Causes and main manifestations of osteosclerosis. Subchondral osteosclerosis of articular surfaces

One of the signs of osteoarthritis, along with the destruction of the cartilaginous surface of the joint and damage to the periarticular ligaments and muscles, is subchondral osteosclerosis. This is an increase in the density of the area of ​​​​the bone lying immediately under the cartilaginous part. This condition develops due to an increase in mechanical load on bone tissue. This overload occurs when the cartilage lining the joint capsule degenerates.

Reasons for development

Subchondral osteosclerosis is not a disease, but a morphological one, that is structural change. Its cause is a progressive joint disease, accompanied by wear and tear of the articular cartilage.

The direct cause of subchondral osteosclerosis is changes in the joint caused by its congenital weakness (dysplasia), trauma or autoimmune inflammatory process (for example, with).

Factors that increase the likelihood of pathology:

• obesity;
• genetic predisposition;
• previous joint surgeries;
• pathological menopause.

Subchondral osteosclerosis occurs at a late stage of osteoarthritis. At this time, the cartilage has already been destroyed, and the exposed bone surfaces begin to rub against each other. As a result, they become damaged and uneven. Bone formation processes begin to prevail over physiological destruction bone tissue. The tissue lying directly under the epiphysis (the end of the bone) thickens and remodels. Clinical and radiological signs of osteosclerosis appear.

A sign of hardening of the bone tissue under the articular surface of the bone is pain. Its characteristics vary depending on the underlying mechanism of occurrence.

The strength of the bones is provided by microscopic tubes - beams intertwined with each other. When the shock-absorbing cartilage is destroyed, the entire load falls on the bone. As a result, the beams are deformed. Bone remodeling irritates the pain receptors in the periosteum and causes pain.

Pain syndrome occurs after loading the joint, mainly in the evening. In addition, it interferes with the patient’s walking and prolonged standing. After a night's rest, the intensity of the pain decreases or disappears altogether.

Bone overload leads to expansion of the choroid plexuses and stagnation of venous blood. This causes receptor irritation vascular wall and leads to the appearance of prolonged night pain that is bursting in nature.

Subchondral osteosclerosis is diagnosed using radiography and computed tomography of bones. X-ray signs of this pathology:

• the bone substance becomes finely looped, small partitions - trabeculae - are visible in it, the reason for this change in structure is the restructuring of the processes of bone formation and resorption;
• the superficial (cortical) layer thickens and becomes uneven;
• the lumen of the bone marrow canal narrows, up to its complete obliteration (overgrowth);
• the shadow of the pineal gland becomes bright and contrasts with the surrounding tissues.

Magnetic resonance imaging is rarely used to diagnose subchondral osteosclerosis. This technique is informative for recognizing lesions in organs rich in water. There is little fluid in the bone tissue, so an MRI may not reveal all the changes.

Osteosclerosis is a symptom of osteoarthritis, so the underlying disease should be treated to slow its progression.

• weight loss;
• physiotherapy;
• limiting the load on the affected joint;
• taking chondroprotectors and painkillers.

All these measures can only alleviate symptoms and temporarily slow down the development of pathology. They make it possible to maintain a normal quality of life until surgical treatment. – the main method of treating osteoarthritis, it also helps to get rid of subchondral osteosclerosis.

To reduce the intensity of pain caused by osteosclerosis, doctors prescribe anti-inflammatory drugs. They reduce blood flow and reduce the release of pro-inflammatory substances. Recommended admission modern means – selective inhibitors cyclooxygenases, which practically do not harm the digestive organs. These are celecoxib, movalis, nimesulide.

Groups of medicinal substances used:

Based on this table, you can select drugs of different pharmacological groups, relieving joint pain.

Many of the listed medications are available not only in tablets, but also in the form of injection solutions. Intramuscular administration indicated for acute pain syndrome; tablets and capsules are suitable for continuous use.

Some NSAIDs are available in suppository form. Their effectiveness is often higher than that of tablets. However, the negative impact on gastrointestinal tract is saved.

It is useful to use ointments with anesthetic and vascular components (troxevasin, fastum-gel and others). Local treatment osteosclerosis is recommended to be supplemented with massage of the affected area, which reduces swelling and bone remodeling.

Subchondral osteosclerosis of the vertebrae occurs in severe cases osteoarthritis of the spine. To relieve its symptoms, the following methods are used:

• drug treatment, including non-steroidal anti-inflammatory drugs and chondroprotectors;
• physiotherapy: treatment magnetic field, ultrasound, introduction of painkillers into the paravertebral tissues using electrophoresis;
• underwater traction, medicinal baths, circular shower;
• massage;
• physical therapy aimed at strengthening the back muscles.

In severe cases it is possible surgical treatment: implantation of an artificial vertebra or denervation to eliminate pain.

Subchondral osteosclerosis is a hardening of the bone area under the articular cartilage. It occurs when excessive load on bone tissue due to the destruction of the cartilage layer lining the joints. The main reason for this condition is.

Osteosclerosis most often develops in the hip, knee or 1st metatarsophalangeal joint of the foot. It manifests itself as a pain syndrome, for the relief of which anti-inflammatory and cartilage-restoring drugs, physiotherapy, massage and special gymnastics are used. In severe cases, an operation is performed to replace the joint with an artificial one – endoprosthetics.

Update: October 2018

Osteosclerosis is a condition—a symptom of many diseases—that involves hardening of one or more areas of bone. As a result, the bone loses its elasticity, and under normal loads, a fracture can occur precisely in the areas of osteosclerosis.

Osteosclerosis of bones does not show itself for a long time, while the process goes deeper and deeper and can lead to immobilization of the limb, the development of tumors, and pathological fractures. The disease is detected using radiography, and based on its results, orthopedists or traumatologists prescribe treatment: either conservative or surgical.

Causes of pathology

Pathology occurs when bone synthesis occurs faster than its destruction. This happens when:

• hereditary diseases. These are osteopetrosis or marble disease, osteopoikilia, melorheostosis, pycnodysostosis, dysosteosclerosis, scleroosteosis, Paget's disease;
• frequent bone injuries;
• poisoning of the body various substances mainly heavy metals (lead, strontium, fluorine);
• frequent and long-term loads on the limbs or spine, when microtraumas constantly occur in the bones, which try to restore the cells synthesizing the bone;
• osteosclerosis of the joints occurs when sedentary life, which is due to the fact that the nutrition of the articular areas of the bone comes from the joint fluid - during movement;
• chronic bone diseases, for example, chronic osteomyelitis, bone tuberculosis;
• insufficient supply of nutrients - with poor nutrition or certain metabolic diseases;
• obesity, which itself represents an increased load on the bones;
• tumors or bone metastases. Bone metastases are characteristic of many types of cancer, especially lung, prostate, and breast cancer;
• osteochondrosis, for example, cervical region spine;
• previous vascular diseases when bone nutrition was disrupted;
• weak (untrained or damaged) muscles that move individual joints;
• blood diseases: leukemia, myelofibrosis;
• undergone bone surgeries.

Types of osteosclerosis

The focus of osteosclerosis can be:

1. Physiological (normal) when it appears in the bone growth zone of a teenager.
2. Pathological. Arises as a result various reasons, which we will talk about below.

If there are many foci of osteosclerosis, and they are located “at random” (this can be seen on an x-ray), the disease is called spotty. It can be large-focal and small-focal. May have rare or multiple focuses.

If it is clear that one large area of ​​osteosclerosis consists of many small foci, it is called uniform.

There is also a classification that takes into account the number and volume of compacted bones. Based on it, osteosclerosis occurs:

• limited (local, focal): located within one bone. It is observed mainly as a result of inflammatory bone diseases;
• diffuse: tubular bones are uniformly affected, mainly in the area of ​​their diaphysis (for example, in chronic osteomyelitis);
• widespread: several bones or an area of ​​the skeletal system are damaged (for example, lower limbs and the pelvic area, bones of the shoulder girdle, and so on);
• systemic (generalized): foci of bone compaction are located in the bones of the entire skeleton. This develops when systemic diseases(leukemia, marble disease).

Depending on the underlying causes, osteosclerosis can be:

• functional: the same as physiological - occurs in the area of ​​growth zones when bone growth stops;
• idiopathic – associated with bone developmental defects;
• post-traumatic - resulting from the healing of a bone after a fracture;
• inflammatory: developed as a result of bone inflammation;
• reactive – arising in response to a tumor or malnutrition of the bone. It occurs at the border between normal and diseased bone tissue;
• toxic - developed as a result of poisoning of the body with heavy metals or other toxic substances.

In addition, osteosclerosis of the bone is distinguished, when the lesions are located in different parts of the diaphysis, and subchondral osteosclerosis. IN the latter case The bone is compacted only in the area under the articular cartilage (“sub” - “under”, “chondros” - cartilage) - the structure that comes into contact with the other bone in the joint. The latter type of disease is also called endplate osteosclerosis or articular osteosclerosis. Main causes of osteosclerosis of this type– this is an excessive load on the joints, degenerative diseases (deforming osteoarthritis), tumors, inflammation. If at the same time a person has vascular diseases, metabolic disorders, chronic infections - areas of compaction in the bones that are subject to the greatest loads are guaranteed.

Symptoms of this condition

The disease does not manifest itself for a long time: the person suffers from degenerative or inflammatory disease bone or joint, and has no idea that smaller or larger sections of his bones have become like glass - dense but brittle.

Only when the areas of compaction become quite large and disrupt the pattern of movement do signs of osteosclerosis appear. They differ slightly depending on the location of the lesion.

Consolidation of the ilium

Osteosclerosis of the ilium is asymptomatic for a long time. You can suspect it by the appearance of pain in the sacral area, which occurs during long walking or after long sitting.

A seal in the area of ​​the ilium, if it is located at the border of its connection with the sacrum, indicates that the person most likely has ankylosing spondylitis. It manifests itself as pain in the lower back and sacrum, which appears at rest, mainly closer to the morning. Gradually the entire spine begins to hurt. He becomes less mobile; stoop appears. Large joints – knee, ankle, elbow – joints may be affected. Complications from the eyes, heart and kidneys also develop.

For osteosclerosis articular surfaces MRI of the ilium and sacrum should be done lumbar region spine, the area at the junction of the sternum and ribs, donate blood for rheumatoid factor, examine other joints using X-rays for arthritis. If the joints are not evenly affected, inflammation and osteosclerosis in the area are noticeable. small joints spine, as well as in the sternocostal joints, negative rheumatoid factor, most likely this is ankylosing spondylitis.

Lump in the hip area

Osteosclerosis of the hip joint is very similar to thickening of the ilium. This is pain in the joint or lower back that appears during prolonged walking or sitting. The progression of the lesion is manifested by lameness, a decrease in the range of movements in the bone joint. This disease is very dangerous because with such meager symptoms, which do not seem to portend trouble, a neck fracture can develop femur– a pathology that can cause long-term immobilization and serious complications.

Consolidation of the subchondral area of ​​the shoulder joint

Osteosclerosis humerus appears quite early, as upper limbs very active and constantly moving, even in sedentary people. It is characterized by the appearance of pain in the shoulder joints, which intensifies when moving the arms, especially when lifting them and moving them back. In this case, the shoulder joint is painless when touched, it is not enlarged and not red.

Subchondral tightness of the knee joint

Osteosclerosis of the knee joint does not appear immediately after hardening of the bone area. It is characterized by rapid leg fatigue and knee pain when sitting. These symptoms are observed long time, not particularly amplifying. Meanwhile, gradually sclerosis and cartilage tissue joint, and it becomes inactive. Such an advanced process is very difficult to treat.

Lump in the spine

Osteosclerosis of the endplates - structures that are in contact above and below with neighboring vertebrae (the intervertebral disc) – develops quite often. It does not have any specific, bright severe symptoms, but can lead to the development of kyphosis (curvature directed convexly backward), osteochondrosis, intervertebral hernia, compression fracture that occurs as a result of a jump from a small height or a slight blow.

The lesion is characterized by the appearance of aching pain in the area of ​​the vertebral bodies. The pain intensifies when standing and lying down, and is relieved when sitting.

Foci of compaction in the bones of the foot

Osteosclerosis in the area of ​​the foot bones (including calcaneus) leads to the appearance fatigue legs, pain in the foot, decreased range of motion. When the process is far advanced, flat feet are formed and the phalanges of the fingers are deformed.

How to understand whether osteosclerosis occurred as a result of congenital causes

Not all genetically determined diseases manifest themselves in early childhood. There are also those that manifest themselves in adolescents or adults. Let us list their main signs so that one or another pathology can be suspected.

Osteopetrosis

It can manifest itself from birth (this form is transmitted in an autosomal dominant manner) or manifest late (autosomal recessive inheritance).

The autosomal dominant type of the disease is visible already at the birth of the child: his head is large and his body length is less than 49 cm. When performing an ultrasound of the brain (neurosonography), hydrocephalus is diagnosed, and as it progresses, compression of the cranial nerves responsible for vision and hearing is observed . The child is pale, as his volume decreases bone marrow, synthesizing blood cells.

X-ray shows that the medullary canal is not expressed, the bones of the skull are compacted, and the size of the air sinuses of the skull is reduced.

The autosomal recessive type of pathology appears between the ages of 5 and 10 years. Its symptoms are similar, but osteosclerosis is not as pronounced.

Dysosteosclerosis

This disease, transmitted in an autosomal recessive manner, manifests itself in early childhood as:

• growth retardation;
• very frequent caries caused by a decrease in the amount of tooth enamel;
• blurred vision due to compression optic nerve in the cranial cavity;
• nasal voice;
• choking.

Foci of osteosclerosis are found in the bones of the pelvis, skull, ribs and collarbones. Osteosclerosis of the vertebrae is also noted.

Pycnodysostosis

This is a disease transmitted in an autosomal recessive manner. It is characterized by its appearance in early childhood. The baby is stunted and his face is deformed:

• the distance between the eyes is increased;
• large frontal tuberosities;
• nose – beak-shaped;
• jaw – wide;
• teeth appear late, not all of them grow. A change in their shape and position is noted.

In addition, there is a shortening of the hands and distal phalanges fingers.

Sclerosteosis

This is another autosomal recessive disorder that appears in early childhood and affects almost all bones. Externally, it manifests itself as a flattening of the face, protrusion of the lower jaw, fusion of the skin of the fingers, and underdevelopment of the nails on the fingers.

X-ray is determined by the compaction of the collarbones, the outer layer of all tubular bones, lower jaw and base of the skull.

Melorheostosis

Given hereditary disease affects the limbs, sometimes the spine or lower jaw. The bones of the skull are not compacted.

The disease manifests itself as pain in the limbs, deformation of the limbs, limitation of their mobility and deterioration in their appearance (pallor, decrease in the amount of hair). More than one limb is affected. On an x-ray, the lumps are arranged in stripes, causing the bone to look like a candle with wax dripping from it.

How to recognize some acquired diseases that cause osteosclerosis

A combination of various symptoms characteristic of the following diseases:

1. Paget's disease affects people over 40 years of age, mainly men. It is characterized by the gradual onset of joint stiffness, in the absence of any other symptoms. Some people may experience mild joint pain.
   If the compacted bone tissue presses on the nerve roots, tingling, muscle weakness, and loss of sensitivity in this area occur. Damage to the bones of the extremities can lead to paralysis, and osteosclerosis of the skull bones can lead to headaches and hearing loss.
2. Chronic Garre's osteomyelitis affects the shoulder, hip or radius. In the area of ​​inflammation, dense swelling appears, above which a network of dilated venous capillaries is visible. The infiltrate does not soften and does not open in the form of a fistula. Over time, the pain intensifies, especially at night, radiating to the lower leg and foot (for lesions in the thigh) or hand (for lesions in the shoulder or forearm).
3. With Brodie's abscess, a cavity appears in the bone filled with serous fluid or pus. Pain appears in this area, and if it is superficial, swelling and redness of the skin occurs. No fistulas occur.

How is the diagnosis made?

Any x-ray of the bone allows you to see foci of osteosclerosis. Here it can be seen that the spongy substance becomes coarsely trabecular and finely looped, the bone shadow begins to protrude into the surrounding soft tissues. The cortical layer thickens, and its internal contour becomes uneven; the bone marrow canal narrows or completely disappears. The diagnosis can be confirmed using scintigraphy (radionuclide examination), computed tomography or magnetic resonance imaging, as well as special research– densitometry, which involves measuring bone density.

In order for the treatment of osteosclerosis to be prescribed correctly, it is necessary not only to “see” areas of bone compaction on an x-ray, but also to determine the disease that caused such changes. To do this, you need to examine the entire skeleton for other foci of compaction, and carefully examine their structure: many diseases are characterized by certain radiological signs:

• “dripping wax” - with melorheostosis;
• thickening of the bone diaphysis in the form of a spindle or half-spindle in combination with a significant increase in the bone shadow - with Garre's osteomyelitis;
• a rounded lesion with smooth contours, along the periphery of which there is moderate osteosclerosis - with Brody’s abscess;
• a focus of softening with fuzzy and uneven edges, surrounded by osteosclerosis - in primary chronic osteomyelitis;
• a focus of bone softening, surrounded on the periphery by a pronounced area of ​​osteosclerosis - with syphilis.

Treatment

If it is subchondral osteosclerosis, treatment is usually only conservative. Appointed:

• chondroprotectors: “Dona”, “Mukosat”, “Arthra”;
• when there are signs inflammatory process– antibiotics and non-steroidal anti-inflammatory drugs;
• drugs that improve the functioning of blood vessels in the affected areas;
• in case of the tumor nature of the disease - antitumor drugs (cytostatics);
• massages in the affected areas - if there are no signs of inflammation;
• Exercise therapy with dosed load on the affected limbs - in cases where there is no acute inflammation;
• physiotherapy: magnetic therapy, UHF, electrophoresis, mud therapy;
• a diet with a daily calorie content of up to 1800 kcal/day - if you need to reduce body weight.

Surgical treatment is performed in cases of:

• stenosis of the bone marrow canals (then a bone marrow transplant is performed);
• if necessary, remove lesions containing necrotic tissue;
• if a large part of the bone is affected or sclerotic bone tissue makes movement in the joint impossible (joint or vertebral prosthetics are performed).

Forecasts

The course of the disease and its outcome depend on the cause of osteosclerosis. Yes, such hereditary diseases, as osteopetrosis, dysosteosclerosis, pycnodysostosis cannot be cured, but it is possible to maintain a sufficient quality of life, provided timely treatment anemia and skeletal deformities.

Melorheostosis has a relatively benign course and a favorable prognosis, but skeletal defects can only be eliminated with the help of surgical intervention. Subchondral osteosclerosis, which occurs as a result of degenerative and inflammatory lesions, responds well to treatment.

Prevention

All that can be done to prevent osteosclerosis is:

• avoid physical inactivity;
• sleep on an orthopedic mattress;
• maintain body weight within normal limits;
• perform at least simple exercises;
• eat well;
• treat inflammatory and tumor diseases in a timely manner;
• to refuse from bad habits.

Orthopedic traumatologist of the first category, specialist in foot surgery, RUDN University, 2008.

Osteosclerosis - what is it and why is it difficult to distinguish it on early stage? This is a pathology in which bone tissue becomes denser. The fact is that initially with this disease there are no pronounced symptoms, and the patient does not go to the doctor with his problem. And when the disease has already developed to a certain stage, its treatment becomes more difficult.

Only an attentive doctor who takes an x-ray for another disease can determine its presence at the very beginning. However, this rarely happens. Suspect osteosclerosis (subchondral, that is, on connective tissue) is possible with osteoarthritis, because these two diseases often go together.

Also, osteosclerosis is often combined with the following diseases:

• Osteoporosis;
• Osteopoikilosis;
• Chronic idiopathic myelofibriosis.

Modern clinics are increasingly offering genetic studies that can determine predisposition to a particular disease. Such studies provide a high degree of accuracy in assessing the risk of disease. At the same time, the danger of osteosclerosis cannot be underestimated, since it can lead to paralysis and even malignant tumors, that is, cancer.

However, osteosclerosis also happens not pathological, but physiological, which appears during the growth of the skeleton in children. In this case, it is detected in the growth zones, but then, as a rule, it goes away on its own. But the pathological one occurs already in adulthood.

The likelihood of developing osteosclerosis is relatively high because it is the second most common bone disease after osteoporosis. Diagnosis and treatment plan are prescribed by a traumatologist and orthopedist.

1. On an x-ray with osteosclerosis, shadows of the bone are visible against the background of the surrounding soft tissues;
2. The spongy substance inside the bone acquires a finely looped structure (looks like many small loops);
3. The internal contour of the bone becomes uneven;
4. The medullary canal becomes narrower or even disappears completely.

Foci of osteosclerosis of the spine, knee, and hip joints look like many evenly distributed light spots. This is piebald osteosclerosis. With it, the cortical layer does not become thinner, but the inner one turns into spongy and loose. There is also even osteoporosis. With him osteosclerotic lesions look transparent. In the spongy substance, trabeculae, that is, plates and septa, are visually visible.

In many cases, systemic osteosclerosis develops due to a genetic predisposition to it. However, there are other reasons - for example, the presence of an infectious disease. It often occurs with tertiary syphilis and bone tuberculosis.

The genetic factor, as well as the load on a particular organ, will help determine where exactly osteosclerosis will develop:

• In the spine;
• IN hip joint;
• In the rib;
• In the shoulder joint;
• In the knee joint;
• In the calcaneus;
• In the femur.

If a person knows about the predisposition, he has a better chance of getting an x-ray done on time and stopping the progress of the disease by initial stage until it led to sad consequences.

An increased risk of developing osteosclerosis appears:

• For Albers-Schönberg disease, fluorosis, saturnism, tumors of the breast, prostate and bronchi;
• If you have other diseases of the joints and bones;
• With low changes in hormone levels during menopause or simply with aging;
• With very serious stress on the joints;
• In case of joint injury;
• With excessive weight, obesity;
• In case of poisoning with heavy metals and chemical components;
• If there is inflammation in the body;
• For benign and malignant neoplasms;
• For fractures of a certain part of the body;
• In case of incorrect nutrition (absorption large quantity junk food);
• For metabolic disorders (metabolism);
• With dysfunction of the endocrine system;
• For marble disease, osteopoikilia and melorheostosis.

Types of osteosclerosis

In addition to dividing osteosclerosis into forms (pathological and physiological, which appears during bone growth), it is also subdivided on other grounds.

By the number and volume of affected bones:

1. Focal;
2. Local;
3. Common;
4. Systemic.

Accordingly, focal osteosclerosis affects the smallest area of ​​tissue, and systemic osteosclerosis affects the entire body. With local, we are usually talking about an injury superimposed on the disease in a certain area of ​​the body, and with widespread, the pathology occurs in several bones at the same time.

The causes of osteosclerosis are:

1. physiological (bone structures stop growing, and then the growth zones are damaged; usually occurs in children and adolescents);
2. idiopathic (due to disruption of the correct process of bone development);
3. post-traumatic (due to dislocations, cracks, fractures);
4. reactive (as a reaction to a new formation, for example, a tumor, and also in cases when nutrients do not enter the bone in the required volume);
5. toxic (due to poisoning by chemicals or heavy metals).

Determining the causes of osteosclerosis helps to correctly prescribe a course of treatment. It will vary depending on the specific reason. For example, in case of toxic poisoning, it will be necessary to detoxify the body, in case of injury, it will be necessary to treat the injury, and so on.

The main difficulty in treating osteosclerosis is that it is difficult to diagnose. By the way, osteosclerosis can affect not only bones, but also cartilage. Of course, on an x-ray you can see the destruction of tissue, the destructive work of the disease, but usually x-rays are not done without external symptoms. Already in later stages pain appears.

If pain appears, or if you are at risk, you should immediately consult a doctor, because it may indicate that osteosclerosis has already entered the next stage, which can lead to serious complications - for example, total loss ability to move.

The greater the load on the organ in which osteosclerosis may have occurred, the more it hurts. If there is a violation in the hip joint, pain will be noted in the sacrum and ilium, usually after a person has sat in one place or walked for a long time. Therefore, office employees, taxi and truck drivers, and sales managers who have to walk a lot suffer from it.

The patient may limp. With this type of osteosclerosis, there is a risk of fracture, so you need to carefully control your loads, not allowing them to be exceeded. The number of complications with improper treatment of this type can be high.

Osteosclerosis of the shoulder joint does not depend on any specific profession, because almost all people experience excessive stress on their shoulders. You need to put your hands behind your back, and if pain occurs, this is enough to go to the doctor. Externally, the deformation does not manifest itself in any way.

Osteosclerosis of the knee joint is very insidious, because with it even the feeling of pain rarely occurs. Most often it is diagnosed when a person already comes in with an injury caused by this disease. Indirect sign may be caused by a feeling of fatigue that quickly occurs when walking. There may also be some pain.

Despite the desire to ignore her, she needs to be given the closest attention and, if possible, an x-ray. If it comes to injury, then treating osteosclerosis will be much more difficult.

For osteosclerosis of the heel and talus the foot and phalanges of the fingers will be bent. Also, the lower limbs experience pain and discomfort, even with little physical activity. It is possible to develop flat feet.

Even osteosclerosis of the tooth root may occur, but it is extremely rare. Typically, those bones that experience the greatest daily stress are susceptible to disease.

To diagnose osteosclerosis of the spine, X-rays are not enough; an MRI (magnetic resonance imaging) will be required. Usually the pain with this type of disease is aching. It can be painful not only to stand, but also to lie down. The curvature of the spine usually becomes visible.

Of course, its presence does not necessarily indicate osteosclerosis - perhaps it is another disease. The doctor must determine which one exactly. The triggering of this type of osteosclerosis can lead to consequences including cancer. In milder cases, there may be hernias, kyphosis, osteochondrosis, which also cannot be called mild complications.

Analyzes

In addition to x-rays, if osteosclerosis is suspected, computed tomography and MRI. Ultrasound may also be required. Genetic testing is expensive, so it is done by those who can afford it. They are good because they high degree accuracy allows you to determine whether there is a predisposition to osteosclerosis.

They also do an analysis of the biochemical composition of blood, urine, and, ideally, tumor markers, because this disease relatively often leads to oncology.

Treatment of osteosclerosis

Treatment of osteosclerosis folk remedies impossible; need to use modern medicine. The basis is injections with glucosamine and chondroitin, which restore bone and cartilage tissue. You need to prepare that the course of treatment will be long - from a quarter of a year to six months.

The administration of drugs is stopped when the doctor sees visible changes on the x-ray indicating that the disease has subsided.

Anti-inflammatory painkillers (hormonal and non-hormonal) are also used. Normalization of bone tissue function is accelerated by physiotherapy, which includes mud therapy, massage, ultrasound, magnetotherapy and electropheresis with medications selected by a doctor.

Therapeutic exercise serves as a complementary aid to the body with osteosclerosis. The load is increased gradually and used during the recovery process. various types simulators. Recovery speeds up proper diet with a minimum of fatty, fried foods and refined sugar.

Braces and bandages protect against injury, which will significantly complicate the course of the disease. A bandage is also necessary when increasing physical activity during treatment. And healthy good sleep helps more rapid change tissues towards normal.

Surgery for osteosclerosis

Surgery for osteosclerosis requires a bone marrow transplant, which helps restore normal bone function. The procedure is unpleasant, but necessary for those who want to forget about the disease.

The operation is also indicated when necrotic areas from dead cells have appeared in the bone; in this case you need to remove them. And finally, when the joint is completely destroyed, it can even be removed.

Prognosis for osteosclerosis

In a large percentage of cases, a complete cure of osteosclerosis is possible, but if the problem has affected the joints and/or spine, then it can only be stopped and the patient relieved of pain, as well as further complications. You will have to constantly adhere to a certain lifestyle. A complete cure requires a bone marrow transplant. In some cases, splenectomy or red blood cell transfusion is used (if anemia develops due to illness).

If the disease is not treated in time, changes in the shape of the skeleton and paresis are possible. facial nerve, anemia, permanent injuries and even cancer. In the worst situation, a person can become disabled or even die.

Prevention

Osteosclerosis is easier to prevent than to treat it. Therefore, those who are at risk (genetic predisposition, huge pressure, living in a bad environment, excess weight) you should take a number of measures to protect yourself from the disease.

• Limit the amount of alcohol you drink;
• Sleep on a hard-soft mattress;
• Make sure your posture is correct;
• Do not overload the joints;
• If you have excess weight, get rid of it;
• Do physical education.

Physical education is good because it improves blood circulation, and good blood circulation promotes normal functioning tissues, reduces the likelihood of developing not only osteosclerosis, but also other joint/bone diseases.

Osteosclerosis literally means a pathological increase in bone density, causing it to have little bone marrow and a predominance of compact, hard substance. The bone partitions (trabeculae) thicken, the spongy bone substance acquires a structure in the form of elongated narrow loops, and the bones become deformed. This phenomenon is exactly the opposite of osteoporosis. It would seem that there is nothing bad in dense bone, but this is far from the case: bone strength with osteosclerosis is greatly reduced, the pathology itself is accompanied by a number of unpleasant symptoms and changes in internal organs. The long tubular bones of the extremities and ilium, however, osteosclerosis of the spine and even the jaw is also possible.

Physiological and pathological osteosclerosis

Osteosclerosis is a rarely observed symptom that may be caused by physiological characteristics in childhood and adolescence, when the skeleton is growing rapidly, and in the growth zone there is a focus of osteosclerosis with increased density. In this case, it is not considered a pathology, since these phenomena disappear when growth stops.

In medicine, the term “osteosclerosis” is usually understood as pathological condition bones at which it has overweight, which occurs in some hereditary, degenerative and oncological diseases.

Causes of osteosclerosis

Symptoms of osteosclerosis are observed in osteoarthritis, bone metastases, as well as for the following congenital diseases family hereditary type:

• osteopetrosis (Albers-Schoenberg disease or);
• Leri's disease (melorheostosis);
• osteopoikilia (ostepoikilosis);
• myelofibrosis.

If you dig deeper

The pathogenesis of excess bone mass is determined by the dysfunction of osteoclasts, while these cells themselves, due to which resorption occurs, that is, bone destruction, can be either small or sufficient, and even more than normal. The mechanism itself primary violation osteogenesis still remains unknown. It has been noted that a phenomenon such as osteosclerosis is accompanied by a deficiency of a special osteoclast enzyme (carbonic anhydrase), due to which they stop pumping calcium salts from the joint into the blood, and their excessive deposition in the bones begins.

Symptoms of osteosclerosis

Let's take a closer look at the symptoms of each disease that can cause osteosclerosis of the spine.

Osteopetrosis

It is observed:

• diffuse osteosclerosis;
• frequent pathological fractures that heal poorly due to sclerosis of the bone canal;
• hypochromic anemia (in childhood);
• enlargement of the liver, spleen and lymph nodes;
• decreased height and deformation of the vertebrae;
• compacted and deformed areas of the ribs and the base of the skull;
• if the base of the skull is affected, hydrocephalus is possible;
• when nerve branches are compressed by deformed bones - paralysis of the limbs, ophthalmological disorders (strabismus, impaired convergence, nystagmus, nerve atrophy and other disorders), hearing problems.

Osteopetrosis in children

Newborns with osteopetrosis may experience:

• complete blindness or very poor vision;
• late appearance of teeth;
• teeth are easily susceptible to caries and periodontal disease;
• often dental problems combined with osteomyelitis or necrosis.

Melorheostosis

This is a congenital focal bone dysplasia of a benign nature, affecting unilaterally the arm or leg, rarely the spine (vertebral bodies) and the skull (mainly the lower jaw).

This creates:

• dull aching pain in bones and muscles;
• bone deformities;
• restrictions on motor functions;
• contractures.

X-ray shows:

• white stripes (dense bony areas, opaque to x-ray radiation), resembling melted wax in shape;
• neighboring areas bordering the affected lesion without changes or with minor signs.

In the photo: Right-sided melorheostosis of the spine (a wavy line of deformation of the vertebrae is visible, resembling frozen wax).

Ostepoikilosis (spotty multiple osteosclerosis)

The disease is observed very rarely, mainly affecting the short bones of the foot and hand (tarsals, carpals), as well as end sections long tubular bones (epiphyses) of the humerus or femur with adjacent metaphyses. Young people and adolescents are susceptible to the disease.

It manifests itself in the heterogeneous structure of the bones: many round spots or stripes of the same size are noticeable on them (from small two-millimeter to two-centimeter).

The picture of the pathology resembles melorheostosis, but with osteopoikilosis there is no pain, deformation, functional limitations and other symptoms. As a rule, pathology is detected during examination for other diseases completely by chance.

Chronic myelofibrosis (myeloid metaplasia)

This is rare serious pathology stem cells, which usually first appears in old age, after 60 years.

Its causes are unknown, but the provoking factor may be partly irradiation, exposure chemical substances(eg benzene).

Symptoms other than typical signs osteosclerosis, with myelofibrosis the following:

• abnormal enlargement of the spleen (splenomegaly): it is so large that it affects the size of the abdomen;
• V in rare cases enlargement of the liver and lymph nodes (with hepatomegaly, splenomegaly is usually not observed);
• proliferation of blood vessels and bone marrow cells;
• autoimmune disorders manifested in the presence rheumatoid factor, autoantibodies, hypergammaglobulinemia;
• autonomic disorders (sweating, hot flashes);
• constant fatigue;
• cachexia (severe exhaustion).

The disease affects the proximal (middle) sections of long tubular bones, areas of the spine, ribs, and skull.

Sometimes a routine examination (ultrasound, blood test) helps to identify pathology:

• Ultrasound shows an enlarged spleen.
• The level of platelets, leukocytes and erythrocytes in the blood is reduced (in a quarter of patients the decrease in these indicators is moderate).
• One tenth of patients have polycythemia vera(hyperplasia of bone marrow cells) with an increase in the number of red blood cells, blood viscosity and thrombus formation.
• The appearance of nucleated cellular components, myelocytes, and immature bone marrow cells (myeloblasts) is also possible.

Subchondral osteosclerosis

Manifestations of osteosclerosis are also possible in pathologies such as deforming osteoarthritis:

• at the second or third stage of the process, the subchondral bone is affected;
• to patch up damage, the body locally inhibits the functions of osteoclasts;
• the subchondral bone becomes denser and osteosclerosis develops in it.

Symptoms of osteonecrosis can be observed with osteoarthritis of the spine at the stage of destruction of intervertebral discs and hyaline cartilage vertebrae In addition to compensatory osteophytes growing along the edges, an osteosclerotic process can be observed in the vertebral bodies: they flatten, become barrel-shaped or concave, the density of the compact solid substance increases, and the end plates are deformed.

Osteoarthritis of the spine is usually a consequence of systemic disease, often also caused by hereditary factors. It affects not only the joints of the vertebrae, but even the ribs, since their areas attached to the sternum consist of cartilage. When arthrosis devours cartilage, to prevent the possibility of permanent subluxation of the ribs, local sclerosis of the ribs occurs, and they form a tight, immovable connection with the sternum.

Osteosclerosis with metastases in the spine

Benign osteosclerosis of the vertebrae is a rather rare phenomenon for the spine, which cannot be said about bone metastases, which often target vertebrae and ribs. Therefore, if the patient lung cancer, prostate gland, lymphogranulomatosis, and he is diagnosed with osteosclerosis of the vertebrae (especially the upper thoracic), then there is a high probability of osteoblastic metastases. (In breast cancer, metastases in women develop predominantly osteoclastic, that is, not with compaction, but with a decrease in bone density). However, before making an accurate diagnosis, the doctor calls the detected changes in the vertebrae osteosclerosis.

Diagnosis of osteosclerotic pathologies

The fundamental research methods are radiographic (X-ray, CT or MRI) and laboratory. A bone marrow biopsy may also be needed. Osteosclerotic diseases can be confused with each other (for example, marble disease with melorheostosis), as well as with other diseases: hypoparathyroidism, osteoblastic metastases, hypervitaminosis vit. D, lymphoma, Paget's disease, Hodgkin's disease, etc. Differential diagnostics are carried out to determine the differences.

• With myeloma, bone thinning occurs rather than thickening, plus malignant plasmacytosis is observed.
• Hypervitaminosis is accompanied by an increase in the vitamin content in the serum.
• Metastases are usually heterogeneous in size and occur mainly in old age, in contrast to osteosclerotic lesions observed almost from the womb.

How to treat spinal osteosclerosis

Myeloid metaplasia (myelofibrosis), as well as marble disease (osteopetrosis), can only be cured with stem cell transplantation. Otherwise, it is purely symptomatic and preventive treatment with the help of corticosteroid and renal hormones (glycoproteins), interferon gamma and other drugs.

Symptomatic treatment of osteopetrosis and chronic myelofibrosis

• Corticosteroids are used to increase bone resorption and thereby reduce bone density.
• Glycoproteins, which include, for example, hematopoietin, are needed to prevent anemia.
• Interferon gamma inhibits bone dysplasia and protects against viral infections.
• In case of complicated course of congenital childhood osteosclerosis, vitamin D intake is combined with interferon gamma, or treatment is carried out with one of these drugs.

Maintenance treatment

Maintenance treatment with constant monitoring by an orthopedic surgeon is also necessary:

• Therapeutic exercises for the prevention of spinal deformities with the exception of stress on the diseased area.
• A massage that relaxes muscles with increased tonic tension.
• to relieve fatigue and back pain.
• Water procedures, swimming.

How to treat osteosclerosis in other cases

• For melorheostosis, only symptomatic treatment, sometimes operating room, if a spinal nerve is compressed by a deformed vertebra.
• With osteopoikilosis, due to the absence of symptoms, treatment is not required. You just need to monitor, limit stress, and protect yourself from bruises and falls to reduce the risk of a pathological fracture.
• Subchondral osteosclerosis, which develops against the background of deforming osteoarthritis, is usually not identified as a separate diagnosis: it is considered one of the symptoms of arthrosis. Treatment is carried out in terms of a single complex therapy

Diagnosed with many older people, former and current professional athletes, overweight people or those suffering from alcohol and nicotine addiction, as well as for citizens who do not fit into any of these groups, but have a certain disposition, the word “Osteosclerosis” is written.

Osteosclerosis - what is it?

Osteosclerosis is a pathological increase in bone tissue density without obvious symptomatic signs. It is only slightly less common than osteoporosis (a disease associated with pathology of the bone structure).

The affected areas with this disorder are easily identified by an x-ray. The volume and outline of the bone in the case of osteosclerotic processes do not undergo changes. The cure of the disease occurs under the guidance traumatologist and orthopedist.

The main problem is the absence of symptoms at the onset of the disease- There is practically no opportunity to start treatment in a timely manner. If left untreated, osteochondral changes can lead to paralysis of the limbs and the formation of malignant tumors.

Symptoms: It's a dull pain in standing and lying positions. In addition, it is deformed spinal column and its structure.

These signs are not unique and can accompany other diseases, so a very accurate diagnosis will be required before making a final diagnosis.

Consequences of spinal osteosclerosis:

• Kyphosis;
• Osteochondrosis;
• Intervertebral hernia.

In the absence of proper medical care and treatment, an imbalance in the bone structure appears. It leads to malignant neoplasms and seals.

Diagnosis of the disease

Due to unexpressed symptoms, this disease can be correctly diagnosed only with the help of radiography.

Treatment

In most cases, osteosclerosis can be cured using a therapeutic approach. The participation of a surgeon (for a bone marrow transplant) may be required only if the disease is severely advanced.

The main points of therapeutic intervention in the treatment of subchondral osteosclerosis include:

• Treatment with drugs. It is prescribed to take medications containing glucosamine and chondroitin. Duration: from three months up to six months, but the result is very clear.
• Gymnastic treatment and massages. More than other activities, the use of an exercise bike is prescribed. But if inflammation begins to develop, then training is limited or completely eliminated until improvements occur.
• Dieting. To reduce the stress on bones and joints affected by the disease, you will need to normalize your body weight. Therefore, fried and fatty foods. Sugar, baked goods and other high-carbohydrate foods will need to be limited.

In the case of articular or vertebral osteosclerosis It is impossible to completely eliminate the consequences of the disease. But all of the above directions of treatment must be followed, since then the disease will not progress, but general state will improve and pain syndrome will retreat.