Mirels Score for Pathological Fracture Risk
Predicts risk of pathological fracture in long bones with metastatic disease (Mirels 1989). Sums 4 features each scored 1–3. Score ≥9 = prophylactic fixation recommended.
Score interpretation
→ Non-operative: radiotherapy (single fraction 8 Gy or 30 Gy in 10#) and bone-modifying agents (zoledronate / denosumab). Continue weight-bearing as tolerated. Repeat assessment if symptoms change.
→ Discuss at orthopaedic-oncology MDT. Consider prophylactic fixation if life expectancy ≥6 weeks AND risk factors present (lower-limb load-bearing). Otherwise palliative radiotherapy + close clinical/imaging review.
→ Prophylactic internal fixation (intramedullary nail / endoprosthesis) PRIOR to radiotherapy. Bone-MDT discussion; consider biopsy if primary unknown. Adjuvant radiotherapy starting ~2 weeks post-op.
Interpretation bands for the Mirels. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Denosumab · Anti-RANKL Monoclonal Antibody
- Pamidronate Disodium · IV Bisphosphonate (Paget's Disease / Bone Metastases / Hypercalcaemia)
- Alendronic Acid (Alendronate) · Bisphosphonate (bone resorption inhibitor)
- Teriparatide · Parathyroid Hormone Analogue (Anabolic Bone Agent)
- Vancomycin (Orthopaedic Bone and Joint Infections) · Glycopeptide Antibiotic
- Gentamicin (Orthopaedic — Bone Cement and Systemic) · Aminoglycoside Antibiotic
- Hip Fracture Management · NICE CG124 / BOA 2020
- Distal Radius Fracture · BOA / NICE
- Ankle Fracture Management · BOA / Lauge-Hansen classification
- Metastatic Spinal Cord Compression · NICE CG75 2020
- Open Fracture Management · BOA/BAPRAS 2017
- OrthoPath: Upper Limb ED Triage · OrthoPath ED Tool — ReviseMRCEM.com
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.