Possible Treatment of Heterotopic Ossification


Question

The patient is a 65 year-old male with h/o stage II adenocarcinoma of the colon who underwent partial colectomy 3/2010. The surgery was uneventful. His post-operative course has been complicated by heterotopic ossification in the midline incision. The ossification was first noted approximately 4 months after the surgery and CT scan of the abdomen demonstrated an area of heterotopic ossification within the scar tissue starting just inferior to the xyphoid process an dextending 12 cm inferiorly. The abnormal bone is slightly tender to palpation but is causing no significant symptoms other than generalized distress regarding its presence. The patient has no other metabolic abnormalities. Calcium level is normal, kidney function normal. He takes no medications.

The key findings from my review of the literature are that the cause of heterotopic ossification is unclear, removal of the abnormal bone prior to bone maturation might lead to a higher risk of recurrence, that there may be a benefit to prophylactic use of NSAIDs just after excisional sugery to try to reduce that risk, and that there is no clear role for bisphosphonates in this setting.

I'm wondering if there are any experts who might comment on this condition, and if there are any other suggestions for timing/indications for surgical resection and prophylaxis to prevent recurrence. Joyce Leary, MD

Response

You have done an excellent review of the literature. Other than removing the heterotopic bone there is no proven and safe way to treat the problem. I also think prophylactic treatments to prevent recurrence are unproven and radiation is potentially dangerous. NSAIDs would be reasonably safe in trying to prevent recurrence after surgery but there is little evidence of efficacy. Frederick R. Singer, M.D.