Mirels impending pathologic fracture score

Mirels

Sum the Mirels 1989 score for diagnosing impending pathologic fractures in long-bone metastatic disease from four caller-assigned items and return the published 4–12 integer total and band (≤7 / 8 / ≥9). Not an operative order and not SINS.

LIVE $0.005 USDC GET /api/calc/mirels

Markdown: /docs/mirels.md · Canonical: https://magentlab.com/docs/mirels

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

When to use

When an agent has already assigned Mirels 1989 site, size, nature, and pain for metastatic disease in a long bone and needs the published integer sum and band, not a surgical order and not SINS (neoplastic spinal instability).

When not to use

Not a medical device. magent does not read radiographs. Site, size, nature, and pain are caller-assigned.
Not an operative order. Bands ≤7 (le_7), 8, and ≥9 (ge_9) follow Mirels 1989; they are not a surgical command.
Not SINS (Fisher 2010 neoplastic spinal instability). This tool is Mirels 1989 for metastatic disease in long bones.
Pain 3 is functional (pain that is functional), not severe. magent does not interview the patient.

Formula

Mirels = site (upper 1, lower 2, peritrochanteric 3) + size (lt_one_third 1, one_to_two_thirds 2, gt_two_thirds 3) + nature (blastic 1, mixed 2, lytic 3) + pain (mild 1, moderate 2, functional 3); Mirels 1989; sum 4-12; bands le_7 (<=7), 8, ge_9 (>=9)

Citation

Title: Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures.
Authors: Mirels H
Source: Clin Orthop Relat Res. 1989;(249):256-264
DOI: none

Worked example

All minimum grades

Given: nature=blasticpain=mildsite=uppersize=lt_one_third

upper 1 + lt_one_third 1 + blastic 1 + mild 1
Score = 4 (max 12); mirels_band le_7. Not an operative order

Score 8

Given: nature=mixedpain=moderatesite=lowersize=one_to_two_thirds

lower 2 + one_to_two_thirds 2 + mixed 2 + moderate 2
Score = 8 (max 12); mirels_band 8

All maximum grades

Given: nature=lyticpain=functionalsite=peritrochantericsize=gt_two_thirds

peritrochanteric 3 + gt_two_thirds 3 + lytic 3 + functional 3
Score = 12 (max 12); mirels_band ge_9. Not an operative order

Also searched as

Mirels score
Mirels criteria
impending pathologic fracture
Mirels 1989
metastatic long bone score
pathologic fracture scoring
Mirels classification
peritrochanteric Mirels

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/mirels?site=upper&size=lt_one_third&nature=blastic&pain=mild

Full URL: https://api.magentlab.com/api/calc/mirels?site=upper&size=lt_one_third&nature=blastic&pain=mild

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/mirels?site=upper&size=lt_one_third&nature=blastic&pain=mild"

Parameters

Name	Type	Required	Description
`site`	string	required · upper, lower, peritrochanteric	Caller-assigned site (Mirels 1989). upper (upper limb) scores 1; lower (lower limb) scores 2; peritrochanteric scores 3. magent does not read radiographs.
`size`	string	required · lt_one_third, one_to_two_thirds, gt_two_thirds	Caller-assigned lesion size relative to bone diameter (Mirels 1989). lt_one_third (<1/3) scores 1; one_to_two_thirds (1/3–2/3) scores 2; gt_two_thirds (>2/3) scores 3. magent does not read radiographs.
`nature`	string	required · blastic, mixed, lytic	Caller-assigned lesion nature (Mirels 1989). blastic scores 1; mixed scores 2; lytic scores 3. magent does not read radiographs.
`pain`	string	required · mild, moderate, functional	Caller-assigned pain (Mirels 1989). mild scores 1; moderate scores 2; functional (pain that is functional) scores 3. Not severe. magent does not interview the patient.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/mirels Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "nature": "blastic",
      "pain": "mild",
      "site": "upper",
      "size": "lt_one_third"
    },
    {
      "nature": "blastic",
      "pain": "mild",
      "site": "upper",
      "size": "lt_one_third"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/mirels",
  "items": [
    {
      "size": "lt_one_third",
      "components": [
        {
          "value": "upper",
          "factor": "site",
          "points": 1,
          "present": true
        },
        {
          "value": "lt_one_third",
          "factor": "size",
          "points": 1,
          "present": true
        },
        {
          "value": "blastic",
          "factor": "nature",
          "points": 1,
          "present": true
        },
        {
          "value": "mild",
          "factor": "pain",
          "points": 1,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Mirels H",
        "id": "mirels-1989",
        "pmid": "2684463",
        "source": "Clin Orthop Relat Res. 1989;(249):256-264",
        "title": "Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures."
      },
      "formula": "mirels",
      "formula_expression": "Mirels = site (upper 1, lower 2, peritrochanteric 3) + size (lt_one_third 1, one_to_two_thirds 2, gt_two_thirds 3) + nature (blastic 1, mixed 2, lytic 3) + pain (mild 1, moderate 2, functional 3); Mirels 1989; sum 4-12; bands le_7 (<=7), 8, ge_9 (>=9)",
      "max_score": 12,
      "score": 4,
      "mirels_band": "le_7",
      "nature": "blastic",
      "pain": "mild",
      "site": "upper"
    },
    {
      "size": "lt_one_third",
      "components": [
        {
          "value": "upper",
          "factor": "site",
          "points": 1,
          "present": true
        },
        {
          "value": "lt_one_third",
          "factor": "size",
          "points": 1,
          "present": true
        },
        {
          "value": "blastic",
          "factor": "nature",
          "points": 1,
          "present": true
        },
        {
          "value": "mild",
          "factor": "pain",
          "points": 1,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Mirels H",
        "id": "mirels-1989",
        "pmid": "2684463",
        "source": "Clin Orthop Relat Res. 1989;(249):256-264",
        "title": "Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures."
      },
      "formula": "mirels",
      "formula_expression": "Mirels = site (upper 1, lower 2, peritrochanteric 3) + size (lt_one_third 1, one_to_two_thirds 2, gt_two_thirds 3) + nature (blastic 1, mixed 2, lytic 3) + pain (mild 1, moderate 2, functional 3); Mirels 1989; sum 4-12; bands le_7 (<=7), 8, ge_9 (>=9)",
      "max_score": 12,
      "score": 4,
      "mirels_band": "le_7",
      "nature": "blastic",
      "pain": "mild",
      "site": "upper"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	mirels
`formula_expression`	string	Exact expression used
`score`	integer	Mirels 1989 integer sum 4-12. Not an operative order.
`max_score`	integer	12
`mirels_band`	string	Mirels 1989 band: le_7 (score ≤7), 8 (score 8), or ge_9 (score ≥9). Not a surgical order.
`site`	string	Caller-assigned site used (upper, lower, or peritrochanteric)
`size`	string	Caller-assigned size used (lt_one_third, one_to_two_thirds, or gt_two_thirds)
`nature`	string	Caller-assigned nature used (blastic, mixed, or lytic)
`pain`	string	Caller-assigned pain used (mild, moderate, or functional)
`components`	array	Per-factor Mirels 1989 points
`citation`	object	Mirels Clin Orthop Relat Res 1989 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "size": "lt_one_third",
  "components": [
    {
      "value": "upper",
      "factor": "site",
      "points": 1,
      "present": true
    },
    {
      "value": "lt_one_third",
      "factor": "size",
      "points": 1,
      "present": true
    },
    {
      "value": "blastic",
      "factor": "nature",
      "points": 1,
      "present": true
    },
    {
      "value": "mild",
      "factor": "pain",
      "points": 1,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Mirels H",
    "id": "mirels-1989",
    "pmid": "2684463",
    "source": "Clin Orthop Relat Res. 1989;(249):256-264",
    "title": "Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures."
  },
  "formula": "mirels",
  "formula_expression": "Mirels = site (upper 1, lower 2, peritrochanteric 3) + size (lt_one_third 1, one_to_two_thirds 2, gt_two_thirds 3) + nature (blastic 1, mixed 2, lytic 3) + pain (mild 1, moderate 2, functional 3); Mirels 1989; sum 4-12; bands le_7 (<=7), 8, ge_9 (>=9)",
  "max_score": 12,
  "score": 4,
  "mirels_band": "le_7",
  "nature": "blastic",
  "pain": "mild",
  "site": "upper"
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_mirels`	site must be upper, lower, or peritrochanteric; size must be lt_one_third, one_to_two_thirds, or gt_two_thirds; nature must be blastic, mixed, or lytic; pain must be mild, moderate, or functional (Mirels 1989). Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

SINS — Sum the Fisher 2010 Spinal Instability Neoplastic Score from six caller-assigned items and return the published 0–18 integer total. Not later SOSG stability strata and not an operative order.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.