Bone Breakdown: Osteolysis

Osteoclasts and Osteoblasts are bone cells which are responsible for controlling the amount of bone tissue. Osteoblasts form bones whereas osteoclasts break down bones. Osteolysis refers to an active resorption of bones by these osteoclasts. Under this condition, new bone cells are unable to replace old bone cells. Over time, Osteolysis may result in weakening, breaking, or formation of holes in bones. Patients who have undergone a Joint Replacement Surgery are at an increased risk of developing this disorder, since the implants may damage the surrounding bones, resulting in speedy decay of old bone cells.  Cancer may also cause bone loss or abnormal growth of bones. Causes The probable causes for Osteolysis are as follows:

1. Bone Growths, such as, Cysts or Cancers
2. Myeloma or Bone Marrow Cancer
3. Prosthetics used for Joint Replacement Surgery
4. Arthritis
5. Infection
6. Inflammation

Risk Factors The following factors may enhance the risk of developing Osteolysis:

1. Increase in age
2. Men are more vulnerable as compared to women
3. Knee Replacement Surgery
4. Genes
5. Over-weight
6. High-impact exercise post Joint Replacement Surgery

Signs & Symptoms Initially the patient may not suffer from any sign or symptom. However, swelling and breakage of bones may induce pain. The pain may arise slowly or suddenly while walking or carrying out other activities, and may subside by taking rest. Specialist The subject matter expert for Osteolysis is an Orthopedic. Diagnosis The specialist will carry out the following diagnosis to confirm the cause of pain suffered by the patient. History: The doctor will inquire if the patient has undergone any joint surgery in the past. He will also need information about the patient's symptoms and overall health condition

Tests: The doctor may suggest imaging tests, such as, X-Rays, CT Scans, MRI, and PET Scans to take images of bones, tissues around the bone, bone marrow, ligaments, and tendons. These pictures may show thinning and breaking of bones and may indicate tumor or cancer. The specialist may also carry out a Bone Biopsy to check for cancer cells.

Treatment Modalities Available for Management of the Disorder Osteolysis may or may not require treatment. However, it is essential for patients to regularly visit the doctor to inform him about new signs or symptoms. Whenever required, the specialist may recommend the following treatment: Pain Killers & Steroids: The doctor may suggest intake of such medicines to reduce pain and swelling. Non-Steroidal Anti-Inflammatory Medicines:  These medicines help in decreasing pain and swelling. Biphosphonates: If bone loss occurs due to Myeloma, the doctor may suggest Biphosphonates to expedite the process of formation of new bone cells. Surgery: The patient may require a Fracture Repair Surgery if he suffers from a broken or thin bone. During surgery, the surgeon may place rods to hold together the broken bones and may fill the holes caused by Osteolysis with crushed bone or bone-like tissue. The surgeon may also perform a surgery for tightening or replacement of joint implant. Known Complications If left untreated, Osteolysis may lead to further weakening or breakage of bones. It may also cause squeezing of the nerves in between broken bones, resulting in pain or numbness. If the patient has joint implants, then Osteolysis may lead to loosening or instability of the implant. Medicines for treatment of Osteolysis have certain side effects, such as, Headache, Dizziness, Stomach Bleeding, Kidney Problems, and Nausea. Surgery may include complications, such as, Excessive Bleeding, Infection, and Damaging of Tissues or Nerves around the area of surgery. Precautions Patients suffering from Osteolysis should undertake the following precautions:

1. Visit the doctor regularly for a check-up of the bones & implants. Inform the doctor about any new signs/symptoms.
2. Take medicines as suggested by the specialist.
3. Maintain a healthy diet and weight. Being over-weight may increase the pressure on the joints.
4. Avoid activities that may increase the risk of breaking of bones, such as, running and other high-impact exercises.
5. Follow the right exercise regimen as suggested by the doctor.

Prevention of the Disorder from Happening or Recurring One should undertake the following measures to prevent Osteolysis from occurrence or recurrence:

1. Patients who have undergone Joint Replacement Surgery should visit the doctor as suggested to check the status of bones and implant.
2. Post Joint Replacement Surgery, the patient should avoid high-impact exercises and contact sports, particularly jumping and running.

Risk to other Family Members Since Osteolysis is a genetic disease, hence it poses a threat to the next generation. Support and Help given by the Caregiver Patients suffering from Osteolysis may experience pain while walking or carrying out simple daily life activities. Under such circumstances, caregivers should provide ample support to patients and help them in coping with pain & discomfort.