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Hypertrophic pulmonary osteoarthropathy (HPOA)

HPOA is a group of symptoms that include inflammation of the bones and joints in your wrists and ankles, and clubbing of the fingers and toes.

What it is

In cancer, HPOA can be caused by substances released by the tumour. Or it may be caused by substances the body makes because it is reacting to the tumour.

Looking at the meaning of each word on its own can help to understand what this syndrome is:

  • hypertrophic means an enlargement or overgrowth of a body organ
  • pulmonary means the lungs
  • osteoarthropathy is a disease of bones and joints

HPOA is a rare syndrome, so there is very little information about it. Most information is about individual case studies reported in medical journals and text books, which can be difficult to understand. 

Who might get it

People with lung disease 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.


HPOA most often causes inflammation of the bones and joints in your 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.

Another common symptom 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. It may be because there is not enough oxygen in the blood. 


Your doctor is most likely to give you painkillers such as non steroidal anti inflammatory drugs. 

There have been some reports that drugs called bisphosphonates can help to relieve pain in people with HPOA. Bisphosphonates help to slow down the destruction of bone. But we don't yet know how well these drugs work as treatment for HPOA symptoms.

Last reviewed: 
31 Aug 2018
  • Digital clubbing and lung cancer

    K Sridhar and others

    Chest. 1998 Dec;114(6):1535-7.

  • Hypertrophic osteoarthropathy presenting as unilateral cellulitis with successful treatment using pamidronate disodium.

    S Bernardo and others

    Journal of Clinical and Aesthetic Dermatology. 2012 Sep;5(9):37-46.

  • Hypertrophic pulmonary osteoarthropathy as a cue for NSCLC: four cases in the light of the current literature

    M Lommatzsch and others

    Pneumologie. 2012 February; 66(2): 67-73

  • A case of pulmonary pleomorphic carcinoma accompanied by pulmonary hypertrophic osteoarthropathy

    D Ihara and others

    Nihon Kokyuki Gakkai Zasshi. 2011 Oct;49(10):765-9.

  • Pain management in hypertrophic pulmonary osteoarthropathy: an illustrative case and review.

    M Kilaru

    American Journal of Hospice and Palliative Care. 2012 Jun;29(4):302-7.

  • Hypertrophic osteoarthropathy as a clinical manifestation of lung cancer.

    M Davis and others

    Clinical Journal of Oncology Nursing. 2011 Oct;15(5):561-3. 

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