Diseases of bones and joints are not as simple as they seem at first glance - they have a wide variety of causes. These diseases occur at absolutely any age, only the forms of manifestation differ. In young people, inflammatory diseases usually predominate: osteomyelitis and arthritis - affecting bones and joints, respectively. Their course is rapid - the processes of tissue destruction occur in a short time.

In contrast, adults and older people develop diseases associated with many years of “exploitation” of the skeleton. At the same time, bone and cartilage tissue loses its former strength and flexibility, which leads to their gradual destruction under the influence of load. The result of this process is the loss of compact bone substance, or arthrosis - a disruption of the normal structure of the joint.

There are also congenital and tumor diseases that can occur in a person at any time in life. If the symptoms slightly limit daily activity, then there is absolutely no need to see a doctor. But any pathology always has a progressive course, so you need to be able to suspect it and treat it in time.

Bone diseases

The basis of any disease is a violation of the main qualities of bone tissue - strength and flexibility. It seems to many that bone consists only of durable minerals, while having a “stony” density. In fact, most of it is occupied by connective tissue, which includes the minerals calcium and phosphorus compounds. They are balanced in such a way that excessive fragility is not created, which would contribute to the development of many fractures. Bone diseases lead to disruption of this stability, developing in two ways:

• During inflammation, metabolic processes are disrupted - immune cells enter the bone through the bloodstream, causing the development of edema. A large number of aggressive substances begin to destroy connective tissue, which immediately begins to transform into purulent masses.
• In the absence of inflammation, the mineral composition changes due to the activation of bone “self-destruction” processes. It contains special cells that perform the opposite work - formation or destruction. When the latter begin to predominate, signs of the disease appear.

Osteoporosis is the dominant pathology of the musculoskeletal system, becoming a real threat for elderly and senile patients.

Osteoporosis

The name of this pathology literally from Greek means the formation of holes in the bone. But in fact, no “pores” appear there - all changes occur at the microscopic level:

• Bone tissue is not solid, but has the form of beams or crossbars along which two specific types of cells move.
• Some are synthesizers; they continuously connect mineral salts and connective tissue with each other, forming strong complexes.
• Others are destroyers, their job is to destroy old or improperly constructed crossbars. They carry out this process continuously, so they can “accidentally” destroy a normal beam that gets in the way.
• Normally, the first cells always work harder, which prevents the “destroyers” from thinning the bone tissue.
• With age, this ratio begins to gradually decrease, and the second cells do not lose activity, continuing to work intensively.
• As a result, a loss of basic bone substance develops, which sharply reduces their resistance to stress and damage.

Since the pathology develops over years, its first sign will be a fracture that develops with minimal trauma. Therefore, for older people, even a simple fall can become deadly. The disease is detected by comparing bone density with a standard on an x-ray.

Treatment of this disease is long-term and ineffective, so the main emphasis is on prevention - good nutrition and an active lifestyle.

Osteomyelitis

Inflammation of the bone tissue is accompanied by vivid symptoms - fever occurs, the limb becomes painful and hot to the touch. If the lesion is located close to the joint, then you can observe swelling, redness and impaired mobility in the joint. Bone inflammation occurs as a result of the following reasons:

1. With closed fractures, fragments can form, which become inflamed if the plaster is applied incorrectly. The process develops without the participation of microbes - by this measure the immune system tries to destroy dead tissue.
2. Everything happens differently with open fractures, when various bacteria can get inside through the wound. Finding themselves in closed and warm conditions, they begin to multiply intensively, causing the formation of an abscess.
3. In traumatology, operations using knitting needles or rods are now widely used to fix fragments. If sterility or care techniques are violated after surgery, microbes also penetrate through wounds on the skin.
4. can form without damaging the bone - in this case, bacteria are carried through the bloodstream. With ulcers of a different location or blood poisoning, microbes may be introduced into the bone tissue, where ideal conditions are created for them.

The disease often occurs latently, when there are no local symptoms in the form of redness, pain and swelling in the area of ​​the abscess. The patient exhibits only fever and sweating, which slightly limit his activity. Meanwhile, the abscess does its dirty work, destroying bone tissue.

Treatment of inflammation is always surgical - the abscess is opened and pathological discharge is removed, after which a course of antibiotics is given.

Tumors

Development combines both pathological processes, combining inflammation and “self-destruction.” Tumors vary in aggressiveness and growth rates, which determines how quickly symptoms occur. Therefore, the disease is divided into two groups depending on the source:

• In the first case, the neoplasm comes from its own tissues - bone, cartilage or connective tissue. This form is considered benign and is also slow growing. The only unpleasant symptom is that the tumor quickly leads to a change in the shape of the bone.
• In the second case, the neoplasm has the nature of metastases, the source of which is in another organ. This complication is typical for cancer of the genital organs (prostate, ovaries and uterus), as well as for leukemia. Since metastases grow very quickly, another clinic takes first place - unbearable pain.

To identify lesions, X-ray methods are used to assess the location and size of the lesions. Then the optimal tactics are chosen: surgical removal, or, if this is not possible, chemotherapy.

Joint diseases

Unlike bone pathology, an element of inflammation is always present. This feature is associated with their structure - membranes and cartilage are tissues to which the immune system responds well. Therefore, even if they are slightly damaged, antibodies are released that provoke an inflammatory process there:

• Normally, this does not occur, since there are no blood vessels inside the joint.
• Its nutrition is carried out by diffusion - this is the name of the exchange between tissue and intra-articular fluid.
• The activity of the process depends entirely on the adjacent parts of the bone - if they are healthy, then the joint receives enough oxygen and nutrients.
• All exchange is carried out through a special barrier of cells, which prevents the penetration of blood elements through the membranes of the joint.
• Diseases of surrounding tissues lead to changes in its permeability, which is manifested by an inflammatory process.

More often, arthritis is observed - acute inflammation of the joint cavity, which is accompanied by clear signs - pain, swelling, impaired mobility.

Arthritis

When the cause that disrupts the permeability of the joint capsule is sudden, the inflammatory process develops immediately after exposure. Therefore, there are not only local, but also general causes that are associated with changes in the circulatory and immune systems:

1. More often, traumatic arthritis occurs, developing in response to damage or excessive load on the joint. It is based on a “true” mechanism - in response to damage to joint tissue, an immune response occurs.
2. After an infection, the development of reactive arthritis is possible, when the microbes themselves or their metabolic products enter the joint cavity.
3. With various allergic diseases, the basis is a change in the activity of the immune system - it begins to react inadequately to its own tissues and develops. In this case, a huge amount of antibodies are formed, which provoke the development of an inflammatory process in any part of the body.
4. Separately, there are rheumatological diseases, the causes of which are still not clearly defined. In this case, the reaction resembles an allergy - the immune system, through unknown mechanisms, begins to attack its own tissues.

The question of origin is very important - further successful treatment depends on it. In any case, all efforts are aimed at eliminating inflammation in order to prevent further progression of the disease.

Arthrosis

This disease is “age-related”, as it mainly affects people in older age groups. The main problem is the lack of adequate treatment, which requires timely prevention from patients and doctors aimed at slowing down the destruction process. It is based on the following pathological mechanisms:

1. Gradual wear and tear of the joints - when they stop working normally, low-grade inflammation occurs, leading to impaired mobility in them.
2. The immune system at this age acts without selectivity, destroying damaged areas of cartilage and ligaments.
3. The joint is no longer able to create adequate restoration and nutrition of cartilage, which leads to the growth of bone tissue at the site of the defects.
4. This further aggravates the impairment of mobility - since it decreases, the body “does not want” to maintain life in the joint any longer.
5. Trying to eliminate instability, he gradually reduces the articulation cavity, making it eventually closed. This completes the final stage, when mobility completely disappears.

The main help for such patients is lifestyle changes, since good nutrition and physical activity slow down age-related destruction of joints.

Congenital anomalies

The last type of pathology affecting the joints are disorders of its structure, which are congenital in nature. In this case, diseases can be divided into two groups:

• In the first case, there is something missing in the joint, or there is underdevelopment of its main components. For such patients, problems begin in childhood, when the defective joint begins to lose its functions – supporting and functional.
• In another case, there is an additional formation - an outgrowth or protrusion of the forming tissues. They represent an obstacle that will be damaged with increased stress, provoking the development of arthritis.

Detecting these diseases is difficult because they themselves do not have clear symptoms. People seek help already with signs of complications, which makes it difficult to find the cause - but with the advent of modern diagnostic methods, this is not a problem.

As you know, the skeleton is a support for the whole organism. Without the skeletal system, we could not only perform various movements, but even stand. Therefore, support is one of the most important abilities necessary for life.

Unfortunately, bone diseases are quite common. Most often they are associated with joint pathologies. In most cases, problems with the musculoskeletal system begin to appear in old age. They develop especially often in women undergoing menopause. However, bone pathologies occur in people of all ages. Children and newborns are no exception.

Pathologies of the skeletal system: description

Diseases of bones and joints are characterized by disorders of musculoskeletal function, which are reflected by symptoms such as changes in gait, inability to bend or turn, deformation of a limb or spine. Pathologies can be either congenital (genetically determined) or acquired during life. Diseases are divided into localized (involve one or several bones) and widespread, which affect the entire musculoskeletal system. Pathologies can be inflammatory, genetic (congenital anomalies), or tumoral in nature. Lesions of the musculoskeletal system also include fractures, joint dislocations, deformations and contractures in systemic pathologies of the body. The diseases have the same prevalence throughout the world. They are more common among the female population. Nevertheless, the percentage of men with pathologies of the musculoskeletal system is also large.

Disease of bones and joints: types

The etiology of osteoarticular pathologies is different. It depends on what takes place in a particular case. Based on this, pathologies are divided into the following groups:

1. Dystrophic lesions. These include rickets in childhood and osteoporosis, which occurs in adults. They arise due to a deficiency of microelements (calcium, phosphorus). A lack of these substances can occur due to poor nutrition, as well as due to disruption of the thyroid gland and ovaries.
2. Inflammatory pathologies - osteomyelitis. This disease develops as a result of the introduction of microbial agents into bone tissue. In this case, its destruction occurs - necrosis.
3. Traumatic lesions of the musculoskeletal system. These include cracks and broken bones. This group also includes damage to joints and ligaments (dislocation, sprain). The causes of traumatic bone diseases are impacts, compression and other mechanical factors.
4. Degenerative (dysplastic) pathologies. These include osteoarthritis and ankylosing spondylitis. The etiological factor of these pathologies is not precisely known. It is believed that they may be hereditary (genetic) in nature, and also relate to autoimmune lesions of bone tissue.
5. Tumor lesions of the musculoskeletal system.
6. Rare genetic syndromes. These include Paget's disease, osteogenesis imperfecta, etc.

Causes of development of bone pathologies

Despite the fact that all bone diseases have a different etiology, there are factors that provoke any of the listed pathologies. These include the following impacts:

1. Poor nutrition. Insufficient consumption of calcium-rich foods leads to decreased bone density. As a result, adults develop osteoporosis.
2. Lack of sunlight. This reason leads to a disease such as rickets. This pathology is common in young children.
3. Hormonal imbalance. This is especially true for the thyroid gland. This organ is responsible for maintaining the balance between calcium and phosphorus necessary for the skeletal system. Also, ovarian dysfunction can lead to pathologies of the musculoskeletal system.
4. Excessive load on the skeleton. This reason means constant carrying of weights, prolonged physical activity, and obesity.
5. Chronic foci of infection. It is worth remembering that bacterial or viral damage to any organ can lead to the penetration of microbes into the skeletal system.
6. Systemic pathologies.
7. Genetic predisposition to bone and joint diseases. For example, osteoarthritis or gout in parents.

Clinical picture of bone pathologies

Symptoms of bone disease depend on the pathology itself, as well as its severity. However, the clinical picture of musculoskeletal diseases has some common characteristics. These include discomfort when moving, deformation of a bone or joint, swelling and pain at the site of the lesion. These signs are characteristic of almost all pathologies. In addition to the listed symptoms, inflammatory bone diseases are manifested by increased body temperature, general weakness, and loss of appetite.

A pathology such as osteoporosis may not have any clinical picture. The disease is usually suspected due to frequent trauma to the patient, leading to bone fractures.

Another pathology that is dystrophic in nature is osteomalacia. In adults it can be considered an independent disease, in children it is a manifestation of rickets. The main symptom of osteomalacia is pain at the site of softening of the bone, discomfort when walking.

Clinical manifestations of cancer of the musculoskeletal system depend on the stage of the process. Typically, a tumor is characterized by the appearance of an area of ​​compaction (elevation) along the bone, which tends to grow. In severe stages, enlarged lymph nodes and weakness are observed.

Diagnosis of pathologies of the musculoskeletal system

To find out what bone diseases a patient may have, it is necessary to conduct an examination not only of the musculoskeletal system, but also of the entire body as a whole. The main reason for visiting the clinic is complaints of pain, limited movement, and deformity. The specialist should find out the following factors: whether there was an injury or excessive physical exertion. After this, an examination of the osteoarticular system is carried out. The doctor asks the patient to perform various movements and evaluates their performance. Among the laboratory data, indicators such as leukocytes and ESR, uric acid, calcium and phosphorus are important. Also, if the patient complains of pain or stiffness in the joints, it is necessary to conduct a detection test. In addition, an x-ray of the bones is performed. If necessary, computed tomography is performed.

Differential diagnosis of bone diseases

In order to distinguish one bone disease from another, the patient must be carefully examined. When injuries occur, X-rays are immediately taken, and making a diagnosis is not difficult. The inflammatory process can be suspected through examination of the limb (presence of a wound with purulent contents, hyperemia and edema), increased body temperature, and laboratory data (leukocytosis, accelerated ESR). Dystrophic changes in bones are diagnosed using x-rays. If a tumor or cyst is suspected, a computed tomography scan is performed. Pathologies such as osteoarthritis or ankylosing spondylitis are detected (to a greater extent) due to the clinical picture. They are characterized by severe deformation of the musculoskeletal system and changes in gait.

Bone diseases: treatment of pathologies

Even if there is minor pain or limited movement, you should consult a doctor. If you receive an injury, it is important to take an x-ray and apply a cast in time, as the bone may not heal properly, after which longer treatment will be required. You should also seek medical help if ulcers appear. This is especially true for patients suffering from diabetes and varicose veins. Despite the fact that these pathologies are not associated with the musculoskeletal system, trophic ulcers can lead to the development of osteomyelitis. If you have a curvature of the spine, flat feet, or gait disturbances, you should consult an orthopedist. The traumatologist is responsible for fractures and dislocations of joints. A rheumatologist specializes in the inflammatory response resulting from an autoimmune process.

Diet therapy for bone pathologies

Any bone disease is an indication for following a diet. Proper nutrition will help not only strengthen bones, but also avoid further development of pathology. This applies most of all to traumatic and dystrophic diseases. To ensure proper levels of calcium in the body, it is necessary to consume dairy products. The highest content of this element is observed in hard cheeses, cottage cheese, and kefir. Other sources of calcium are liver, cabbage and nuts. Consumption of sugar, grapes, beans and alcoholic beverages is not recommended.

Drug and surgical treatment

For inflammatory diseases of bones and joints, drugs from the NSAID group are used. These include medications “Diclofenac”, “Artoxan”, “Aertal”. Taking painkillers is also recommended. For example, the drug "Ketonal". This medication is also necessary for traumatic bone lesions. Women during menopause often develop osteoporosis. To reduce bone fragility, the use of estrogen-containing drugs is recommended. In case of severe deformation of the musculoskeletal system, surgical intervention is performed. Surgical treatment is also indicated if a tumor is detected and osteomyelitis develops.

Prevention of bone pathologies

To avoid the appearance or development of bone pathologies, it is necessary to follow a diet and lose excess weight. It is also recommended to perform a set of physical exercises, but the main thing here is not to overdo it. Prevention of inflammatory processes is the sanitation of foci of infection and antibiotic therapy during exacerbation of chronic diseases (sinusitis, tonsillitis).

Metastatic bone lesions
Bone metastases are an extremely common complication of advanced cancer. Most often they occur in patients with breast and prostate cancer, as well as kidney cancer, lung cancer, and lymphomas. Bone metastases lead to serious complications, such as severe pain, bone fractures, life-threatening fluid and electrolyte imbalance, and compression syndrome of the spinal cord or nerve roots. Treatment of patients with bone lesions is often very difficult, since severe pain and neurological changes are often difficult to treat and lead to a significant deterioration in the quality of life of patients. Bone metastases indicate the presence of widespread, i.e. incurable process, but with fairly active complex treatment it is possible to achieve not only an improvement in the quality of life, but also a significant prolongation of it.
Types of bone metastases
Depending on the processes predominant in the bone, osteolytic and osteoblastic metastases are distinguished. An osteolytic lesion means that the tumor is destroying the bone, which appears to melt or dissolve. This occurs due to loss of calcium from the bone. On X-rays, this process appears as holes inside the bone. The osteolytic type of lesion is most characteristic of a malignant disease called myeloma. Osteoblastic lesion, on the contrary, is manifested by an increase in bone tissue production at the site of the lesion. The tumor sends signals to the bone that lead to an overproduction of bone cells, creating hard, stiff, discolored bone. A typical variant of an osteoblastic lesion is prostate cancer metastases. In most cases, with other types of tumors, one of the types of lesions is observed - osteolytic or osteoblastic, but mixed metastatic foci are found. Patients with breast cancer, as a rule, have osteolytic lesions and only 15-20% of patients develop osteoblastic lesions.
Why are bones affected?
The skeleton is a fairly common site for the formation of metastatic foci, not only in patients with prostate and breast cancer, but also in the lungs, kidneys, stomach, bladder, uterus, thyroid gland, colon and rectum. Researchers hypothesize that frequent bone lesions are associated with increased blood flow to the bones and bone marrow. When cancer cells gain access to blood vessels, they can migrate within the body. They are usually directed to where the blood flow is more intense. In addition, tumor cells themselves can secrete adhesion molecules that form bonds with the bone matrix and bone marrow cells. Interactions with these tumor molecules result in signals that lead to increased bone destruction and accelerated tumor growth in the bones. Research in recent years has shown that bones are the source of many factors that induce cells to divide, grow and mature. When bone is damaged by cancer cells, many such factors are released, which in the future stimulate the growth of tumor cells. This interaction leads to a vicious cycle, supporting bone destruction and tumor growth.
Symptoms of bone metastases
The initial symptoms of bone metastases are often difficult to recognize; they are disguised as various conditions. Most patients who develop problems associated with metastatic bone disease note that the symptoms that occurred in the past could be caused by many reasons. The most common symptom is pain in the back, limbs and other places, which are often mistaken for manifestations of osteochondrosis, arthrosis, etc. Bone fractures without previous trauma are also common. Colon and bladder dysfunction may occur, including urinary or stool incontinence (more common) and severe constipation or urinary retention. Other patients may notice weakness and/or decreased sensation in the legs, poor coordination of movements, and a feeling of greater heaviness. The latter symptoms are very serious and indicate that the tumor has spread to the spinal cord and is compressing the nerve roots. Such conditions require immediate treatment. A rarer manifestation of metastatic disease is an increase in serum calcium levels, which leads to constipation, abdominal pain, and in more severe cases, loss of consciousness.
If you experience pain in your back or limbs, be sure to contact your doctor, who will prescribe the appropriate examination. Do not start with consultations with chiropractors and neurologists who, not knowing that you have had cancer in the past, may prescribe you massage or electrical procedures, which are strictly prohibited for cancer patients. In addition, by taking painkillers and not receiving special treatment, you are wasting your time. The sooner you begin treatment for bone metastases, the greater your chances of achieving success.
Diagnosis of bone metastases
Currently, there are many studies that make it possible to identify bone metastases when patients have relevant complaints. In some cases, it is possible to diagnose metastatic disease before symptoms appear. Doctors use x-rays, bone scans (osteoscintigraphy), and magnetic resonance imaging to diagnose this type of tumor spread. Conducting a conventional x-ray examination is most useful and informative in the presence of a predominantly lytic type of lesion. On radiographs, such lesions appear as “holes” or dark spots against a background of relatively normal bone tissue. Unfortunately, X-ray examination is informative only in cases where the tumor has destroyed a significant part of the bone tissue. In contrast, bone scans can detect bone metastases very early. This study consists of injecting intravenously a small amount of a radioactive substance with a very short decay period. The rays emitted by this source are recorded by a special crystal some time after the injection. The substance with which the emitter is associated accumulates mainly in the foci of the metastatic process, appearing in the image as brighter areas (increased density of drug accumulation). Due to the high sensitivity of the method, it is sometimes difficult to distinguish arthritis, some infectious processes, and sites of old fractures from the true tumor focus. Bone scanning is also used to monitor the effectiveness of treatment in patients with already identified metastatic processes. Computed tomography can sometimes also show metastatic bone lesions. Magnetic resonance imaging is more useful in studying the condition of the nerve roots if they are suspected of being compressed by a tumor or bone fragments due to their destruction by the tumor. MRI is most often used when spinal cord compression is suspected. Recently, a completely new diagnostic method has appeared - pseudoPET or MRI in the “whole body” mode, which makes it possible to identify minimal lytic foci in the skeleton in the early stages.
Until recently, there was no blood test that could be used to diagnose metastatic bone disease. But over the course of several years, studies were conducted that revealed a significant increase in the serum level of one of the enzymes that is specific for bone metastases. It is called tartrate-resistant acid phosphatase. It has been proven that changes in its concentration appear before radiological changes, in addition, a decrease in the level reflects the effectiveness of the treatment. For example, an increase in calcium levels or an enzyme called alkaline phosphatase may be associated with the presence of bone metastases, but these findings alone are not sufficient to make a diagnosis.
Treatment
The main treatment for metastatic bone lesions is treatment of the primary tumor. Therapy may include chemotherapy, hormone therapy, radiation therapy, including radiosurgery, immunotherapy, or treatment with monoclonal antibodies. Narcotic and non-narcotic analgesics (NSAIDs) are used to treat pain. Currently, there are a large number of painkillers, including combination ones; consult your doctor which drug you should prefer. In addition, there is no need to be afraid (if necessary, caused by severe pain) to take narcotic drugs for some time. American studies have shown that people who take drugs for chronic pain syndrome almost never become drug addicts. Prescribing drugs is not a sign that further treatment is inappropriate, but an attempt to improve your general condition until special antitumor therapy takes effect.
Surgery may be necessary if there is a threat or presence of a fracture of bones or vertebrae, as well as in cases of tumor damage to nerves and nerve roots. In recent years, the use of a minimally invasive technique called puncture vertebroplasty has also become widespread. Its essence lies in the introduction of a special polymer into the affected vertebra through a needle, which cements and strengthens the vertebrae, preventing the occurrence of fractures and associated serious neurological problems.
Radiation therapy is a traditional means of pain relief for metastatic skeletal lesions. Local irradiation can reduce the severity (intensity) of pain in approximately 80% of patients; more than 50% of patients report complete disappearance of pain in the area that was irradiated. In addition, radiation therapy makes it possible to achieve consolidation (remineralization) of pathological fractures and is an effective means of combating compression syndrome (compression of the nerve roots or spinal cord by a tumor. The duration of the course of analgesic radiation therapy is determined by the characteristics of a particular clinical case - this can be a single irradiation, when it is given simultaneously a fairly large dose, or a longer course of treatment (irradiation is carried out from 4 to 12 times). A breakthrough in the treatment of metastatic lesions of the spine was the use of the CyberKnife, which makes it possible to deliver a large dose sufficient to eradicate the tumor without damaging the spinal cord and nerve endings.
Currently, phosphorus-32 and strontium-89 are widely used for the treatment of multiple bone metastases in patients with breast and prostate cancer, but this method of therapy is associated with a high level of severe myelosuppression (inhibition of hematopoiesis by red bone marrow). The use of samarium-153, which has a rapid analgesic effect, with significantly lower myelosuppression than traditional radiopharmaceuticals, is becoming more popular.
Hormone therapy also gives positive results - it increases the duration of the disease-free period and improves the quality of life of patients, primarily patients with breast and prostate cancer. The combination of bisphosphonates with hormone therapy has a more pronounced analgesic effect, especially in the treatment of patients with breast cancer and multiple myeloma.
Recently, a new class of medications has also been increasingly used - bisphosphonates, created to treat pain caused by metastatic bone lesions and which can restore bone structure.
Depending on the characteristics of your clinical case, the doctor will choose the optimal combination of antitumor effects for you.
Bisphosphonates
Bisphosphonates are a group of drugs that reduce the intensity of pain associated with metastatic bone lesions and improve the overall structural condition of bones. Bisphosphonates are analogues of a natural bone component called pyrophosphate and prevent fractures. This class of drugs is widely used to treat and prevent osteoporosis and some other bone diseases (eg, Paget's disease), and for elevated serum calcium levels (a condition called hypercalcemia). Bisphosphonates inhibit the destruction of bone by cells called osteoclasts and may also indirectly stimulate the formation of new bone structure by affecting cells called osteoblasts. According to the above, as well as the results of many clinical studies, bisphosphonates are among the most effective drugs for reducing pain with metastatic bone lesions, they have a significant place in the treatment of this group of cancer patients. Unfortunately, bisphosphonates are not considered as a means of radical treatment. It has been proven that bisphosphonates prevent the occurrence of severe and serious complications of metastatic bone lesions and can increase the survival of patients with lytic lesions. myeloma. Most researchers agree that these drugs are more effective and useful as a means of restoring bone structure in the presence of osteolytic foci and, somewhat less, in osteoblastic metastases. At the same time, bisphosphonates can effectively reduce the intensity of pain in both types of lesions.
There are oral (tablet) and infusion (intravenous) bisphosphonates. Some oncologists prefer intravenous administration once a month, considering it more convenient for patients, while others prefer long-term oral administration, believing that this regimen is more favorable for restoring bone structure.
Depending on the type of your tumor and the type of metastatic lesion, as well as certain biochemical indicators (for example, the level of calcium in the blood serum), your doctor will prescribe you certain medications and their regimen. The results of many studies have shown that the use of bisphosphonates provides significant advantages in the treatment of patients with metastatic bone lesions, so when observed for six months, bisphosphonate therapy leads to a reduction in the risk of fractures of the vertebrae and other bones by 35%, and the risk of such serious, threatening life, conditions such as hypercalcemia, the need for radiation therapy is reduced. Studies with a follow-up period of more than one year have also shown a reduction in the need for orthopedic surgery.
It should be noted that the effect of bisphosphonates is better the earlier they are used, i.e. they should be prescribed immediately when bone lesions are detected. It has also been proven that the period of use of drugs should be at least 6 months. The dependence of the severity and duration of the clinical effect on the duration of taking bisphosphonates has been established - that is, the longer, the better. In addition, their use significantly increases the time before complications of bone metastases occur.
Long-term use of bisphosphonates prevents the formation of new bone lesions not only in patients with breast cancer and multiple myeloma, but also in patients with prostate cancer.

There are about 245 different bones in the human body, and soft tissue rests on each of them and almost all muscles are attached to them. Humans need joints for more mobile and smooth articulation of bones. In most cases, diseases of the joints and bones are associated with the presence of trauma or damage.

Classification of diseases

Each bone disease belongs to a specific group of diseases:

• Diseases that have traumatic sources;
• Inflammatory diseases;
• Dysplastic diseases;
• Diseases of a dystrophic nature;

Diseases that have traumatic sources include, first of all, cracks or fractures, with which people go to specialized medical institutions - emergency rooms. Most often, the reasons for each subsequent case of a fracture of the femur or other bones are accidental falls, failure to comply with safety precautions, or simply carelessness.

The bone tissues themselves are characterized by increased strength, but any of them can break if they cannot withstand the pressure that is periodically applied to it. This does not mean that the person has brittle bone disease, just that the bones could not withstand the load. Bone tissues can be either closed or open.

In addition to fractures, there are also cracks. The presence of cracks indicates that the bone withstood the overload, but a trace remained.

From fractures and cracks in the human body, deep and very complex changes can occur, which are caused by the breakdown of vital substances, such as tissue proteins or carbohydrates, as well as many others. Disorders of metabolic processes associated with bone tissue may also be noted.

One of the most dangerous and at the same time popular inflammatory diseases of bone tissue is a serious disease called osteomyelitis. This disease can manifest itself against the background of infections of the joints and bone tissue, penetrating into the bone through the bloodstream or from an external source, or from distant foci.

Various diseases related to dystrophic diseases are associated with malnutrition. This could be, for example, rickets.

Dysplastic diseases of bone problems are those diseases that develop based on violations of natural bone forms, which changes the structure of the skeleton.

Bone diseases

Many adults most often suffer from two types of bone diseases - osteoporosis and osteomalacia. Both diseases are associated with insufficient vitamin D in the body.

Osteomalacia is characterized by flexibility resulting in curvature. Most often, this disease can be observed in pregnant women. Osteoporosis refers to porosity or disease of the soft bones.

The main causes of insufficient vitamin D levels are:

• Lack of sufficient absorption of this vitamin. This indicates that kidney function or intestinal function is impaired;
• Unsuitable environmental conditions for living and normal development of the body;
• Insufficient amount of ultraviolet radiation.

The most common and most common disease of the entire skeletal system is osteochondrosis - degeneration of cartilage and bone. The disease most often manifests itself in the vertebral discs.

Another widespread and well-known bone disease is called curvature of the spine, which affects the entire skeletal system as a whole. The disease can manifest itself in the form of kyphosis, scoliosis or lordosis.

Classification

Diseases of varying severity in different parts of the body are widespread today. Among the majority, the following can be noted:

Arthritis. This is an inflammatory disease that affects the joints. The disease may occur on its own or as a result of another disease. The main clinical manifestation is morning pain in the joint area, which gradually decreases and disappears after the start of movement;

Arthrosis– a whole group of different diseases that affects not just a bone or joint, but all components associated with it. These are cartilages, as well as adjacent bones, synovium, muscles and ligaments. The pain is felt somewhere deep in the joint, intensifies with any, even the most insignificant loads, and decreases with rest. The main cause of the disease is a change in the basic biological characteristics and properties;

Osteoarthritis most often appears in those joints that experience maximum stress. Most often this is a disease of the shin bones and knee joints (this disease is called gonarthrosis), as well as diseases of the femur, pelvic and hip bone diseases (this disease is called coxarthrosis). The shoulder and elbow joints are least commonly affected. But most often rheumatic diseases associated with bones occur.

The most popular of them is rheumatoid arthritis.

Paget's disease of bone. This disease is also known as acute dystrophy. Paget's disease is a chronic disease, and the main characteristic here is a violation of the structure of both one and several bones of the human skeleton. In most cases, these are diseases of the humerus, collarbone, skull, and lower leg. The disease most often affects the elderly, and women suffer from it two to three times less often than men. On the territory of the Russian Federation, this disease is quite rare, so the possibility of hereditary determination of the disease cannot be excluded. The disease can develop either independently or against the background of certain chronic viral infections. It occurs in two different forms - polyostotic and monossal. This is one of the key signs that sarcoma will soon form.

Myeloma bone disease is a disease that belongs to the classification of paraproteinemic leukemia. It occurs in the blood, but directly affects bone cancer. Most often, this disease occurs in older people, but there are also rare cases in which the disease can occur in people under 40 years of age.

Periostitis- This is inflammation in the periosteum. It can be either infectious or aseptic and chronic, being a disease of the tibia and other bones. However, most often the disease spreads to the lower jaw.

11 main causes of disease

Today you can find many case reports of humerus fractures, as well as many others. There are many main reasons for the occurrence of bone diseases, but the most popular and most common are:

1. Repeated hypothermia;
2. Hereditary or genetic probability;
3. Constant physical overload;
4. Lack of loads;
5. Poor nutrition;
6. Various injuries;
7. Infectious or colds;
8. Muscle inflammation;
9. Lack of vitamins in the body;
10. Nervous overload;
11. Overweight.

Another cause of bone diseases in humans is infectious heart diseases, which can easily include endocarditis. The main symptom of the disease is pain in the bones and joints. Exactly the same pain can occur during inflammation in the liver area or with cirrhosis.

Gradually, with the increase in the number of years lived, the metabolism in the body slows down, which leads to the destruction of the joints and spine

Treatment of diseases

Diseases of bones and joints are treated with various complexes, which may consist of various treatment methods:

Medication. This method involves taking various drugs against certain diseases with bone pain. These drugs include creams, ointments, various painkillers, drugs that have a beneficial effect on blood circulation or relieve inflammation. It should be noted that these remedies are aimed only at superficial relief, so they will not help with diseases that destroy bones. In this way, you can get rid of the main pain symptoms for a while.

Physical training. For some bone diseases, an excellent way to cope with pain and improve your health is through sports and recreational physical education. You can do swimming, walking, stretching. It is important not to increase the permitted weight and not overload your body. Running, jumping or squatting is not recommended.

Nutrition. You need to eat a balanced and nutritious diet, but not excessively. It is important to completely eliminate alcohol and also limit your intake of sugar and salt. It is also important to eat foods rich in gelatin and calcium.

Mud therapy. This procedure helps improve blood circulation.

Massage. Therapeutic massage is one of the recommended procedures for the treatment of bone diseases. Massage helps improve tone and strengthen skin and muscle tissue.

Manual therapeutic procedures. This method promotes rapid restoration of tissues and joints. This method also improves blood circulation and relieves pain.

Physiotherapeutic treatment. This method activates metabolic processes in both bone and cartilage tissues. Physiotherapy procedures include laser therapy and other methods.

Acupuncture. Another professional method of treating ailments is acupuncture or pressure on certain points.

Traditional medicine. The variety of traditional medicine methods, proven by generations, in most cases is not aimed at treatment, but at reducing pain, swelling, removing salt deposits and toxins, as well as restoring the natural metabolic function.

Surgical operations. In fact, there are a lot of surgical techniques, ranging from restoration of infected areas to complete bone replacement. Surgical intervention is a last resort measure, used only when others have not given the desired effect.

All of the above methods for treating bone diseases are distinguished by the presence of individual contraindications. That is why it is necessary to first carry out an accurate diagnosis of the affected bones, joints and areas, and then consult with a qualified specialist.

How can diseases be treated using traditional medicine?

Recipe No. 1: Chamomile oil. Chamomile oil is best for treating paralysis, external curvature of the facial muscles, as well as cramps and bone pain. You need to fill one bottle of any small container with chamomile flowers (this is pharmaceutical chamomile), then pour oil over them and let it brew. This solution must be infused for at least 40 days in a tightly sealed container. From time to time it is necessary to shake the contents of the bottle. After 40 days have passed, it is necessary to infuse the contents of the bottle in a boiling water bath. This needs to be done for one hour. After this, it is enough to strain the solution and squeeze out the remainder.

It is recommended to take the resulting traditional medicine three times a day, one teaspoon. Does this 1.5-2 hours after eating. A solution of chamomile oil can also be used for any colds, as well as pain or cramps in the stomach. Girls will benefit from taking chamomile oil if their menstrual cycle is delayed. When used externally, the oil helps to heal ulcers, is an excellent remedy for hemorrhoids, and also cures ear pain.

Recipe No. 2: Lavender. For bone pain, you can prepare another good, effective remedy. This is Lavender. To prepare it, you need to fill a container with red lavender flowers, add honey, and then let the resulting solution settle. You need to infuse the product for 6 months, stirring it from time to time. It is recommended to take the product three times a day, exactly one large spoon, and only before meals. The medicine will be useful for any poisoning with various toxic substances, as well as for melancholy, epilepsy, central nervous system disorders and other similar diseases.

Recipe No. 3: Soda foot baths. If the pain of spurs and bunions on your feet is very severe and often annoying, you need to take a soda bath. It must be taken twice in seven days. In order to complete the procedure, you need to pour 1-2 tablespoons of soda into 3 liters of distilled (optional) water, as well as about 10 drops of iodine. The temperature of the water in the selected container should be neither hot nor cold. The maximum permissible duration of one such procedure is no more than 10 minutes. Immediately after completing the procedure, it is important to thoroughly wipe the sore areas. At night they must be lubricated with a 5 percent iodine solution. In the morning, apply a little Vaseline to the sore spots.

What should be the lifestyle

When treating bones and joints, you must follow a few simple rules every day:

• Less overwork. If fatigue suddenly sets in, the right thing to do is to stop and rest.
• During the day, a two-hour rest is required;
• Must lift or carry no more than 5 kilograms at a time;
• We need to walk more and use less transport, both personal and public;
• If your legs hurt, you need to monitor the smoothness and softness of each step when walking. You need to give up running and even minor jumping. When going down the stairs, you must first lower your healthy leg, and then put the already sick leg on it. It is necessary to do the same when climbing somewhere: put the leg affected by the disease only after the healthy one has been raised onto the step. It is important to remember that static loading is not as dangerous as impact loading;
• Preference for shoes: they should be comfortable enough and soft enough;
• It is necessary to sleep only on hard beds so that the spinal column does not sag;
• Special attention should be paid to nutrition. The most important thing: you need to limit your intake of protein foods and completely avoid eating mushrooms.

A person’s age plays an important role in the treatment of bone diseases, since the older the person, the more difficult it will be to treat the disease. However, you can always achieve a positive effect if you identify the disease in time and treat it in a timely manner.

Depending on the nature, severity and location of the spread of bone disease (for example, disease of the radius), various doctors can deal with it, from rheumatologists and therapists, to orthopedists and traumatologists (if, for example, we are talking about diseases of the heel bone). However, the most important point is to contact a specialist in a timely manner. No pills can help.

Osteochondropathy, or aseptic necrosis, is a chronic degenerative-necrotic disease, which is based on the vascular-dystrophic process of the subchondral parts of the epiphyses of some bones. The disease is more common in childhood and adolescence, has a chronic benign clinical course and a favorable outcome.

Etiology osteochondropathy is unknown, but there is an opinion that the disease can develop as a result of injury, infection, hereditary predisposition, impaired nerve trophism and metabolism.

Pathogenesis. Osteonecrosis develops as a result of local disruption of the vascular nutrition of bone tissue and bone marrow in the area of ​​the epiphysis or apophysis.

The dystrophic-necrotic process that occurs during this disease is conventionally divided into five stages:

Stage I of necrosis is the result of impaired blood circulation in any part of the epiphysis or apophysis;

Stage II of a secondary impression fracture occurs at the slightest load, similar to a pathological fracture;

Stage III of fragmentation develops against the background of resorption of individual sections of necrotic cancellous bone;

Stage IV repair occurs due to the proliferation of connective tissue;

Stage V of consolidation occurs as a result of ossification with the formation of deformation of the epiphysis or with its complete restoration with proper treatment.

Osteochondropathy of the femoral head

Osteochondropathy of the femoral head (Legg-Calvé-Perthes disease) is one of the most common osteochondropathy. Age ranges from 5 to 12 years, but cases of the disease up to 18–19 years are not uncommon. Boys and young men suffer 4–5 times more often than girls.

Clinic. The process is one-way. There is no indication of trauma in the medical history. After walking, minor and intermittent pain appears in the hip joint, which intensifies in the future. Joint contracture, muscle atrophy, constant lameness and, in advanced cases, shortening of the affected limb by 1–2 cm occur.

X-ray manifestations are diagnosed only after 6 months, i.e. in stage II of the disease, when uniform darkening of the femoral head occurs due to necrosis and impression fracture. The head is flattened, the joint space widens.

After 1.5 years from the onset of the disease, individual fragments of the head are detected on radiographs, its even greater flattening, and only after 2–3 years it acquires a normal bone structure and shape, if correct treatment was carried out, or a mushroom shape.

IN treatment Early unloading of the affected limb is of utmost importance to maintain the normal shape of the head using orthopedic devices and crutches. In some cases, surgical interventions are used to improve blood circulation to the femoral head (tunnelization of the femoral neck, transplantation of a muscle flap into a previously prepared canal in the femoral neck).

Osteochondropathy of the tibial tuberosity

Osteochondropathy of the tibial tuberosity (Osgood-Schlatter disease). Damage to the tibial tuberosity is usually unilateral.

It occurs and clinically manifests itself, as a rule, after injury. Among the patients, there are very often strong young people who are actively involved in sports (football players, track and field athletes, runners).

Clinical picture. Spontaneous pain appears in the area of ​​the tibial tuberosity, which intensifies when pressing on the tuberosity and when bending the knee joint. Swelling and slight swelling of soft tissues are detected; upon palpation, a hard bone growth is detected.

X-ray fragmentation or separation of the tuberosity from the bone is determined.

Treatment consists of limiting walking, running, and physical exercise. Physiotherapeutic procedures are prescribed: warm local baths, massage, elastic bandage on the knee joint.

The disease ends after 1–1.5 years with complete recovery if physiotherapeutic treatment and balneological procedures were carried out.

Osteochondropathy of the navicular bone of the foot

Osteochondropathy of the navicular bone of the foot (Köhler disease-I) is rare and occurs after injury. Children aged 3–7 years are affected, most often boys.

Clinical manifestations. On the back of the inner edge of the foot, for no apparent reason, swelling and moderate pain appear, sometimes causing children to limp and walk on the outer arches of the foot.

On radiographs fragmentation and flattening of the scaphoid bone in the sagittal direction in the shape of a sickle or lentil are detected.

Treatment consists of creating long-term rest for the foot using a plaster boot and carrying out physiotherapeutic procedures. Surgical treatment is contraindicated.

The total duration of the disease is about a year. The function of the foot and sometimes the anatomy of the navicular bone are restored.

Osteochondropathy of the head of the II and III metatarsal bones

Osteochondropathy of the head of the II and III metatarsal bones (Alban Köhler-II disease) mainly occurs in young women. The cause is unknown, but a predisposing factor is prolonged walking in high heels.

Clinic. Pain in the foot gradually progresses, intensifying while walking. Changing shoes and moderate walking lead to clinical recovery, but aseptic necrosis of the metatarsal head continues until the formation of deforming arthrosis.

On radiographs The compacted head of the metatarsal bone is revealed, then its fragmentation, flattening and partial or complete resorption. The joint space is widened, osteophytes grow like deforming arthrosis.

Treatment It is carried out conservatively: the load on the leg is reduced, physiotherapeutic treatment is carried out, it is recommended to wear instep supports that relieve the load on the forefoot. Resection of the metatarsal head is indicated only to eliminate extensive bone growths in the head area.

Osteochondropathy of the lunate carpal bone

Osteochondropathy of the lunate bone of the wrist (Kienböck's disease). The disease occurs quite often in men aged 20–30 years after heavy physical manual labor and in athletes.

Clinic manifests itself as long-term, non-disappearing pain in the area of ​​the wrist joint, disruption of its function, and a sharp increase in pain when pressing on the back of the hand.

On radiographs compaction of the bone (necrosis) is visible, then spotty clearing, over time the bone takes on a triangular shape.

Treatment. The best results are obtained by scraping out necrotic masses with a sharp spoon without removing the thickened cartilaginous part of the bone. Conservative treatment methods can include long-term immobilization with a plaster cast and physiotherapy.

Vertebral body osteochondropathy

Osteochondropathy of the vertebral body (Calvet's disease). The vertebrae of the lower thoracic and upper lumbar regions are predominantly affected, i.e. the vertebrae that bear the heaviest load.

Occurs more often after injury. The cause is embolic infarction a. nutricia.

Clinic. After a fall or injury, pain appears in the area of ​​the affected vertebra, which intensifies during exercise and disappears with rest.

When examining the back, muscle tension and protrusion of the spinous process of the affected vertebra are detected due to wedge-shaped compression of its body.

On radiographs There is a uniform flattening of the body, usually of one vertebra, sometimes with a small wedge anteriorly. Adjacent intervertebral discs are enlarged. As Calvet puts it, “there is too little bone and too much cartilage.”

Treatment. Complete unloading of the spine is required using bed rest and reclination (for the entire period of vertebral regeneration).

Drug therapy, vitamin therapy, ultraviolet irradiation, and special physical therapy techniques are used.

Forecast disease favorable. Complete restoration of the shape of the vertebra usually does not occur - the deformity in the form of a “fish vertebra” remains.

Osteochondropathy of the vertebral apophyses

Osteochondropathy of the vertebral apophyses (juvenile kyphosis, osteochondropathy kyphosis), or Scheuermann-Mau disease, is quite common.

Young men suffer more often. Sometimes the disease is determined only during examination of conscripts. Familial forms of spinal osteochondropathy have been described. As a rule, the middle and lower thoracic spine are affected.

At the age of 10–12 years, additional apophyseal points of ossification of the vertebral body, or “marginal bone borders,” appear in the intervertebral cartilaginous discs.

This typical osteochondropathy is most likely based on multiple small necrosis with subsequent recovery phenomena.

Significant deformation - osteochondropathic kyphosis - gives a poor prognosis in terms of restoration of shape. Kyphosis usually remains for life.

In this case, the VIII–IX vertebrae are subject to the greatest deformation, and to a lesser extent, the VII and X vertebrae of the thoracic spine.

Clinic. The patient notices fatigue in the spine, first after physical activity, then after walking and prolonged sitting. Gradually, spinal fatigue turns into pain, stooping and kyphosis appear. The disease progresses slowly over years.

X-ray Mau distinguishes three stages of the disease.

The initial stage of the disease is characterized by the fact that the apophyses become loose and have a mottled appearance on radiographs.

In the initial stage, the epiphyses take on a jagged appearance, and the contours of the anterior part of the vertebral body become osteoporotic.

In the destructive stage, deformation of the vertebrae occurs - the body of the affected vertebra is compressed from top to bottom and, from the middle of the body towards the front, becomes sharpened in the form of a truncated wedge.

In the recovery stage, the structure of the vertebrae is restored and the apophyses merge with the vertebral bodies.

In severe cases, the process leads to spondylosis deformans.

Treatment symptomatic. Patients should remain in bed on a hard bed with a shield in the supine position.

Gymnastics are prescribed to strengthen the muscles of the back and abdomen.

In the acute stage with pronounced clinical manifestations in the form of pain, they resort to positioning in a plaster bed.

Partial wedge-shaped osteochondropathy of articular surfaces

Dissecting osteochondrosis, or Koenig's disease, is expressed in aseptic necrosis and separation of the wedge-shaped portion of the head or articular epiphysis of the medial femoral condyle. The disease is observed in children and adults.

The typical location of the disease is the knee joint, but others can also be affected (elbow, less commonly shoulder, hip, ankle).

Clinic. The separated osteochondral piece of the epiphysis falls into the joint cavity, where it moves freely, and if pinched, it blocks the joint.

Acute pain occurs in the joint, from which the patient gets rid of it independently by carefully bending and straightening the thigh or lower leg.

The clinical picture of Koenig's disease before strangulation is expressed in pain in the joint while walking; upon palpation of the medial femoral condyle, a local painful point is determined. After the blockade, effusion appears in the joint.

The clinical course is divided into two stages.

Stage I – chronic arthrosis-arthritis – lasts for 1–1.5 years. The lesion is slowly demarcated, then it is held in place by the still undamaged cartilage.

Stage II – the stage of “intra-articular mice”. Infringement of the intra-articular body occurs, accompanied by joint blockade and severe pain. Cartilage slowly changes its structure and is destroyed under the influence of a minor injury.

X-ray picture very characteristic. Initially, a small oval depression is detected in the medial condyle.

After the sequestrum is rejected, a small and shallow defect is visible in the condyle - a “niche”, and in the joint cavity - a bean-shaped sequestrum, called an articular mouse.

The dimensions of the niche and the intraarticular body may not correspond to each other. The joint loose body leads to chronic irritation of the joint and is the cause of secondary disfiguring phenomena.

Treatment. In stage I of the disease, the operation is technically difficult. The affected area may be barely noticeable, the cartilage remains alive and has a normal appearance, which makes localization and removal of the lesion difficult. In stage II, the operation consists of removing the intra-articular bodies of the “articular mouse”.

Tumors of the musculoskeletal system are one of the important and difficult diagnostic and therapeutic areas of clinical oncology and orthopedics. Most often, bone tumors affect children and young people.

The first place in frequency is occupied by myeloma, the second by osteogenic sarcoma, the third by primary chondrosarcoma, then by other skeletal tumors.

Classification of bone tumors

Bone has a multi-tissue structure, and tumors of different histogenesis can develop in it.

In practical work, clinical classifications are important, allowing one to distinguish the stages and forms of benign and malignant tumors, which helps in determining the indications for surgery and, to some extent, allows one to predict the course of the disease.

The classification of bone tumors according to V. Ya. Shlapobersky distinguishes primary and secondary bone tumors, in turn, they are divided into benign and malignant.

According to morphological characteristics, primary bone tumors can be from bone tissue, cartilage tissue, reticuloendothelial tissue, connective tissue, vascular tissue and rare bone tumors - from nervous, adipose tissue, notochord tissue, epithelial tissue, as well as odontogenic tumors.

Secondary bone tumors are divided into metastatic tumors that grow into the bone from surrounding tissues; malignant tumors developing from processes bordering on tumors (fibrous dysplasia, Paget's disease, Ollier's disease, osteochondral exostoses, etc.).

General diagnostic principles

Additional methods are required for diagnosis: X-ray - computed tomography, angiography, radioisotope diagnostics (scintigraphy), magnetic resonance imaging, laboratory tests, etc.

Clinic

The symptom complex of bone tumors consists of three cardinal signs:

1) pain in the affected part of the skeleton;

2) palpable tumor;

3) dysfunction of the limb.

The development of symptoms depends on the nosological form of the tumor, the nature of its growth, localization, and local spread of the process. With rapidly growing sarcomas, the tumor can be detected quite early, and a pathological fracture may occur.

With benign bone tumors, paraosteal sarcoma, and well-differentiated chondrosarcoma, clinical signs develop slowly, sometimes over several years.

Patients often associate the onset of the disease with injury. If pain, swelling and dysfunction bother the patient for a long period after the injury or, after disappearing, recur after a long “clear” interval, this should alert the doctor to a possible bone cancer.

Pain– one of the main symptoms of malignant bone tumors. At the beginning of the disease, they are of an uncertain nature, gradually intensify and become more and more intense, and do not decrease with the use of immobilization and at rest.

The most intense pain is characteristic of Ewing's sarcoma, poorly differentiated chondrosarcoma and osteogenic sarcoma; among benign tumors, osteoid osteoma is accompanied by severe pain.

When the pelvic bones and spine are affected, the localization of pain often does not correspond to the topography of the process.

A tumor detected by palpation indicates an advanced process.

The slower the tumor grows, the longer the period of time passes between the onset of pain and the appearance of a palpable mass.

Functional disorders due to the anatomical location of the tumor. The occurrence of a tumor near large joints often leads to the development of contractures, restriction of movements due to severe pain leads to muscle atrophy, compression of neurovascular bundles by tumor masses, and in the case of tumors of the spine and spinal cord can lead to severe neurological and trophic disorders.

Primary malignant bone tumors are most often localized in the area of ​​the knee joint (osteogenic sarcoma, paraosteal sarcoma), diaphyseal lesions are observed in Ewing's sarcoma, and chondrosarcoma is often localized in the pelvic bones.

Diagnostics

X-ray method is the most important component of a comprehensive examination and includes radiography of the bones and organs of the chest, tomography (including computed tomography), and angiography. X-ray semiotics depends on the nosological form of the tumor, growth rate, and anatomical region.

The most often identified are foci of destruction with characteristic lysis, signs of pathological bone formation, various types of periosteal reactions (for example, Codman’s “visor” characteristic of osteogenic sarcoma or “bulbous” periostitis in Ewing’s sarcoma).

X-ray detection of a tumor focus in bone tissue is possible when the calcium content decreases by 30% or more.

Morphological method. To determine treatment tactics, it is necessary to know the morphological shape of the tumor, the stage of the disease and the extent of the tumor process.

Material for histological examination of the tumor can be obtained using invasive diagnostic methods - biopsy.

Private methods include needle biopsy to obtain material for cytological research from hard-to-reach areas.

Open biopsy(or knife) gives the highest percentage of correct diagnoses. Negative aspects are the need to perform surgical access to obtain material, as well as greater trauma to the tumor than with a closed biopsy.

The immunohistochemistry method using special markers helps reduce the percentage of erroneous diagnoses.

Radionuclide method. Osteotropic radionuclide preparations are used to diagnose the extent of the tumor process and identify foci of mineral metabolism disorders in the human skeleton, which may not be detected by conventional x-ray examination.

Laboratory methods have an auxiliary value. Thus, the study of proteins by serum electrophoresis and determination of the albumin-globulin coefficient and Bence-Jones protein are reliable methods for multiple myeloma.

Osteoblastic tumors tend to increase alkaline phosphatase, while osteolytic tumors tend to have high levels of calcium in the blood serum and urine.

Basic principles of treatment of primary bone tumors

Surgical intervention is the main component of any complex of therapeutic measures for bone tumors. Benign bone tumors can only be treated surgically.

For malignant tumors, indications and contraindications for surgery depend on the histological structure, the nature of the growth of the tumor, the degree of its prevalence, anatomical localization, the general condition of the patient and sensitivity to radiation and chemotherapy.

In the area of ​​resection of the pelvic bones, operations are performed from various approaches, ensuring the least traumatic intervention and achieving good anatomical and functional results.

Spinal tumors are aggravated by frequent phenomena of neurological deficit due to compression of the dural sac by tumor tissues, as well as in advanced cases by the presence of pathological fractures of the vertebral bodies.

The definitive surgical treatment for primary osteosarcomas is amputation.

Surgical treatment of malignant tumors is often carried out in combination with chemotherapy and radiation therapy. In some cases, these treatments should be considered as primary treatments (for example, for inoperable tumors).

Clinical opportunities use of antitumor drugs are directly dependent on the location and stage of development of the tumor process, the histological structure of the tumor, and the characteristics of the patient’s body.

When using preoperative chemotherapy, the need to perform radical (extensive) operations is reduced, there is a low rate of local relapses and favorable long-term results for high-grade sarcomas of the extremities.

Its use is advisable due to the high frequency of hematogenous spread of soft tissue sarcomas in the early stages of development.

Radiation therapy As an independent method of treating bone sarcomas, it is rarely used due to the low radiosensitivity of a number of primary bone neoplasms of the skeleton. This method is of greatest importance as one of the components of complex therapy in combination with surgery or chemotherapy. Radiation is most effective in treating Ewing's sarcoma, reticulosarcoma of bone, and soft tissue sarcoma, which are highly sensitive to radiation. The use of adjuvant radiation therapy after economical surgical interventions can increase the frequency of good treatment results.

Benign tumors are not subject to radiation treatment.

Benign bone-forming tumors

Osteoma– a benign bone tumor originating from osteoblasts. Depending on the predominance of the constituent elements, compact, spongy and mixed osteomas are distinguished. It is relatively rare (from 1.9 to 8% of cases). Osteomas most often affect the bones of the skull, spongy and mixed.

Often located in long bones, mainly in the femur and humerus. They occur with equal frequency in people of both sexes, aged 10 to 25 years. They grow very slowly over several years.

Clinical manifestations depend on the location, most often this is painless.

X-ray A distinction is made between tabular osteomas (wide-based) and pedunculated osteomas. The shape is round or oval, with smooth contours and clear boundaries, the structure is homogeneous, there is no osteoporosis or destruction.

Treatment surgical - knocking a chisel from a section of healthy bone. The operation is performed according to indications: presence of pain, dysfunction, large size. There is no malignancy.

Osteoid-osteoma. Most scientists attribute the disease to benign primary bone tumors; some consider it an inflammatory process. Osteoid osteoma accounts for about 10% of all benign bone tumors and occurs between the ages of 10 and 25 years, predominantly in men.

The main localization is the diaphysis of long bones, sometimes found in the pelvic bones.

Clinic. Osteoid osteoma is characterized by severe pain in the affected area, especially at night; the pain is so intense that it sometimes deprives patients of sleep. A characteristic symptom is the subsidence of pain when taking salicylic acid.

X-ray in the initial phases, the tumor focus is clearly visible in the form of a poorly defined round defect, 1–2 cm in diameter (“nest” of the tumor). The bone surrounding the defect is thickened and sclerotic. In later stages, the defect is filled with newly formed bone tissue.

Histologically the tumor is represented by osteoid and osteogenic tissue.

Generally accepted method treatment– radical surgical removal of the focus (“nest” of the tumor) en bloc with the surrounding strip of sclerotic bone tissue. Scraping the nest is not recommended, as it can lead to relapse. Malignancy has not been described.

Osteoblastoclastoma(giant cell tumor) is a primary single benign bone tumor with a predominant localization at the ends of tubular bones: femur, tibia, radius, etc. The tumor affects spongy tissue, grows slowly, reaching the border of the articular cartilage. It accounts for 12 to 25% of tumor lesions of the skeleton.

It occurs in people aged 20–40 years, but can occur in children and the elderly. Women are affected somewhat more often than men.

Morphological process consists of the destruction and replacement of bone substance and hematopoietic elements of the bone marrow with small mononuclear (osteoblasts) and mainly giant multinucleated (osteoclasts) cells.

The tumor is a soft tissue formation penetrated by vascular plexuses, which are easily damaged and form internal hemorrhages, which gives the tumor a brown color. Hence the name “brown tumor”.

Clinical classification(V. Ya. Shlapobersky, 1960)

Benign form:

1) Group I (with a calmer course, radiologically cellular);

2) group II (with a more aggressive course, radiologically lytic);

3) recurrent form.

Malignant form:

1) primary malignant;

2) secondary malignant.

Clinical picture depends on the location - pain in the affected limb, tumor, dysfunction. Giant cell tumors grow slowly over years and reach large sizes.

Pain usually occurs after injury and is not intense. The skin covering the tumor is stretched, shiny, and bluish.

When palpating the tumor, especially with force, a small crunch may be felt, like the crunch of snow, associated with multiple tiny fractures of the thinned cortical layer of the deformed bone. A pathological fracture often occurs. Metastases are a rare occurrence.

X-ray picture quite specific. The lesion is located asymmetrically in the epimetaphyseal zone, has a rounded shape and is clearly demarcated from the unchanged bone, up to the appearance of a sclerotic rim.

The lesion may have a cellular-trabecular structure or the appearance of a homogeneous bone defect. Almost always there is a “bloating” of the bone.

Treatment is carried out differentially, depending on the form of the tumor (benign, recurrent, malignant), stage of the course and age of the patient. There is no consensus on treatment to date.

Excochleation of the tumor is more often used for the cellular-trabecular form, marginal and segmental bone resections are used for the lytic form of osteoblastoclastoma.

For recurrent and malignant forms of the tumor, combined treatment methods are used, combining radiation and chemotherapy with bone resection or limb amputation.

Malignant bone-forming tumors

Osteogenic sarcoma– one of the most common primary malignant bone tumors, occurring in 80% of all malignant bone tumors.

It can occur in any bone of the skeleton, most often affecting long bones, mainly the metaepiphyses of the bones that make up the knee joint (79.4%). There is a definite connection between the tumor and bone growth zones. Apparently, age-related acceleration of skeletal growth plays a role in the genesis of this tumor, when, under the influence of exogenous or endogenous factors, enchondral osteogenesis is disrupted, followed by blastomatous growth.

Osteogenic sarcoma– monoosseous disease, extremely aggressive, prone to early, predominantly hematogenous metastasis, most often to the lungs (60–95%), and it is possible to other parts of the skeleton and lymph nodes.

Clinically There are two types:

1) rapidly developing, with an acute onset, sharp pain and rapidly developing death;

2) more slowly developing tumors with less pronounced clinical manifestations.

45–50% of patients have a history of injury; the period from the moment of the last one varies from several days to 1.5 years.

The main symptom is pain, at first moderate and periodic, and then more pronounced and constant. The appearance of pain is associated with the involvement of the periosteum in the process. Night pain is common.

The second important symptom is the appearance of a palpable tumor. General symptoms develop in the later stages in the form of weight loss, poor sleep, general malaise, and weakness. They are accompanied by progressive anemia, often increased alkaline phosphatase.

Pathological fractures are uncommon and are characteristic of the osteolytic form.

X-ray The following varieties are distinguished:

1) osteolytic;

2) mixed;

3) osteoblastic:

a) central option;

b) peripheral option.

The most pathognomonic signs are peculiar osteophytes that arise at the border of the external defect of the compact layer of bone and the extraosseous component of the tumor; they have the appearance of a characteristic visor or triangular spur (“Codman’s visor”). Another symptom is spicules—thin, needle-like calcifications located perpendicular to the long axis of the bone.

Treatment complex, including radiation and chemotherapy, surgery. Surgical treatment most often consists of amputation; recently, segmental resections have been performed followed by bone grafting or endoprosthetics. After complex treatment, the five-year survival rate ranges from 35.5 to 60%.

Paraosteal osteosarcoma refers to rare forms of tumors, which occur in 2% of all malignant skeletal neoplasms.

It develops mainly between the ages of 20 and 40 years. The main localization (more than 80%) is the metadiaphyseal section of the long bones that form the knee joint.

Clinical picture characterized by long-term (up to several years) development of symptoms. There are two phases: the initial – benign and the subsequent – ​​malignant. The disease begins gradually with the appearance of mild aching pain, later a dense, lumpy tumor appears, painless on palpation, and later (after 3–5 years) paraosteal osteosarcoma acquires all the features of a malignant neoplasm: pain intensifies, the tumor grows rapidly, growing into the surrounding tissues, begins ulcerate.

At radiography in most cases, extraosseously located tuberous “bone masses” are detected; as paraosteal osteosarcoma grows, it can cover the entire cylinder of the bone in a muff-like manner.

A peculiar sign is the intactness of the underlying bone layer.

For histological structure diversity is characteristic in different areas of the same tumor: there are structures characteristic of osteogenic sarcoma, chondro- and fibrosarcoma, malignant osteoblastoclastoma, osteochondral exostosis and other pathological processes.

By selection method treatment For paraosteal osteosarcoma, segmental resection with replacement of the defect with a metal endoprosthesis or bone grafting is considered. In cases where this operation cannot be performed, amputation or disarticulation of the limb is indicated.

Forecast– in general, the course of the disease is slow, and the 5-year survival rate is up to 70%.

Benign cartilaginous tumors

Chondroma. Currently, most experts believe that chondromas should be treated with caution, keeping in mind that they can be potentially malignant tumors. Enchondromas are understood as central chondromas, and ecchondromas are peripheral ones.

Chondromas are common - 10–15% of all benign bone tumors. Age can vary widely.

Chondromas are most often multiple, their favorite localization is short tubular bones (phalanxes of the fingers, metacarpal bones and metatarsals), single forms are more often found in the proximal thigh and shoulder.

In an uncomplicated course, chondromas give few clinical symptoms, which is associated with their very slow growth. The presence of pain without a pathological fracture should be alarming in terms of possible malignancy.

X-ray– enchondroma is located inside the bone and, as it grows, it pushes the bone from the inside. Against a homogeneous background of clearing, isolated inclusions of foci of cartilage calcification are found. Echondroma originates from the bone and grows towards the soft tissue.

Microscopically chondroma consists of normal mature cartilage.

Treatment. Currently, there is no consensus on the extent of surgical intervention in the treatment of enchondromas. Some experts believe that it is enough to scrape out the latter and replace the cavity with autologous bone; others, due to the risk of malignancy, suggest performing segmental resection followed by plastic replacement of the defect.

Forecast if the operation is radically performed, favorable.

Chondroblastoma(Cadman tumor) is a benign tumor arising from germ cartilage cells (chondroblasts) and characterized by a favorable outcome. Chondroblastoma is quite rare.

Favorite localization is the metaepiphyseal sections of long bones.

Clinical picture– nonspecific and consists of the presence of a tumor, pain syndrome, and dysfunction of the limb.

X-ray chondroblastoma manifests itself as small foci of destruction 2? 5 cm, located eccentrically relative to the bone. The lesion is clearly demarcated from the healthy bone by a sclerotic stripe.

At treatment The method of choice is segmental resection with bone grafting.

Malignant cartilage-forming tumors

Chondrosarcoma can develop as a primary malignant tumor and as a secondary one as a result of malignancy of a benign cartilaginous tumor or a dysplastic process.

Primary chondrosarcomas can arise in any bone developing from cartilage through enchondral ossification, and are characterized by a wide range of clinical manifestations - from a locally destructive tumor to a neoplasm with pronounced malignant potential, which depends on its morphological structure. The less pronounced the anaplasia, the more favorable the course of the disease.

Clinical picture characterized by the same symptoms as other primary malignant bone tumors (pain, swelling, dysfunction). The location of the tumor in the bone matters. In the central form, pain appears first; swelling as the first sign is noted mainly in the peripheral version.

X-ray central well-differentiated chondrosarcomas appear as a single focus of destruction of irregular shape, the bone is swollen and thickened, fusiformly deformed, accompanied by the formation of a cellular-trabecular structure with the presence of foci of calcification. In low-grade tumors, the focus of destruction is small-focal, blurred, and the process spreads over a considerable distance along the long axis of the bone.

Treatment depends on the form of chondrosarcoma and is mainly aimed at radical surgical removal of the tumor within healthy tissue.

Forecast with radical treatment, the 5-year survival rate ranges from 15 to 76.4%.

Secondary chondrosarcoma develops on the basis of previous benign cartilaginous tumors and chondrodysplasias. Chondromas, osteochondral exostoses, foci of dyschondroplasia (Ollier's disease) and vascular-cartilaginous dysplasia (Maffucci's disease) are most prone to malignancy. Cases of tumor occurrence due to osteomyelitis have been described.

The onset of malignancy is usually difficult to determine; it most often manifests itself as a noticeable increase in pain and rapid growth.

X-ray– characterized by a rapid increase in destruction, destruction of the cortical layer, and the appearance of periosteal layers.

The method of choice for treatment is wide resection of the affected part of the bone.

Forecast in the treatment of chondrosarcomas depends on the form of the tumor (primary or secondary), the degree of its morphological maturity.

Myeloma

Myeloma (myeloma disease, or O. A. Rustitsky's disease) is a sarcomatous tumor of the bone marrow, expressed in intense malignant proliferation of modified plasma cells in the bone marrow, called myeloma cells.

S. A. Reinberg divided multiple myeloma on the basis of anatomical, clinical and radiological signs into four types:

1) multifocal;

2) diffuse-porotic;

3) osteosclerotic;

4) solitary.

Multiple-focal myeloma mainly affects the flat bones of the skull, pelvis, spine, sternum and, less commonly, long tubular bones.

Multiple myeloma most often affects men in middle age, but children and the elderly can also suffer.

Clinic. The disease begins with pain in the bones, then loss of body weight and loss of strength are noted, often a pathological fracture occurs, which may be the only clinical sign of the disease. The malignant process rapidly progresses, complicated by kidney damage, accompanied by the release of pathological Bence Jones protein and metastases to the spleen, liver, and lymph nodes. Cachexia, anemia, hyperproteinemia, hypercalcemia develop, and ESR accelerates.

X-ray picture Multiple myeloma is characterized initially by diffuse osteoporosis, then multiple oval foci of osteolysis appear, primarily in flat and short bones containing red bone marrow: sternum, ribs, vertebrae, calvarium, pelvic and tubular bones.

The affected bone appears expanded with a thinned cortical layer, without periosteal reaction, as if perforated in many places by a punch.

Solitary myeloma(plasmocytoma) is observed mainly in flat bones. A focus of decalcification forms in the affected bone, slowly enlarging. Sometimes the area of ​​osteolysis can reach large sizes, resembling a cyst-like formation without reactive periostitis.

Clinical symptomatology is not as pronounced as with multiple myeloma, but pathological fractures are often observed.

Diagnostics myeloma is often difficult due to the similar clinical and radiological picture with many diseases of the skeletal system.

These include: giant cell tumor, osteolytic osteosarcoma, solitary cancer metastases, Paget's and Recklinhausen's disease, etc.

Myeloma is characterized by a triad of clinical symptoms:

1) bone damage (pain, tumor formations, pathological fractures);

2) blood changes (anemia, increased ESR);

3) kidney damage (“excretory nephrosis” with Bence-Jones protein).

To clarify the diagnosis, a bone marrow puncture is performed.

Treatment. Of all the conservative treatments, radiation and chemotherapy have proven to be the most effective in treating myeloma.

In some cases, combination treatment is used. To stabilize the blood during chemotherapy, ACTT and steroid hormones are prescribed, blood transfusions, leukocyte and platelet masses are given.