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Mirels score

Estimates pathological fracture risk in long-bone metastases and assists decisions between radiotherapy and prophylactic surgical fixation.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Mirels 1989: site/pain/lesion/size 1–3, total 4–12

The 1989 Mirels was developed in metastatic long-bone lesions irradiated without prophylactic fixation, with fractures assessed over six months. The original abstract and later interpretive versions do not necessarily use the same decision cutoff; the edition and corresponding management must be explicit. The total alone does not establish the choice between radiotherapy and surgery.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Lesion site
Pain
Radiographic appearance
Size (fraction of bone diameter)

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Four items, 1 to 3 each: site (upper limb 1, lower 2, peritrochanteric 3), pain (mild 1, moderate 2, functional 3), lesion (blastic 1, mixed 2, lytic 3), size relative to bone diameter (<1/3: 1; 1/3 to 2/3: 2; >2/3: 3). Total 4 to 12.

References

Identifier: escore-de-mirels

Original clinical content: Brazilian Portuguese.

Method version

Mirels 1989: site/pain/lesion/size 1–3, total 4–12

escore-de-mirels@native-2026-10-05+2c1ee6469354

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Lesion site: Upper limb
Pain: Mild
Radiographic appearance: Blastic
Size (fraction of bone diameter): Less than 1/3

{
  "local": "1",
  "dor": "1",
  "lesao": "1",
  "tamanho": "1"
}

Expected result

{
  "score": 4,
  "level": "low"
}

Actual result

{
  "score": 4
}

Case 2

reference-002

Inputs

Lesion site: Lower limb
Pain: Moderate
Radiographic appearance: Mixed
Size (fraction of bone diameter): 1/3 to 2/3

{
  "local": "2",
  "dor": "2",
  "lesao": "2",
  "tamanho": "2"
}

Expected result

{
  "score": 8,
  "level": "mid"
}

Actual result

{
  "score": 8
}

Case 3

reference-003

Inputs

Lesion site: Peritrochanteric
Pain: Functional (with weight bearing)
Radiographic appearance: Lytic
Size (fraction of bone diameter): 1/3 to 2/3

{
  "local": "3",
  "dor": "3",
  "lesao": "3",
  "tamanho": "2"
}

Expected result

{
  "score": 11,
  "level": "high"
}

Actual result

{
  "score": 11
}

Case 4

reference-004

Inputs

Lesion site: Lower limb
Pain: Moderate
Radiographic appearance: Lytic
Size (fraction of bone diameter): 1/3 to 2/3

{
  "local": "2",
  "dor": "2",
  "lesao": "3",
  "tamanho": "2"
}

Expected result

{
  "score": 9,
  "level": "high"
}

Actual result

{
  "score": 9
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

README

Local installation

Code license: Apache-2.0

Guidelines and conditions

This repository’s license applies to the code. Third-party instruments, questionnaires, data and models remain subject to their owners’ conditions.

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

Specific oncological application

Assesses fracture risk in metastatic lesions of long bones. It requires lesion characterization and specialist judgment.

Applications: Metastasis · Adverse effects and safety