Osteoid Osteoma: Why It Happens & How It’s Treated
What is osteoid osteoma?
An osteoid osteoma is an abnormal spot of bone that does not turn to aggressive (malignant) cancer. They are easily treated. —Dr. Heather Finlay-Morreale
An osteoid osteoma is a small bone tumor that usually occurs on the shin bone (tibia) and thigh bone (femur) or spine, but it can occur in any bone. The tumor is benign, which means it does not spread and isn’t cancerous. It’s not known what causes it.
An osteoid osteoma is smaller than 2 centimeters. They usually occur in children over 4 years old, teenagers, and young adults (under 30). They are more common in boys. The main symptom is severe pain at night. The pain can be treated with over-the-counter pain relievers.
Osteoid osteomas typically disappear on their own over several years, but if pain is severe, a doctor may recommend that it be removed. While osteoid osteomas aren’t harmful, it’s important to see a doctor to rule out other causes of bone pain.
Most common symptoms
The main symptom of an osteoid osteoma is bone pain. You or your child usually just feel the pain in the area where the osteoid osteoma is. The pain is often worse at night and it can be so severe that it can wake you up. If you touch your skin at the location of the pain, you may feel pain or tenderness.
If it is in the leg, you might limp and have weakness in the leg. If it’s in the spine, you may feel tingling or a feeling like an electric shock. Your bone may be more likely to fracture if it has an osteoid osteoma.
- Bone pain at night
- Tenderness when you press a certain spot on your bones
- The pain improves or goes away with over the counter medication, like ibuprofen
Other symptoms you may have
- Spine tingling or a shock-like feeling in your back
- Limping or leg weakness
- Scoliosis (a bend in the spine)
- Joint pain or stiffness near the osteoid osteoma
- Bone fracture
What else could leg pain be? Most commonly leg pain at night is growing pains. This is usually in both legs, mild, and typically improves with massage and acetaminophen. In contrast, osteoid osteoma pain is in one leg, severe and unrelenting, and getting worse. And it does not improve with acetaminophen but does improve with ibuprofen. —Dr. Finlay-Morreale
Who gets osteoid osteoma?
People ages 5-30 years old are most likely to have this but most are found in those aged 5-20 years old. Boys are more likely to have osteoid osteoma than girls.
Osteoid osteoma in children
Osteoid osteoma is more likely to occur in children and teenagers. Your child may complain of bone pain, and pain may be worse at night. You may also notice them walk stiffly or with a limp. They may yelp if you touch a certain place on their legs or back.
Osteoid osteoma may be confused with “growing pains,” which are pains in the arms or the legs. But growing pains are thought to be caused by muscle overuse. Osteoid osteoma pain comes regardless of how much physical activity your child has had.
Osteoid osteoma in the spine may lead to a curve in the spine, called scoliosis. Treatment for osteoid osteoma in children depends on several different factors, including the location of the growth, how much pain your child is in, and whether the growth is causing any abnormalities to the bone.
Ask your doctor: Is this large enough or severe enough that surgery or ablation (burning) of the osteoid osteoma would be helpful? If mild enough that only medication is needed, what medication should I take and what is the dose? Is this at risk of causing a broken bone? —Dr. Finlay-Morreale
If you have pain in your back, legs, or arms that does not go away, make an appointment with your doctor. Take note of when the pain occurs and where the pain is located. Your doctor may order a test or refer you to an orthopedic surgeon. Tests may include:
- X-rays, which may show osteoid osteoma.
- Computed tomography (CT) scan. Some osteoid osteomas—about 1 in 4—may not show up on an x-ray.
- If an X-ray and CT scan are inconclusive, a special bone scan (a radionucleotide scan or a bone scintigraphy scan) may also be used for diagnosis.
What is the treatment for osteoid osteoma?
If you suspect an osteoid osteoma in yourself or your child, make an appointment with your doctor. They can rule out other causes and discuss treatment options. Once the diagnosis of osteoid osteoma is made, you have several options for treatment.
If pain is mild and the osteoid osteoma is not affecting the bone growth, you can likely leave it alone. The pain can be treated with over-the-counter medication like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil/Motrin) and naproxen (Aleve). There are also some prescription NSAID options that are stronger. Osteoid osteomas usually go away on their own over several years.
If pain is severe or is impacting movement, surgery may be needed. In the most common procedure, the center or source of the osteoid osteoma can be burned using radiofrequency ablation and a CT scan to guide the orthopedic surgeon. This procedure is minimally invasive (using tiny incisions) and done under general anesthesia. In rare cases, the osteoid osteoma may require open surgery to remove the affected bone.
Heather Finlay-Morreale, MD is a pediatrician working in primary care. She went to medical school at the University of Cincinnati and completed a residency at Tufts and now is an Assistant Professor at the University of Massachusetts Medical School. She is interested in mental health, mindfulness, wellbeing, and social media. She also chronicles her experiences as a chronic pain patient navigating the healthcare world as both a physician and a patient. Her essays have been featured on JAMA Neurology, Pharos, Psychology Today, KevinMD, Doximity, and the Mighty.