1 Introduction

Benign bone tumors (BBTs), also known as nonmalignant bone tumors, make up approximately 40 % of the skeletal and musculoskeletal proliferative lesions and are generally related to a good survival rate.¹ These tumors may be challenging to diagnose and differentiate between one another due to their similarities, therefore, the need for a complete and clear description of their main characteristics is necessary.¹ The most frequent BBTs are osteochondroma, osteoma, osteoid osteoma, osteoblastoma, giant cell tumor, aneurysmal bone cyst, fibrous dysplasia, and enchondroma.¹ Osteochondromas are the most common, accounting for 30 %–35 % of benign bone tumors. Giant cell tumors account for 20 %, osteoblastomas for 14 %, osteoid osteomas for 12 %, and all others are less common.² The incidence of BBTs is hard to calculate since they are often asymptomatic and difficult to detect.¹ Typically, BBTs arise in people less than 30 years old and are often triggered by hormones that stimulate growth.¹

As far as researchers know, there's no way to prevent BBTs from forming.³ Although these tumors generally do not metastasize, they can still be dangerous as they may grow and compress healthy tissues and lead to poor outcomes. BBTs may present as a lump, swelling, localized pain, or fractures to weakened bones due to the tumor.³ Bone scans and imaging tests such as computed tomography, x-ray, and magnetic resonance imaging may be used to diagnose a BBT.³ Management varies with type of tumor, location, symptoms, and risk of recurrence.² Some tumors such as enchondroma and osteochondroma are typically asymptomatic and generally require no intervention.² Others such as osteoid osteoma can cause symptoms and require surgery or percutaneous ablation.² Also, others like giant cell tumor of bone and osteoblastoma can be aggressive and require surgery and other therapies.² Although malignant transformation is rare for BBTs, all patients should be monitored with serial imaging.²

The Rio Grande Valley (RGV) is an underserved community with a distinct demographic profile that warrants investigation of various health issues. This community has a high prevalence of chronic conditions, such as obesity and diabetes.⁴ This region is also medically underserved, impoverished, and has a large population of undocumented immigrants.^5,6 The machismo construct is another factor that may further contribute to the health of this region as this may deter Hispanic males from seeking medical care due to it being perceived as feminine.⁷ To our knowledge, there are no studies that have analyzed benign bone tumors in this unique community. This study seeks to identify the characteristics of patients diagnosed with BBTs. The principal objective was to evaluate the demographic and clinical characteristics linked to BBTs in individuals from the RGV. We hypothesized that older age and males would have greater frequency of BBTs.

2 Material and methods

3 Results

A total of 89,135 charts were reviewed and a cohort of 108 patients with BBTs was examined between January 1, 2028 and September 4, 2024. This indicates an incidence rate of 0.00018 per person-year. The average age was 38.8 years (SD 24.0), with females representing 58 % (63/108) of the sample. The mean BMI was 28.4 kg/m^2 (SD 7.4), and Hispanics constituted 73 % (77/106). The majority resided in Hidalgo County, accounting for 71 % (53/75), and the UTH Orthopedic clinic was the predominant consultation venue, with 91 % (98/108) of participants utilizing it. The sex distribution regarding various demographics is presented in Table 1. The age-by-sex distribution exhibited a bimodal pattern for younger patients (under 20 years) and those beyond 50 years of age (Fig. 1).

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Fig. 1 Distribution of age by sex. Note both sexes have bimodal distribution. The hollow diamonds represent the median age by sex.

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4 Discussion

A cohort of 108 patients with benign tumors was examined between January 1, 2018 and September 4, 2024. This indicates an incidence rate of 0.00018 per person-year. Current literature states that the true incidence of benign bone tumors is unknown mainly due to the fact that most are asymptomatic and are usually discovered incidentally.⁸ As a rough estimate, they may occur more than 100 times more often than primary malignant tumors of bone.⁸ The American Cancer Society states that about 3970 new cases of primary malignant bone neoplasms were diagnosed in 2023 (2270 in males and 1700 in females).⁹ The estimated population in the United States was around 336 million in 2023.¹⁰ This indicates that the yearly incidence of primary malignant bone tumors in the United States was around 0.00001 per person-year in 2023. A rate 100 times more than this would give a rough estimate of the incidence of BBTs in the United States in 2023, which would be 0.001 per person-year. The incidence rate of BBTs in our study is lower than this 2023 United States BBTs incidence rate. The lack of accessibility to healthcare, lower quality of healthcare, an impoverished population, high number of illegal immigrants, individuals without healthcare, and the machismo construct are all factors that may play a role in decreased diagnoses of BBTs in the RGV.^5–7

The average age was 38.8 years (SD 24.0) with the age-by-sex distribution exhibiting a bimodal pattern for younger patients (under 20 years) and those beyond 50 years of age. The large standard deviation in the average age of individuals with BBTs in our study is due to the bimodal age distribution of BBTs. This does not agree with current literature which states that most benign bone tumors occur before the age of 30.³ This bimodal distribution in our study may be due to the distinct biological processes regulating bone formation and degradation across the lifespan in the Hispanic population that dominates the RGV. Possibly beneficial, future studies should analyze the bone formation, degradation, and overall bone health across a lifetime in Hispanic populations, especially those of South Texas, and compare to other ethnicities to determine if there are any significant dissimilarities.

The mean BMI was 28.4 kg/m^2 (SD 7.4), females represented 58 % (63/108), and Hispanics constituted 73 % (77/106) of our study cohort. To our knowledge, there are no studies that analyze the BMI or ethnicity of individuals with BBTs, therefore our study does not relate to any current literature. This may be because the incidence of BBTs is not truly known due to the fact that most BBTs are asymptomatic and typically discovered incidentally.⁸ Generally, in regard to all BBTs, there is no significant gender predilection, although some tumors such as chordoma and Paget's sarcoma, show a higher prevalence in males.¹¹ Our results do not agree with this as females made up 58 % of our BBT individuals, indicating a higher frequency of BBT in females compared to males. We believe that this is due to the unique culture and environment of the RGV. One important factor is the machismo construct, which may deter Hispanic men from seeking medical care.⁷ The construct of machismo originates from work with men of Mexican-origin and has been used colloquially to characterize all Latino men.⁷ In this construct, traditional beliefs about gender norms, masculinity, and masculine identity are socially constructed and significantly impact behaviors and an individuals' embodiment and perception of what they believe it means to be a man, especially in the Latino culture.⁷ A consequence of this is that male behavior is molded by trying to explicitly avoid behaviors that may be perceived as feminine, such as eating healthy, applying sunscreen, and seeking medical.⁷ If they are not seeking medical care as much as women, they are less likely to have the finding, incidental or not, of a BBT. This could explain the sex distribution in our results.

Most of the individuals in our study resided in Hidalgo County (71 %) with the rest residing in Cameron (28 %) and Starr (1 %) county. These percentages follow the trend of total population in these counties in 2023 with Hidalgo having the greatest population (898,471), followed by Cameron (426,710), and then Starr County (65,934).^12–14 Also, the majority of UTRGV facilities are in Hidalgo County, which theoretically should increase the number of patients seen in this county.

This study has limitations. Data was only collected from UTRGV UTHealth electronic databases, therefore, individuals who sought care at an institution not associated with UTRGV were not considered in this study. Specifically, most of the patients were from the UTHealth Orthopedic clinic (91 %). Therefore, this study may not be generalizable to the South Texas population. The RGV is a medically underserved, poverty-stricken area with a large number of illegal immigrants and individuals without health insurance.^5,6 This patient community indicates that the results of this study may not be universally applied. Most of the patients analyzed in this study were of Hispanic ethnicity, which suggests that our results may not be generalizable to the United States or another nation's population whose ethnical landscape varies from the one in our study.

Future studies should focus on obtaining a larger sample size, including more demographic factors that could play a role in probability of obtaining BBTs such as smoking or previous bone conditions, obtaining data from a less biased population to increase generalizability, and analyzing the various types of BBTs individually.

5 Conclusion

The RGV is a unique region with a distinct set of qualities such as decreased healthcare accessibility and quality, a large number of unemployed and uninsured individuals, numerous illegal immigrants, and being poverty stricken. The results of this study illustrate the need for further studies and policy interventions for this population to better the understanding, prevention and management of BBTs in this population.

CRediT authorship contribution statement

Blake C. Martin: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing – review & editing. Mohammad Khalil: Conceptualization, Validation, Writing – review & editing. Juan Lopez-Alvarenga: Formal analysis, Methodology, Writing – original draft. Michael Sander: Supervision, Validation, Writing – review & editing.

Guardian/patient consent

This research did not involve human participants.

Data statement

The data used in this study was gathered from patient medical charts and can only be obtained by a UTRGV associated individual with prior IRB approval.

Ethical statement

All procedures were performed in compliance with relevant laws and institutional guidelines and have been approved by the appropriate institutional committee. Institutional Review Board (IRB) approval was obtained prior to starting this study. The IRB protocol number is 24–0306 and was approved for our study on 08/21/2024.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.