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Hypertrophic pulmonary osteoarthropathy (HPOA)

Hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer.

What hypertrophic pulmonary osteoarthropathy (HPOA) is

HPOA is a group of symptoms that can affect the organs, lungs, bones and joints. It is a rare syndrome, so there is not much information about it. It is also called Bamberger–Marie syndrome or osteoarthropathia hypertrophicans.

In cancer, HPOA can be caused by substances released by the tumour. Or it could be caused by substances the body makes when reacting to the tumour.

Signs and symptoms

The signs of the condition include:

  • swelling of the ends of the fingers (called clubbing)
  • spoon-shaped nails
  • inflammation, swelling and pain in the hands, fingers, knees or ankles

Who might get HPOA

People with lung conditions can get HPOA. It affects about 5 out of every 100 people (5%) with cancer of the windpipe (bronchus) or lung, and up to 50% with pleural mesothelioma.

In cancer, it is most common in people with non small cell lung cancer.

We don't really know why some people with lung cancer get it and others don't.

Symptoms of HPOA

HPOA most often causes inflammation of bones and joints in the wrists and ankles. Sometimes this shows up on bone scans or x-rays. Ankles and wrists can become swollen and inflamed, causing a lot of pain and difficulty with movement.

One of the most common symptoms of HPOA is a condition known as clubbing. This means the fingers and toes broaden at the ends, and the nails curve and thicken.

Clubbing of the fingers is a common symptom of lung and heart conditions. No one knows exactly why clubbing develops but it may be because there is not enough oxygen in the blood.

Treatment for HPOA

Treatments for the lung cancer can help to reduce the symptoms of HPOA.

Painkillers, such as non steroidal anti inflammatory drugs, can reduce the inflammation and help to reduce swelling and pain.

There have been some reports that drugs called bisphosphonates can help to relieve pain in people with HPOA.

Bisphosphonates help to slow the break down of bone. But we don't yet know how well these drugs work in helping to treat symptoms of HPOA.

Coping with HPOA

The symptoms of HPOA can make you uncomfortable and can be very hard to cope with. Your doctors will do all they can to make sure you are as comfortable as possible.

Your doctor or specialist nurse can give you information about your condition.

Last reviewed: 
01 Nov 2019
  • Successful Treatment of ROS1-rearranged Lung Cancer Complicated by Hypertrophic Pulmonary Osteoarthropathy with Crizotinib Therapy
    N. Katsurada and others
    Internal Medicine, 2019. Vol 58: pages 1467-1471

  • Impact of hypertrophic pulmonary osteoarthropathy on patients with lung cancer
    Yu-Hung Fang and others 
    OncoTargets and Therapy 2017:10 pages 5173–5177

  • Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance
    J Callemeyn and others
    Acta Clinica Belgica, 2016, vol. 71, Issue 3

  • Hypertrophic Pulmonary Osteoarthropathy: A Rare But Treatable Condition in Palliative Medicine
    M Pourmorteza and others
    Journal of Pain Symptom Management, 2015 Aug;50(2): pages 263-7

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