day we used aspirin .what is the useful advise. Doctor advise me surgery.
Osteoid osteomas are known to regress with time. However, if pain is not being relieved or it is affecting activities of daily living, surgery can be considered.
I was recently diagnosed with an atypical osteoid osteoma in my lower femur (there was no nidus present). My ortho oncologist plans on following me for a while to see what happens. The pain was horrible before my biopsy. I had a wide excisional biopsy to rule out chondrosarcoma. The pain after the surgery was much better, after recovering from the surgery itself which was aweful. I still hurt at times, but nothing like it was before. NSAIDs seem to work pretty good.
@Chris,
Good to here that you were relieved of the ailment.
Dear Doc,
Recently my wife was diagnosed to be suffering from osteod osteoma in hip joint area & also with vitamin D defficiency. She is having trouble walking. Pl suggest what should we do & which is the ideal place for treatment. Is the problem permanently curable by surgery or RFA.Pl help with your suggestions
@rajesh,
Both surgery and RFA are effective. The best place of treatment would a center with experience in musculoskeletal cancer surgeries.
I have a small bone growth in my forehead. I cannot find any surgeon to remove it.Please help
@Diana,
Please ask your local health care provider
Hey,
I have being suffering with a ankle problem for 7 years, I've had 4 MRI scans, many X-rays& key hole surgery as well as many sessions with a physio therapist. After my 4th MRI scan they now suspect I have osteod osteoma. It is possible to be suffering with this for 7 years? I have researched all the symptoms and I have had most of them. If I do have osteod osteoma and it's been going on for this long could it be more difficult to cure?
I look forward to you reply
Many thanks
Erin
@Erin lewis,
Osteoid osteoma needs either surgery or ablation. Did you discuss it with your treating doctor.
Dear Sir/Madam,
My son is being diagnosed having osteoid osteoma in his right leg just below the knee joint, he is 6 yrs old, he is being given vitamins and pain killers and under observation for next 15 months. My wife and parents are suggesting to go ayurvedic treatment in sri lanka. Please tell me what is the best possible treatment, will he suffer in the long run, he is only 6 years, what would be his future?? please help
Thank you very much.
@B K Perera,
I cannot comment on Ayurvedic treatment. Osteoid osteomas are known to resolve spontaneosly and that is why you might been asked to wait while your child is put on symptomatic treatment.
Best thing now is to wait.
Dear doctor..
i am having pain in my right knew from last 3 weeks..it occurs mostly in the night and the pain is very strong.. i had my knee surgry done about 4 years ago and the bone tumer was removed with the lazor in orthopedic hospital….i have been to my doctor and he adviced me to take asprine..and if the treatment is done once.. why does it come back again ??
@RAY,
What tumor was removed?
Osteoid osteoma?
Hello
am 25 years old male
i have diagnosed with osteoid osteoma in the lower quarter of the femur
i dont want to do the surgery
and thereis not ablation in my country
could i stay like that
if there is just a little pain wich i can bare
please give me the ansower
@fuad,
Most of them spontaneously resolve. You might want to wait if you could bear the discomfort or manage with symptomatic treatment.
Dear Dr.Singh- My son who is now almost 14 is going through his second bout with an O.O. that initially occured in the L5-S1 juncture. He is experiencing unbelievable pain that predictably worsens even more @ night. The first time this tumor occured it took over 4 months of tests & misleading diagnosis (he had developed a 7degree scoliosis of the spine) & went through a nightmare of being told by 2 MD's that he should not be in the amount of pain that he was reporting. Thankfully we were seen by Dr. Frank Gerow, MD who was able to diagnose my son with 1 examination & a thin-slice CT of the area.(Tx.Children's Hosp.,Houston, Tx.) It took another 2 months to find an Interventional Radiologist who was willing & able to do the RF ablation procedure in Feb.2010. My son was pain free til the recurrance in the last 2 mo. We are awaiting a surgical date for the 2nd RF ablation. Due to my son's age, it seems doctors have been reluctant to treat his pain & anxiety appropriately until surgery. (He is 5'6" & now weighs 180# due to his inability to be mobile.) Thank you for putting good info out for research. Do you think that this tumor will keep recurring?
@Niki W.,
Recurrence can occur and usually the second procedure provides complete cure.
If still it recurs, the tumor should be removed surgically.
All the best.
my son is suffering from osteoid osteoma neck of femur (Lt -intra articular) from 2005. the size is around 1cm. Initially he had lot of pain. Now no pain. As per the latest CT the size is same. He plays bascketball and can run for long distance (5 Km). What should we do. I want to know that this OO remains benign or it becomes malignant?. If it gets cured on its own than after how many years approx. Since physical excision is complicated in this case, for RF ablation also requires drilling through bones or what?. If yes than how much time required to heal. I eagerly waiting for the reply. Thank you.
@vageesan R,
Would you please ask your query at http://boneandspine.net
That way we can discuss over a longer period of time, and discuss all the options and concerns.
I was diagnosed with this osteoma on the side of my skull. The hospital consultant said it was nothing to worry about and removal would only be cosmetic and shaving some of my long hair off. He said, if it wasn't causing any pain, not to worry about it. I have read that osteoma is benign. But that could change to malignant right??
Yes! But then risk is with every living cell. Just watch it and if there is a pain or sudden increase in the size, seek consultation. Otherwise be in regular followup with your doctor.
I was suffered from Osteoid Osteoma for which I had undergone a surgery in april 2011,but their is no relief from pain,again I have repeated CT & MRI scan last week,but nidus was not seen in it,now what to do? Are their any other tests?Whether I should prefer RFA? if yes then please mention me best centre of RFA in India which should also be cost effective to me,and whether mediclaim can be received against RFA. Please suggest….
@Manoj,
If the nidus has been removed, I do not think there is need to worry.
But as the area involves the skull please consult your doctor if RFA is applicable to that part.
I would look at info on RFA centers in India and would let you know.
I had a bone swolen on d lower part of my left leg b4 d ankle since 1996, almost 16yrs. which i dont count it as anything, until lately wen it startd increasing up to lime size and just last week i went for an x-ray and they detected oestoid oestoma. Pls doctor, since the pain is not severe, can my takin aspirin only everyday bring total cure? Wat else can i use that wil melt the growth or that wil make it com back to normal. Tanx
@Adey,
Osteoid osteomas are known to remit with time. Just keep a watch and take symptomatic medication for few years if it is possible.
My nephew is 17. He have been in pain on and off for 4month, CT telling he had a 4mm Osteoid Osteoma in the neck of his left femur. He would like to go through the operation to remove the tumor in order to get rid of the pain. He is busying in basketball training. How long is it going to put him in bed after the operation if it is successful? thank you.
@Lucia,
It would depend on the size of lesion and sugery done. Because it is a wt bearing joint I expect 6-8 weeks of rest. But ultimate answer would be given by your treating doctor.
Hi! i have had osteoid osteoma for three years. My only suggestion is that if your a parent and you care about your child's health and happiness you will get a surgery as soon as possible. Waiting it out is a painful experience and i understand that you may be in a tough financial situation but there are options you should explore before settling with waiting it out.
Hi! Friends , I was suffered from osteoid osteoma in my tibia,for which I undergone a surgery which was unsuccessful,then I opted CT Guided RFA (radio frequency ablation) to cure this last month,which was successful,now I am painless and having good sleep.
I suggest all the patients to opt CT guided RFA,which is short and painless procedure.
hi,
i am suffering frm oseoid osteoma from about 1 year.at first i was not knowing about this.and then after somedays it started paining.i went through x ray of my right hand radius …but in x ray it didnt showed clearly ..aftr the suggestion of a doctor i went through a mri…….and the mri report stated that i having tumor but then i went through fnac test and came 2 know that its not tumor…..aftr that i went for a bone scan test in which i came to know that its osteoid oestoma…doctors told me that i have 2 go through a surgery…bt as i in military feild so i am looking for a beeter treatment rathar than surgery…i am also havinh some homeopathic medicine…bt no improvement is till now seen…plz suggest me some beeter treatement.
@aditya,
There are only following options available
1. Wait and watch while you take medicines to kill your symptoms. Quite few of the OOs disappear after few years
2. Surgery
3. Radiofrequency ablation
You can talk to your doctor about each for yout particular case context
Hello Doctor,
I am suffering from OO. Its been over 2 years now and just 2 months back when it got detected, I am doing certain exercises to get over the tumor.
I had a doubt regarding this, can the tumor be cured naturally?I mean without doing anything or by doing any exercises.
P.S. The exercises have been mentioned by a doctor (a specialist)
Thanks
@hiren,
OO resolves in some cases with time. If it is not troublesome, you may opt for wait and watch.
My son was diagnosed with an osteoid osteoma on the anterior face of the sacrum, one on the base [top ] on the right side and one in the first foramen of the sacrum. Thermal ablation worked for the one on the base, but doctors at Texas Children's Hospital refuse to do ablation or surgery for the one on the first foramen because of the spinal nerves tracking through that opening. The first diagnosis was at age 11, now he's 16 and has significant pain at night, especially when we get a cold front. Use of NSAIDS has given him terrible gastro-intestinal problems [he's currently bleeding internally and in process of being treated for ulcers]. Do you have any advice for treatment or removal?
I'm feeling very anxious about his future. Do osteoid osteomas burn themselves out? Should we investigate RF ablation? Is it any safer than thermal ablation?
Help! Thanks!
@Ruth,
Osteoid osteomas are known to regress with time but the may not occur in all the cases.
I think sufficient time has passed to wait for regression.
Surgical removal is another option which can be considered.
Hi, I am 18 years old and I have osteoid osteoma in my thigh and it causes severe pain in my foot and calf. I have had it since I was a child and it reoccurs every 6 months or so. It is so severe it gets me out of bed and nothing relieves the pain. It brings me to tears and I have a relatively high pain tolerance. What should I do??
@Ashley Geiser,
Osteoid osteoma is treatable. What has your doctor suggested?
i recently had a sergical operation for the treatment of osteiod ostema but my night pain are back after i had sergical operation i had relief for 15 days but at 16th day my pain are back mr.dr i want to know that does osteiod ostema reappear after sergical operation if not why my night pain are back but pain last for short hour before operation.
@sujan bhusal,
Usually not if the nidus has been removed.
How are you now?
hi,
i am a 17 year old boy and i am suffering from osteoid oestoma in my right hand's ulna from 2 years …earlier i was not knowing about this but once it started pain and then got my x-ray done but nothing was clear from that and then with the reccomendation of an orthopaedic i got my m.r.i and bone scan done…..and the m.r.i report stated that i am having bone tumor but the report was wrong when i got my F.N.A.C test done…plz suggest me some treatment irrespective of operation or surgery……
@aditya,
Osteoid osteoma is a bone tumor. What was declared wrong in FNAC..
Hi Dr. my leg was hurting me i made an x ray and CT some doctors told me it is a osteoid osteoma and some told me it is not am confused and i don't know if i have to make an operation or not kindly help me.
@Danial,
First thing is to be sure as what the condition is. You may seek another opinion. biopsy and so on. One cannot contemplate surgery without a definitive diagnosis.
I am kishor from pune
since last 3 months i have pain in my hip joint
in MRI and CT scan
i founf that osteoid osteoma is there
surgery is critical for removal of osteoid osteoma doctor said joint has to be dislocate so it is risky
i got info about RF it is easy way than surgery
can i do RF ablation
help me plzzzz…
@kishor,
it would depend on site and size of the lesion.
I am kishor from pune
since last 3 months i have pain in my hip joint
in MRI and CT scan
i founf that osteoid osteoma is there
surgery is critical for removal of osteoid osteoma doctor said joint has to be dislocate so it is risky
i got info about RF it is easy way than surgery
can i do RF ablation
help me plzzzz…
I have a 1cm osteoid osteoma on my femur. My doctor suggested that only surgery is an option and RFA is not a solution. Could you recommend any hospital or surgeons providing RFA in Bangalore.
Thanks
Reshma
@Reshma,
I am sorry I am not aware of centers in Banglore. A search with local medical community would help.
hi i m gurpreet i was having pain in my right hip joint doctor advised me to get X ray done. In X ray report a small lytic lesion was detected in my one third proximal of my right femur. subsequently MRI CT and Bone scan was done but ailment is not diagnosed yet. my all reports indicates lytic lesion of 2cm in size in diaphysis of my right femur . it is eccentrically located and is epicentred predominantly in intra meduallary region with cortical extension causing thinning and breach of cortex(as in MRI report). after that biospy was done twice , bone tissue processed was non representative of any neopathlogy evidence. plz suggest me right path.
@gurpreet singh,
If it is a benign lesion as you suggest, curettage and bone graft is one the methods to be considered. That way whole tissue can also be removed for examination.
hello sir i m Gurpreet Singh i was having pain in my right hip joint doctor advised me
to get X ray done. In X ray report a
small lytic lesion was detected in my
one third proximal of my right femur.
subsequently MRI CT and Bone scan
was done but ailment is not
diagnosed yet. my all reports
indicates lytic lesion of 2cm in size in
diaphysis of my right femur . it is
eccentrically located and is epicentred
predominantly in intra meduallary
region with cortical extension causing
thinning and breach of cortex(as in
MRI report). after that biospy was
done twice , bone tissue processed
was non representative of any
neopathlogy evidence. plz suggest me
right path.
@gurpreet singh,
Was it a open biposy or through a needle?
sir my bro is suffering from this in rip hip femur . plz tell me what we do . its size is 8.8 mm . . . plz send me your email address
@Talha Jamal,
contact [at] boneandspine.com
I went for a second opinion and the doctor diagnosed it as bone island. Since I have mild pain near the hip joint he wants to wait for a few months and if the pain is more to remove it. As bone islands are generally not supposed to be painful, is there instances of them causing pain and is the surgical removal only option available ?
Thanks
Reshma
@Reshma,
Bony islands are not painful in general sense but some of them have been known to cause discomfort after exertion.
If your second diagnosis is right, all you need is symptomatic treatment. But make sure your diagnosis is right.
Hello, I was diagnosed with an Osteoid Osteoma on my right thigh bone in 2009 when I was 25, and suffered a few times a week. The pain was bad, but motrin or advil always did the trick. My Dr said that most burn out within 24 months, and last year, I noticed the pain was gone. I was so relieved. I am now 18 weeks pregnant with my 1st child, and have been having DAILY O.O. pain since about 6 or 7 weeks. I have been taking Tylenol but hate to do that on a daily basis. The pain now seems to "spread" to my knee, and while Tylenol works, I dont want to be dependent on it. I refused to have an x-ray or surgery while pregnant, but will definitely look into treatment after the birth of my child. My question is…does pregnancy tend to cause an O.O. to come back? I believe mine was gone, or almost gone, and now it seems like its back, with a vengeance! Thanks so much.
@Annie,
I do not think there is a known relation between the two.
How are you now?
I was fist diagnosed with osteoid osteoma some 5years back, when my daughter was born, when she was diagnosed with a large PDA, i totally forgot my pain, looking at the pain suffered by my daughter, looks like the pain has recurred, i dont want to get into surgery, as i am self employed and running, taking care will be a difficult one. Can i get some non-surgical treatment available in bangalore, can this be covered under insurance. Too much of pain killers are also a scary, as i underwent surgery for kidney stone 2 yrs back. I am 40years old.
Radiofrequency ablation is another option. Whether it is available in your place or not would need to be searched. Coverage by insurance would depend on type of insurance you have.
Hie i am 26 years old in Zimbabwe & was diagnised with osteoid osteoma on the middle of the femur. My doctor however advised me not to take any treatment. Is this safe. The pain is not increasing.
@Happiness,
Every procedure does carry a risk and you need to discuss it beforehand if there is any concern about complication etc.
Hello Dr., I am 43 years old, underwent total abdominal hysterectomy 1 year ago.. My CT scan result states that Multiple axial tomographic sections of the right tibia were obtained without contrast. There is a small, round, well-circumscribed, lesion eccentrically located within the medulla of the proximal tibia with a central hypoechoic nidus and a thick sclerotic rim. It measures 1.2 x 1.1 x 0.9 cms. (LxWxD). The surrounding bony parenchyma is intact with no surrounding reaction noted. Conclusion was OSTEOID OSTEOMA, PROXIMAL TIBIA, RIGHT… The Dr. advice me to take Perispa, Osteo D & Arcoxin and to have follow-up check-up after 2 weeks for possible biopsy. I can't feel pain when in sitting position but when I stand up, that's the time I feel the pain some part in my right knee.. After taking in the medicine, I can't feel better.. May I ask if there a medicine or alternative not to have surgery? Please help me.. Thanks for this site
Osteoid osteomas can go on their own in number of cases. You may want to wait while avoiding painful activities, if that does not put you under much stress.
My younger brother developed pain in right leg , above knee joint 18-24 months back and after CT scan/detailed investigation by an orthopedic surgeon , the disease was diagnosed as oestoid osteoma. At present he has been recommended pain killers only and is experiencing severe pain almost regularly.
We have been told that the only possible permanent treatment is surgery but after some research on internet, i have read that treatment for this Bone Tumor(oestoid osteoma) also exists through RF ablation which is safer and is considered more successful mean of treatment.
We are confused that should we opt for surgery at the first place or prefer RF ablation first ?
also if the treatment facility for its cure through radio frequency ablation exists in Pakistan or where else can we get the treatment.
Thankyou
Where i s the tumor located?