Osteolysis

“Osteolysis“ is the medical term for bone tissue in your body breaking down. It’s normally part of how your bones stay strong and healthy by regrowing their own cells. Old bone cells break down and get replaced with healthy new cells. But certain issues and health conditions can lead to more osteolysis than you need. This throws your bones’ regrowth cycle out of balance and can lead to bone loss.

Too much osteolysis makes your affected bones worn down or too thin. This can lead to problems, including:

• Pain
• Unusually shaped bones
• Trouble moving or using a bone normally
• Weak bones that break more easily than usual

Types of osteolysis

There are several types of osteolysis. Three of the most common are:

• Distal clavicle osteolysis: This is a type of repetitive strain injury that affects your shoulder joint. It’s also called AC joint osteolysis or weightlifter’s shoulder. The bones in the AC joint in your shoulder can experience excess osteolysis if you put a lot of stress on them with hobbies, like lifting weights, or physical work. Overusing your shoulders can lead to small stress fractures. Continued stress on your shoulders won’t give them time to heal. That means your bones can wear down without time to rebuild themselves.
• Periprosthetic osteolysis: “Periprosthetic“ is the medical term for something that happens around an artificial implant. So, this type of osteolysis happens around an implant, like a joint replacement. It’s a complication after joint replacement surgeries. Particles or debris that rub off the implant (called wear particles) can trigger your immune system’s defenses. Your body creates inflammation in response to wear particles, which can lead to osteolysis.
• Acro-osteolysis: This type of osteolysis affects the tips of your finger and toe bones. Health conditions or injuries that damage your bones, nerves or blood vessels can make it hard for the right amount of blood to get to these bones. If they aren’t getting enough blood supply, they can’t rebuild and repair themselves.

Symptoms of osteolysis

Symptoms can vary depending on which type you have. Some of the most common osteolysis symptoms include:

• Bone pain that gets worse when you use that part of your body
• Pain or discomfort in or near a joint you had replaced
• Swelling around the bone
• Weakness, or feeling like you can’t use or put weight on part of your body
• Your bone looking noticeably shorter, dented or different than usual
• Breaking a bone much more easily than usual from a minor injury

Periprosthetic osteolysis may not cause symptoms you can feel or notice until it causes a more serious complication, like a broken bone or loosened implant. Contact a healthcare provider if you notice any changes or symptoms in or near your joint that was replaced. The sooner you get issues examined, the better.

Osteolysis causes

Osteolysis happens when your body breaks down your bone tissue faster than it can regrow. Normally, special cells called osteoblasts and osteoclasts work together to recycle old bone tissue and start growing new cells in its place. Osteolysis happens when that process gets thrown out of whack. Your body ends up breaking down bone cells it shouldn’t. How this occurs depends on which type of osteolysis you have.

Distal clavicle osteolysis causes include:

• Working out your shoulders too much or too intensely without giving them time to rest and recover
• Playing sports that put lots of stress on your shoulders, like volleyball, basketball, tennis or swimming
• Doing physically demanding work that puts a lot of stress on your shoulders or makes you do the same kind of repetitive motion often

Periprosthetic osteolysis is a complication after joint replacement surgery. After a hip replacement, your body might mistakenly break down more bone tissue in your hip than it should. That’s because the implanted joint reduces the kind of everyday stress your bones typically would use to know how much to rebuild themselves. It’s almost like the replacement works too well at supporting your hip. Healthcare providers call this “stress shielding.“

Other causes of periprosthetic osteolysis include:

• Plastic or metal particles wearing off the joint implant
• Chronic inflammation near the implant
• Infections

Acro-osteolysis can result from lots of issues, including:

• Diabetes-related neuropathy
• Scleroderma
• Psoriatic arthritis
• Sarcoidosis
• Frostbite or burns
• Exposure to toxins or harmful chemicals

Risk factors

In addition to the issues and health conditions above, you may be more likely to develop osteolysis if you have:

• An autoimmune disease
• Hereditary connective tissue disease
• Ischemia
• Metabolic bone disease
• Tumors

How doctors diagnose osteolysis

A healthcare provider will diagnose osteolysis with a physical exam and some tests. Your provider will examine your bone and ask about your health history. Tell them if your work or hobbies put a lot of stress on the same parts of your body often. Make sure to mention if you have health conditions or have had surgery on your bones or joints.

Your provider will use some tests to take pictures of your bones and check their health, including:

• X-ray
• Bone scan
• MRI
• CT scan

Your provider might order blood tests to check for infections or signs of other issues.

Treatments for osteolysis

Which osteolysis treatments you’ll need depends on which type you have. In general, your healthcare provider will suggest treatments that manage the symptoms, treat their cause and protect your bone health.

Treatments for distal clavicle osteolysis and acro-osteolysis may include:

• Pain medications: NSAIDs and corticosteroids can relieve pain and inflammation. Your provider may give you steroid injections.
• Treating the cause: Once your provider diagnoses what’s causing the osteolysis, they can treat its cause. You might need to modify physical activities or manage a health condition. You might need surgery to remove a tumor or restore blood flow to your bones.
• Treating bone loss: Your provider will try to slow done the bone loss. You might need medications, like bisphosphonates. They may suggest surgery to reshape your bones or replace damaged joints.

Treating periprosthetic osteolysis is a little different. Your provider will take a series of X-rays over time. They’ll monitor your joint and the implant. You might need another surgery to repair or replace the implant if wear particles are causing osteolysis, or if the bone loss becomes unsafe.

The sooner your provider identifies issues with your implant, the better. Contact them as soon as you notice any new pain or other symptoms in your joint.

What can I expect if I have osteolysis?

Your healthcare provider will help you understand what to expect. It depends on which type of osteolysis you have, what’s causing it and how well your body responds to treatments.

Some cases get better with treatment and don’t lead to long-term complications. But you might have to manage a health condition that affects your bones for the rest of your life.