From the Research
The recommended treatment for non-aggressive fibrous dysplasia of the upper end of the tibia is typically observation with regular follow-up imaging, with consideration of bisphosphonates or denosumab for pain management, as supported by the most recent study 1. For asymptomatic lesions, a conservative approach is preferred as many cases remain stable without intervention.
- Key considerations include:
- Lesion size and location
- Presence of pain or mechanical symptoms
- Risk of pathological fracture If the patient experiences pain, bisphosphonates such as pamidronate (60-90 mg IV infusion over 2-4 hours) or zoledronic acid (5 mg IV annually) may be prescribed to reduce bone pain and potentially slow disease progression, as shown in studies 2, 3.
- Alternatively, denosumab may be considered for patients with challenging surgical cases, as demonstrated in a recent case report 1. For persistent pain or mechanical symptoms, surgical intervention may be considered, typically involving curettage and bone grafting to provide structural support, as discussed in 4 and 5.
- Prophylactic internal fixation might be recommended if there is risk of pathological fracture, particularly if the lesion involves more than 50% of the bone diameter or is larger than 6 cm. Regular monitoring with X-rays every 6-12 months is essential to detect any progression or complications.
- This conservative approach is justified because fibrous dysplasia is a benign condition with low malignant transformation risk (less than 1%), and unnecessary surgical intervention may lead to complications without providing significant benefit for non-aggressive lesions.