An assessment of fracture risk was performed, including tumor type, treatment received, duration of disease, tumor size, lesion location, whether the lesion was osteolytic or osteogenic, and whether the lesion caused symptoms. In 1989, Mirelsr8] developed the Mirels scoring system after retrospectively studying 78 long bone metastatic tumor lesions in 38 patients with four variables: location of the lesion (upper extremity, lower extremity, peri-rotor); degree of pain (mild, moderate, severe); type of lesion (osteolytic, osteogenic, mixed); and degree of cortical destruction (<1/3, 1/3 to 2/3 The Mirels score totals 12 points, with a score of ≤7 indicating a low risk of pathological fracture ("%), a fracture risk of 15% at a score of 8, and a fracture risk of 33% at a score of 9. Prophylactic internal fixation should be performed when the score is >9. A study of the repeatability, validity, and applicability of the Mirels scoring system to physicians with different levels of experience and training backgrounds showed that it is highly repeatable and applicable to physicians of different specialties; the greatest variation in pain scores was found among the individual items, followed by the degree of cortical destruction, type of lesion, and location of the lesion; the score had an overall sensitivity of 91% and a specificity of only 35%. Although strict adherence to the Mirels scoring system may lead to some degree of overtreatment, the consequences are more severe once a patient develops a pathological fracture.