The Journal of Bone and Joint Surgery (American). 2005;87:1848-1864.
doi:10.2106/JBJS.D.02942
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

Fibrous Dysplasia

Pathophysiology, Evaluation, and Treatment

Matthew R. DiCaprio, MD1 and William F. Enneking, MD2

1 Schenectady Regional Orthopaedic Associates, 530 Liberty Street, Schenectady, NY 12305. E-mail address: mdicaprio{at}nycap.rr.com
2 Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, 3450 Hull Road, Gainesville, FL 32608

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Fibrous dysplasia is a common benign skeletal lesion that may involve one bone (monostotic) or multiple bones (polyostotic) and occurs throughout the skeleton with a predilection for the long bones, ribs, and craniofacial bones.

The etiology of fibrous dysplasia has been linked to an activating mutation in the gene that encodes the {alpha} subunit of stimulatory G protein (Gs{alpha}) located at 20q13.2-13.3.

Most lesions are monostotic, asymptomatic, and identified incidentally and can be treated with clinical observation and patient education.

Bisphosphonate therapy may help to improve function, decrease pain, and lower fracture risk in appropriately selected patients with fibrous dysplasia.

Surgery is indicated for confirmatory biopsy, correction of deformity, prevention of pathologic fracture, and/or eradication of symptomatic lesions. The use of cortical grafts is preferred over cancellous grafts or bone-graft substitutes because of the superior physical qualities of remodeled cortical bone.


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