Meningioma and Bone Hyperostosis: Expression of Bone Stimulating Factors and Review of the Literature

Andrea Di Cristofori, Massimiliano Del Bene, Marco Locatelli, Francesca Boggio, Giulia Ercoli, Stefano Ferrero, Alessandro Del Gobbo

Research output: Contribution to journalReview article


BACKGROUND: Several hypotheses have been proposed regarding the mechanisms underlying meningioma-related hyperostosis. In this study, we investigated the role of osteoprotegerin (OPG), insulin-like growth factor 1 (IGF-1), endothelin 1 (ET-1), and bone morphogenetic protein (BMP) 2 and 4.

METHODS: A total of 149 patients (39 males and 110 females; mean age, 62 years) who underwent surgery were included. Depending on the relationship with the bone, meningiomas were classified as hyperostotic, osteolytic, infiltrative, or unrelated. Expression of OPG, and IGF-1, ET-1, BMP-2, and BMP-4 was evaluated by tissue microarray analysis of surgical samples.

RESULTS: Our series comprised 132 cases of grade I, 14 cases of grade II, and 3 cases of grade III meningiomas, according to the World Health Organization classification. Based on preoperative computed tomography scan, the cases were classified as follows: hyperostotic, n = 11; osteolytic, n = 11; infiltrative, n = 15; unrelated to the bone, n = 108. Four cases were excluded from the statistical analysis. Using receiver operating characteristic curve analysis, we identified a 2% cutoff for the mean value of IGF-1 that discriminated between osteolytic and osteoblastic lesions; cases with a mean IGF-1 expression of <2% were classified as osteolytic (P = 0.0046), whereas those with a mean OPG expression of <10% were classified as osteolytic (P = 0.048). No other significant relationships were found.

CONCLUSIONS: Expression of OPG and expression of IGF-1 were found to be associated with the development of hyperostosis. Preliminary findings suggest that hyperostosis can be caused by an overexpression of osteogenic molecules that influence osteoblast/osteoclast activity. Based on our results, further studies on hyperostotic bony tissue in meningiomas are needed to better understand how meningiomas influence bone overproduction.

Original languageEnglish
Pages (from-to)e774-e781
JournalWorld Neurosurgery
Publication statusPublished - Jul 2018



  • Biomarkers/metabolism
  • Bone Morphogenetic Protein 2/biosynthesis
  • Bone Morphogenetic Proteins/biosynthesis
  • Endothelin-1/biosynthesis
  • Female
  • Gene Expression
  • Humans
  • Hyperostosis/diagnostic imaging
  • Insulin-Like Growth Factor I/biosynthesis
  • Male
  • Meningeal Neoplasms/diagnostic imaging
  • Meningioma/diagnostic imaging
  • Middle Aged
  • Osteoprotegerin/biosynthesis

Cite this