From the Research
No specific treatment is needed for a small bone island as these are benign, non-progressive lesions that typically require no intervention. Bone islands, also known as enostoses, are incidental findings on imaging studies and are characterized by compact bone within the cancellous bone. They are generally asymptomatic and do not pose any health risks. For most patients, simple observation is sufficient, with no need for follow-up imaging unless there are concerning changes such as growth, pain, or other symptoms. If a bone island shows atypical features (such as being larger than 2 cm, showing growth over time, or causing pain), further evaluation with additional imaging like CT or MRI might be warranted to confirm the diagnosis and rule out more concerning conditions, as suggested by 1. The benign nature of bone islands is due to their composition of mature compact bone tissue that forms within the medullary cavity, representing a focus of arrested bone remodeling rather than a true neoplasm.
Some key points to consider when evaluating a small bone island include:
- The lesion is usually an incidental finding on imaging studies, with a preference for the pelvis, femur, and other long bones, as noted in 2
- The characteristic radiographic features of a bone island include a homogeneously dense, sclerotic focus in the cancellous bone with distinctive radiating bony streaks ("thorny radiation") that blend with the trabeculae of the host bone, creating a feathered or brush-like border, as described in 3
- Bone islands are usually "cold" on skeletal scintigraphy, but reports of histologically confirmed bone islands that were scintigraphically active have raised a note of caution about relying on this modality in the differential consideration of lesions otherwise characteristic of bone islands, as discussed in 3
- Accurate identification and multidisciplinary management are of utmost importance, especially in cases where orthodontic treatment is planned, as cautioned in 4 and 1
In general, the management of a small bone island should be guided by the individual clinical situation and the morphological features of the lesion on plain radiography, CT, and MRI, without regard to the lesion's activity on bone scan, as recommended in 3. Simple observation is usually sufficient, and no specific treatment is needed for a small bone island, as supported by the most recent and highest quality study 1.