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We thank Drs. Munk, Malfair, Rashid, and Torreggiani [1] for their interest in our article [2], “Radiofrequency Ablation of Solitary Eosinophilic Granuloma of Bone” and agree with their comments regarding the importance of careful discretion in patient selection to minimize treatment-related morbidity.

Although posttreatment MRI was not performed in our cases, our colleagues correctly point out that significant medullary and even cortical necrosis and predisposition to possible fracture can be expected with weakening of the bone. We agree that this issue is particularly relevant in our cases because they involved large lesions in weight-bearing bones. Posttreatment rehabilitation for any lesion in a weight-bearing bone should be carefully considered before any therapy is undertaken. The age of the patient and the potential of the bone to heal and remodel are paramount when considering treatment of such lesions. In case 1 of our study [2], the age of the patient (7 years) as well as the presence of cortical buttressing surrounding the femoral diaphyseal lesion required only protected weight bearing until the bone healed. On the other hand, patients with lesions in the weight-bearing acetabulum, such as in case 2 [2], may benefit from the structural support of cement injection. Given that patient's youth (14 years) and potential to heal, protected weight bearing was deemed adequate.

Older individuals, those who have had radiation therapy, or patients with lesions in locations without a robust blood supply may be at higher risk of pathologic fracture and benefit from filling the defect with methylmethacrylate cement or structural bone graft substitute (hydroxyapatite). Obviously, in those at high risk of pathologic fracture, operative intervention may be a better approach.