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Osteolysis

GENERAL INFORMATION:

What is osteolysis? When one or more areas of a bone wear out and get thin, it is called osteolysis. Osteolysis happens most often to the bones of the hip, leg, rib, spine, and thigh. Normally, old bone cells are replaced with new bone cells over time. Osteolysis occurs when there are not enough new bone cells being made to replace old bone cells. This condition may slowly get worse over time. Osteolysis weakens bones, and may cause holes to form in them.

What may cause osteolysis?

  • Cancer: Bone cancer may lead to osteolysis. Myeloma (bone marrow cancer) may also cause osteolysis.

  • Cancer metastasis: If you have cancer of the breast or prostate gland (in men), the cancer may spread (metastasize). If it spreads to your bones, the cancer can cause osteolysis.

  • Inflammation: Inflammation (swelling) of the area around joints may lead to osteolysis. Joints are the places in your body where two bones meet, such as your knees and elbows. This may happen if you have psoriasis, rheumatoid arthritis, or periodontal disease. Psoriasis causes your skin to swell and become scaly, red, and itchy. Rheumatoid arthritis is painful swelling of the joints in your arms, hands, legs, and feet. Periodontal disease is an infection of the gums and tissue around your teeth. The swelling that is caused by these diseases can damage nearby bones. If you have one of these diseases, ask your caregiver for more information about it.

  • Joint replacement surgery: Your hip or knee joints may be damaged by inflammation, or after an injury. Surgery may be done to replace the bones and tissues of your damaged knee or hip joint with a man-made joint. Implants made of ceramic, plastic, or metal may be used to replace the damaged bone or bones. After surgery, tiny pieces of the implant may react badly to the bone left around it. This makes old bone cells die quicker than they should. Bones will get thin and weak, and the implant put in during surgery may get loose. You may have trouble walking and doing activities, and there may be pain in the area. Weak bones around the implant may break easily.

What increases my risk of having osteolysis? Your risk for osteolysis may increase with any of the following:

  • Age and gender: If you are male, you are at risk of getting osteolysis as you age. Levels of male sex hormones decrease as you grow older. This decreases bone mass (weight and strength of your bones).

  • Hip or knee replacement surgery: Your risk of having osteolysis increases if you have had surgery to replace your hip or knee joint.

  • Genes: You may have been born with genes that increase your risk of having osteolysis. Genes are little pieces of information that tell your body what to do or what to make.

  • High-impact exercise after joint replacement surgery: Avoid high impact exercises, such as jumping and running. It is also important to avoid moving the joint too much right after surgery. These activities can increase your risk of having osteolysis after joint replacement surgery.

  • Weighing more than what is suggested by caregivers: Weighing more than you should can cause problems with your joints. Extra weight increases pressure in your joint, and increases your risk of getting osteolysis.

What are the signs and symptoms of osteolysis? At first, you may not have any signs or symptoms. You will feel pain if your joint swells or your bone breaks. The pain may come on slowly or suddenly as you are walking or doing other activities. Your pain may go away with rest.

How is osteolysis diagnosed? Your caregiver will ask you questions about your health. Tell him when your signs and symptoms started. Tell your caregiver if you have medical problems, or if you have had surgery. Tell your caregiver if you have ever had bleeding in your stomach. Your caregiver will check your joints and bones. You may need blood tests, and one or more of the following:

  • Biopsy: During a biopsy, a sample of your bone tissue is removed and sent to a lab for tests. This may show if your osteolysis is caused by cancer cells. Ask your caregiver for more information about a bone biopsy.

  • X-ray: Pictures of your bones and tissue in your joint are taken during this test. The pictures show thin bones and fractures (bone breaks). More than one x-ray may be taken over time.

  • Computed tomography scan: This is also called a CT scan. This special x-ray machine takes pictures of your bones and bone marrow (tissue inside bones). A CT scan will show if your bones are thin. You may be given dye through a intravenous (IV) tube that is placed in your vein before pictures are taken. The dye will help your caregiver see the pictures more clearly. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish.

  • Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures of your bones are taken. You will need to lie very still during the test. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.

  • Positron emission tomography scan: This test is also called a PET scan. A PET scan can show osteolysis. If you have cancer, this test can show if the cancer has spread to your bones.

How is osteolysis treated? You may not need any treatment for osteolysis. Caregivers may want you to have regular follow-up visits, and to tell them about any new signs or symptoms. Caregivers may suggest treatment to decrease pain and other symptoms. Treatment may also help your bones heal, and prevent more bone damage. You may need one or more of the following treatments:

  • Medicine: Ask your caregiver for more information about medicines that you need to take to treat osteolysis.

    • Pain medicine: This medicine may be used to help decrease or take away your pain.

    • Biphosphonates: This type of medicine may help prevent osteolysis by making new bone cells form faster. You may be given biphosphonates if your bone loss is caused by myeloma. You may also be given this medicine if you have had total joint replacement surgery.

    • Non-steroidal anti-inflammatory medicine: This type of medicine is also called NSAIDs. NSAIDs may help decrease joint pain and swelling. This medicine can cause stomach bleeding or kidney problems in certain people.

    • Steroids: Steroids may be given to decrease joint pain and swelling.

  • Surgery: Caregivers may talk to you about the following surgeries. Ask them for more information about the surgery that you may need.

    • Vertebroplasty: You may need a vertebroplasty if your vertebrae (bones of your spine) have been damaged. During this surgery, bone cement is placed into weak or broken vertebrae. This surgery may decrease your pain, allow you to be more active, and help you stay at your normal height.

    • Fracture repair: You may need surgery if you have a broken bone. You may also need surgery if your bone is thin or weak. During surgery, rods may be placed to hold together broken leg bones. Holes caused by osteolysis may be filled with crushed bone or bone-like tissue.

    • Joint replacement: You may need surgery to replace your hip or knee. If you have a joint implant that has loosened, part or all of the implant may need to be replaced.

What are the risks of having osteolysis?

  • Medicine to treat osteolysis may cause headaches, dizziness, nausea (upset stomach) and muscle and bone pain. With surgery, you may bleed too much, or get an infection. You may have an allergic reaction or infection if cement is used during surgery. Tissues or nerves near the area of surgery may get damaged. If nerves are hurt, you may lose feeling or have trouble moving certain body parts.

  • If osteolysis is not treated when treatment is needed, your bones may get weaker, and they may break. If you have an implant, it may also break. Nerves may be squeezed in between broken bones, causing pain or numbness. If cancer has spread to your bone, it may spread to other areas of your body. Osteolysis may cause problems with joint implants. This can result in pain during sports and activities. The implant may also feel loose and unstable. You may need surgery to fix or replace the implant. If myeloma has caused your osteolysis, the damage to your bones will still be there, even after the myeloma has been treated.

What can I do to decrease the risk of osteolysis getting worse, or causing fractures?

  • Keep follow-up appointments. If you have had surgery to replace a damaged joint, you may need to visit your caregiver often. Your caregiver may do x-rays and other tests to check your bones and your implant. If you have not had surgery, caregivers will see you for follow-up visits. They will ask you about pain, or any new signs and symptoms of osteolysis.

  • Take medicines as ordered by your caregiver. If your osteolysis is caused by cancer, you may need to take vitamin D supplements (pills). Vitamin D may help prevent bones from getting weaker. Ask your caregiver for more information about vitamins or minerals that are right for you. Ask caregivers for information about a healthy diet. You may need to change your diet to get the vitamins and minerals that you need. Ask caregivers for help if you need to lose weight.

  • Do the right amount and kind of exercise. With osteolysis, you may need to avoid activities that increase the chance of breaking bones. Ask caregivers about exercise and sports that should be avoided. If you have had joint replacement surgery, talk to caregivers about the right exercise plan for you. Avoid high impact exercise, such as running, after having total hip replacement surgery.

When should I call my caregiver? Call your caregiver if:

  • You feel pain in your chest, back, hips, groin, knees or legs with sudden movement, or while resting.

  • You have a fever (high body temperature).

  • You get a new skin rash after starting to use a new kind of medicine.

When should I seek immediate help? Seek care immediately or call 911 if:

  • You have severe (very bad) joint pain, which does not decrease or go away after using pain medicine.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.


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