The Evaluation and Treatment of Polyostotic Lesions Andrew J. Rosenbaum, MD Timothy T. Roberts, MD Garrett R. Leonard, MD Matthew R. DiCaprio, MD Investigation performed at the Division of Orthopaedic Surgery, Albany Medical College, Albany, New York COPYRIGHT © 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED » Polyostotic skeletal lesions represent a multitude of non-neoplastic, benign, and malignant conditions. » In children, adolescents, and young adults, chronic recurrent multifocal osteomyelitis, Langerhans cell histiocytosis, polyostotic fibrous dysplasia, and enchondromatosis can present as multifocal skeletal lesions. » In adults, skeletal metastases, multiple myeloma, osteitis fibrosa cystica, and Paget disease can present as multifocal skeletal lesions. » The evaluation of such patients must begin with a comprehensive history, physical examination, and radiographs. » When there is concern regarding polyostotic disease, a bone scan is often of great utility for the identification of all sites of skeletal disease and for monitoring disease progression or regression. T he approach to skeletal lesions has been well described 1-3 . Nevertheless, these lesions remain intimidating to both clinicians and patients. This is particularly true in the setting of polyostotic lesions, which can represent a metastatic process. Although it is imperative to consider this diagnosis, especially in adults, multicentric skeletal lesions can be the manifestation of a plethora of processes, ranging from non- neoplastic and benign conditions to more devastating malignant lesions and meta- static disease (Table I). In order to ensure accurate diagnosis and treatment, ortho- paedic surgeons must be familiar with these conditions and the necessary workup. This article presents the approach to poly- ostotic disease while also reviewing some of the more common conditions presenting as multicentric skeletal lesions. Presentation and Evaluation There are many ways in which patients with polyostotic lesions present to or- thopaedic surgeons. Some patients al- ready will have had imaging studies performed, whereas others are being seen for the first time. Regardless, a thorough history and physical examination must be performed as it is only with the com- bination of a history, physical examina- tion, and imaging that a differential diagnosis can be appropriately formulated. Once a lesion is identified, a bone scan is useful for identifying the extent of skeletal involvement. Although a mul- titude of other imaging studies can be performed (e.g., magnetic resonance imaging [MRI], computerized tomog- raphy [CT]), they are not always indi- cated. Laboratory workup, in addition to Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. | JBJS REVIEWS 2014;2(11):e3 · http://dx.doi.org/10.2106/JBJS.RVW.N.00016 1