{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:06:31Z","timestamp":1790845591734,"version":"4.1.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The aim of this study was to investigate if the risk of pathological fracture can be predicted with the proportion of body weight that can be put through the affected leg in patients with metastatic bone disease of the lower limb. A prospective observational study was conducted in patients with metastatic disease in the lower limb. Receiver Operator Characteristic curves were used to identify the optimum threshold level of single stance weight bearing to predict fracture and compared to the Mirels score. Patients who underwent surgery could weight bear significantly less than those who did not have surgical intervention. The optimum threshold to predict pathological fracture was 85% of total body weight. No patient below the threshold level of 85% single stance body weight sustained a pathological fracture. The use of single stance body weight can be a useful in conjunction with the Mirels score to predict pathological fracture. If less than 85% of total body weight can be put through the affected limb, the risk of fracture increases, and consideration of treatment is suggested.<\/jats:p>","DOI":"10.1038\/s41598-019-50636-9","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T10:02:32Z","timestamp":1569924152000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Prediction of pathological fracture in patients with metastatic disease of the lower limb"],"prefix":"10.1038","volume":"9","author":[{"given":"Emma L.","family":"Howard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian L.","family":"Cribb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"key":"50636_CR1","doi-asserted-by":"publisher","first-page":"S138","DOI":"10.1016\/j.injury.2014.10.038","volume":"45S6","author":"A Piccioli","year":"2014","unstructured":"Piccioli, A., Spinelli, M. S. & Maccauro, G. Impending fracture: a difficult diagnosis. Injury. 45S6, S138\u2013141 (2014).","journal-title":"Injury."},{"issue":"8","key":"50636_CR2","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1002\/cncr.22991","volume":"110","author":"F Saad","year":"2007","unstructured":"Saad, F. et al. Pathologic fractures correlate with reduced survival in patients with malignant bone disease. Cancer. 110(8), 1860\u20131867 (2007).","journal-title":"Cancer."},{"issue":"1","key":"50636_CR3","doi-asserted-by":"publisher","first-page":"83","DOI":"10.4103\/0019-5413.143915","volume":"49","author":"MG Agarwal","year":"2015","unstructured":"Agarwal, M. G. & Nayak, P. Management of skeletal metastases: an orthopaedic surgeon\u2019s guide. Indian Journal of Orthopaedics. 49(1), 83\u2013100 (2015).","journal-title":"Indian Journal of Orthopaedics."},{"key":"50636_CR4","unstructured":"Tillman, R. et al. Metastatic bone sisease: a guide to good practice. British Orthopaedic Oncology Society and British Orthopaedic Association, http:\/\/www.boos.org.uk\/wp-content\/uploads\/2016\/03\/BOOS-MBD-2016-BOA.pdf (2015)."},{"issue":"Suppl","key":"50636_CR5","doi-asserted-by":"publisher","first-page":"S230","DOI":"10.1097\/01.blo.0000093849.72468.82","volume":"415","author":"WG Ward","year":"2003","unstructured":"Ward, W. G., Holsenbeck, S., Dorey, F. J., Spang, J. & Howe, D. Metastatic disease of the femur: a surgical treatment. Clinical Orthopaedics and Related Research. 415(Suppl), S230\u2013244 (2003).","journal-title":"Clinical Orthopaedics and Related Research."},{"issue":"3","key":"50636_CR6","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/s11999-015-4453-0","volume":"474","author":"TA Damron","year":"2016","unstructured":"Damron, T. A. et al. CT-based structural rigidity analysis is more accurate than Mirels scoring for fracture prediction in metastatic femoral lesions. Clinical Orthopaedic and Related Research. 474(3), 643\u2013651 (2016).","journal-title":"Clinical Orthopaedic and Related Research."},{"key":"50636_CR7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00003086-198912000-00027","volume":"249","author":"H Mirels","year":"1989","unstructured":"Mirels, H. Metastatic disease in long bones. a proposed scoring system for diagnosing impending pathologic fractures. Clinical Orthopaedics and Related Research. 249, 256\u2013264 (1989).","journal-title":"Clinical Orthopaedics and Related Research."},{"issue":"8","key":"50636_CR8","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1302\/0301-620X.100B8.BJJ-2018-0300.R1","volume":"100-B","author":"EL Howard","year":"2018","unstructured":"Howard, E. L., Shepherd, K. L., Cribb, G. & Cool, P. The validity of the Mirels score for predicting impending pathological fractures of the lower limb. Bone and Joint Journal. 100-B(8), 1100\u20135 (2018).","journal-title":"Bone and Joint Journal."},{"key":"50636_CR9","unstructured":"Sing, T., Sander, O., Beerenwinkel, N. & Lengauer, T. ROCR R package version 1.0-7, https:\/\/cran.r-project.org\/web\/packages\/ROCR\/ROCR.pdf (2015)."},{"key":"50636_CR10","unstructured":"Stevenson, M. et al. epiR R package version 0.9\u201397, https:\/\/cran.r-project.org\/web\/packages\/epiR\/index.html (2018)."},{"key":"50636_CR11","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.bone.2013.10.009","volume":"58","author":"L Anez-Bustillos","year":"2014","unstructured":"Anez-Bustillos, L. et al. Finite element analysis and CT-based structural rigidity analysis to assess failure load in bones with simulated lytic defects. Bone. 58, 160\u2013167 (2014).","journal-title":"Bone."},{"issue":"8","key":"50636_CR12","doi-asserted-by":"publisher","first-page":"e174","DOI":"10.1097\/BOT.0b013e3182809748","volume":"27","author":"R Sivasundaram","year":"2013","unstructured":"Sivasundaram, R. et al. The biomechanical effect of proximal tumor defect location on femur pathological fractures. Journal of Orthopaedic Trauma. 27(8), e174\u2013e180 (2013).","journal-title":"Journal of Orthopaedic Trauma."},{"issue":"1","key":"50636_CR13","first-page":"9","volume":"11","author":"S Gonnelli","year":"2014","unstructured":"Gonnelli, S., Caffarelli, C. & Nuti, R. Obesity and fracture risk. Clinical Cases in Mineral and Bone Metabolism. 11(1), 9\u201314 (2014).","journal-title":"Clinical Cases in Mineral and Bone Metabolism."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-50636-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-50636-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-50636-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T14:12:51Z","timestamp":1671286371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-50636-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["50636"],"URL":"https:\/\/doi.org\/10.1038\/s41598-019-50636-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,1]]},"assertion":[{"value":"29 October 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"14133"}}