Hypertrophic pulmonary osteoarthropathy (HPOA)

Hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer. It most often causes inflammation of bones and joints in the wrists and ankles. Another common symptom is clubbing of the fingers.

What is hypertrophic pulmonary osteoarthropathy (HPOA)?

HPOA is a group of symptoms that can affect the bones and joints. It is a rare syndrome. It is also called Bamberger–Marie syndrome. 

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.

Who might get HPOA?

People with lung conditions can get HPOA. In cancer it is most common in people with non small cell lung cancer. It also affects people with pleural mesothelioma.

We don't 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 much pain and difficulty with movement.

One of the most common symptoms of HPOA is a condition known as clubbing. This means:

  • the nails seem to ‘float’ instead of being firmly attached to the nailbed
  • the nails form a sharper angle with the cuticle
  • the last part of the finger may appear large or bulging and may be warm and red
  • the nail curves downward, so it looks like the round part of an upside down spoon

Clubbing of the fingers is a common symptom of lung and heart conditions. It is thought that it is caused by vascular endothelial growth factor (VEGF). VEGF is a type of growth factor. Growth factors are chemicals produced by the body that control cell growth. The lack of oxygen in the blood stimulates VEGF.

Treatment for HPOA

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

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

Bisphosphonates can help to relieve pain in people with HPOA whose lung cancer doesn’t respond to treatment. Bisphosphonates help to slow the breakdown of bone.

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.

  • 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

  • Clubbing in patients with fibrotic interstitial lung diseases
    MJG van Manen and others
    Respiratory Medicine, Volume 132, November 2017, Pages 226-231

  • Clinical manifestations of lung cancer

    UpToDate website

    Accessed December 2022

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in.

Last reviewed: 
14 Dec 2022
Next review due: 
14 Dec 2025

Related links