Brown tumors presenting with pathological fractures: case series focused on metabolic management

Introduction: Brown tumors are rare benign osteolytic lesions resulting from prolonged primary or secondary hyperparathyroidism. Their clinical and radiological presentation may mimic aggressive bone neoplasms, often leading to delayed diagnosis and unnecessary orthopedic interventions. Case presentation: We report two cases of female patients aged 75 and 65 years who presented with large lytic lesions of the tibia and fibula. One patient developed a pathological fracture, while the other presented with a painful mass. Laboratory studies in both cases revealed hypercalcemia, elevated parathyroid hormone (PTH), increased alkaline phosphatase, and hypophosphatemia. Advanced imaging demonstrated multifocal skeletal involvement and parathyroid adenomas. Both patients underwent parathyroidectomy as definitive treatment. In the patient with fracture, orthopedic surgery was deferred, and spontaneous bone consolidation occurred after normalization of PTH levels. Clinical discussion: Brown tumors may closely resemble malignant bone lesions, which can result in misdiagnosis and inappropriate surgical management. Recognition of the metabolic origin is essential, particularly in elderly patients with lytic lesions. Definitive management with parathyroidectomy often leads to regression of the lesions, underscoring the importance of early diagnosis and metabolic control. Conclusion: Brown tumors should be considered in the differential diagnosis of lytic bone lesions in older adults. Prompt identification and treatment of the underlying endocrine disorder can avoid unnecessary orthopedic procedures and associated complications.