Osteosclerosis of the joints. Subchondral osteosclerosis

Osteosclerosis can be a normal variant, as well as a serious pathology. In what cases does it occur and what is the threat to the patient? To do this, you should delve into the features of this condition.

What is osteosclerosis?

Bone consists of a number of structural elements - osteons, which fold into trabeculae (bone crossbars). They are visible on an x-ray or cross-section with the naked eye.

Based on the position of the trabeculae, two types of bone substance are distinguished - spongy (bone beams are laid loosely, absorbs the load) and compact (dense structure, can withstand heavy weight).

Osteosclerosis is the growth of a dense, compact substance, with thickening and compaction of the areas where it is physiologically located and displacement of the spongy substance. At the same time, the bone becomes denser and less elastic, resists stress less well, and is susceptible to pathological fractures.

Development of osteosclerosis

Osteosclerosis of articular surfaces can also be physiological - it accompanies the growth and ossification of the skeleton in childhood and recovery from injuries.

Types of osteosclerosis

There are several types of osteosclerosis depending on the causes and characteristics of the lesion:

physiological(ossification of growth zones in children);
pathological(all other cases);
congenital(increased bone density, osteopetrosis - premature closure of growth zones);
acquired(result of injury, inflammation or tumor).

Also by type of localization and prevalence:

uniform(affects the entire bone or a large area);
spotted(affects several small areas);
local or local(occupies an area of bone tissue, may be associated with loads in a certain area);
limited(occupies an entire area of the bone);
common(the process affects several bones);
systemic– lesions are noted far apart throughout the skeleton.

Some types of pathology deserve special attention. Subchondral osteosclerosis develops with osteoarthritis, a joint disease that is accompanied by degradation of cartilage tissue.

Such osteosclerosis is considered a characteristic diagnostic sign. Damage to the spinal endplates is a diagnostic sign.

Foci of osteosclerosis in the bones

Pathological foci are visible on an x-ray in the form of lighter areas (on an x-ray – darkening) of denser bone tissue in the patient’s body without clear boundaries. Their shape and size may vary depending on the form of the disease.

Foci of osteosclerosis on an x-ray image

Diagnostics

Which doctor should I consult for osteosclerosis? If you have complaints, you should start with a therapist. Most likely, he will write out a referral to a surgeon or traumatologist. The treatment of the disease is carried out by an orthopedic doctor, who may request consultations with a surgeon, infectious disease specialist, traumatologist and oncologist, if necessary.

Radiography plays an important role in the diagnosis of osteosclerosis. The appearance of moderate foci of denser tissue on X-ray examination is a sufficient reason to begin treatment.

If necessary, a sample may be taken for a biopsy (for cancer testing). Densitometry helps determine the mineral density of bone tissue.

X-ray image of osteosclerosis

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Osteosclerosis can occur for several reasons, most often acquired:

injury and recovery period after it;
inflammation (osteomyelitis,);
tumor process;
intoxication.

Causes of osteosclerosis of bones

Among the congenital anomalies are disorders of phosphate metabolism, as well as genetic disorders that predispose to such diseases. Systemic connective tissue diseases are possible, which lead to the development of osteosclerosis.

Symptoms of osteosclerosis

The change in bone structure itself does not cause any characteristic symptoms. However, the patient notices decreased mobility in the joints, pain in the limbs or back.

But most often osteosclerosis is diagnosed with pathological fractures. This is the name for injuries that occur during normal, non-extreme loads for a given patient - walking, running, lifting light weights, morning exercises.

Localization	Pain syndrome	Mobility impairment	Other
	Lumbar, less often sacral, cervical and thoracic regions, positions in which there is no discomfort are impossible to find	Decreased flexibility, pain when bending over and sudden movements	Increased risk of pinched vertebrae and spinal injuries
	Absent for a long time, occurs only during prolonged exercise, relieves after rest	Increased fatigue of the joint, rather mildly expressed, the condition is alleviated after rest	Sluggish course, erased symptoms
Upper limb joints	Occurs in the early stages, provoked by movement. A characteristic symptom of damage to the shoulder joint is pain when abducting the arm.	Mobility is preserved, but painful. Particularly pronounced in relation to the fingers	Symmetrical lesion
	Strong in the standing position in the pelvic area, especially during walking in the femur	Lameness often occurs in the affected limb	A common complication is a femoral neck fracture.
	Permanent, migrating, intensified at rest and with intense exercise, weakened with moderate intensity exercise	Not expressed	A disease of professional athletes, most often symmetrical damage to the heel bones or foot
Ilium	In the groin, sacrum, lower back, sternum, sides. May be constant or come and go	Not expressed	During pregnancy there is a high risk of rupture of the symphysis pubis
Edge	Severe, when breathing, mistaken for heart pain	Not expressed	Risk of deformation, injury
acetabulum	While standing or sitting, while walking	Significantly pronounced, leads to lameness	Rare pathology, high risk of hip dislocation

Treatment

Currently, osteosclerosis of any localization is preferably treated conservatively (that is, using medications and physical therapy techniques). The use of surgical methods is required only in severe cases of the disease, when other means have proven ineffective.

It is mandatory to prescribe a treatment regimen and diet - this increases the effectiveness of procedures and drug treatment. After the operation, a fairly long recovery period is recommended. Physical activity must be strictly dosed.

Drug treatment of osteosclerosis

Drug treatment of osteosclerosis is carried out strictly as prescribed by the doctor:

Among medications for the treatment of osteosclerosis, the most important are chondroitin and glucosamine preparations (Chondrogard and others). They allow effective restoration of bone and cartilage tissue and support the growth of normal osteons and trabeculae.
For osteosclerosis of the knee joint the drugs are prescribed in the form of tablets or intra-articular injections. The course of treatment is up to six months.
If other joints are affected, injections are not used from the risk of damaging the ligaments.
Additionally, restorative treatment, phosphorus and calcium supplements, vitamin D, which improve the metabolism of minerals in the bones. It is possible to prescribe hormones that regulate bone mineralization.

Physical therapy and exercise

Physical activity is extremely important for the normal formation of trabeculae. is selected taking into account the localization of pathological changes and the nature of bone lesions.

For osteosclerosis of the lower extremities, the most effective exercise is considered to be an exercise bike, walking, running and squats. If the shoulder joints are affected - rotation, raising and lowering the arms.

Pull-ups and push-ups are not recommended. Affected elbows and hand joints require flexion, extension and rotation. A special restraint (knee pad, elbow pad) must be worn on the affected joint to limit mobility.

An approximate set of exercises for patients with osteosclerosis of the knee joint:

Warm-up– raising on toes – 20 times, rotating the knee joint – 10 times in each direction.
Squats– 20-30 times, more is possible if you are in good physical shape.
Exercise bike– 30 minutes, or run 30 minutes.
Stretching– bending over with straight knees.
Completion– slow walking for 2-3 minutes.

You should check the set of exercises with your doctor - the same techniques are not suitable for all patients. If the spine is affected, you can perform some of the exercises while sitting or lying down.

Among the physical treatments for osteosclerosis, preference should be given to massage with warming oils and ointments. Gels can also be used. This procedure should be carried out by a professional massage therapist to avoid the risk of accidental injury.

This is especially important when it comes to osteosclerosis of the spine - an insufficiently qualified massage therapist can provoke or.

In addition to massage, other types of physiotherapy are indicated:

Warming procedures are also necessary, which increase blood circulation, improve tissue nutrition - infrared irradiation, .
Electrophoresis with chondroprotectors and painkillers is prescribed agents, less often - anti-inflammatory drugs.
Possible use of UHF and ultraviolet irradiation to increase blood circulation in diseased bones.

Physiotherapy methods are used as additional to the main treatment regimen.

Surgical intervention

Considered a last resort. It is prescribed in cases where other methods have proven ineffective, as well as for deformations and bone fractures. Operations for osteosclerosis can be divided into two types – therapeutic and restorative.

X-ray after surgery

Restorative traumatological operations are prescribed for severe spinal deformities and vertebral osteosclerosis, which cannot be restored in other ways, as well as for fractures and dislocations of bones and joints. This involves repositioning the fragments, restoring the normal structure and fixing it with the help of traumatological structures.

Therapeutic operations for osteosclerosis - transplantation of healthy bone tissue into the affected area. The method is effective, but is associated with risks for the patient, like any operation.

Traditional home remedies

Folk remedies are not effective enough, however, many patients prefer to use them.

Among the most popular are:

cinquefoil (it is included in many ointments for joints and bones);
propolis tincture;
dead bees infused with alcohol;
snake poison;
a mixture of Vishnevsky ointment and heparin ointment.

Vishnevsky ointment Heparin ointment Propolis tincture

The effectiveness of such means is questionable. However, cinquefoil and snake venom are used as components of medicinal ointments.

Below are some recipes:

250g is infused in 3 liters of cold water and added to the bath.
Alcohol-based honey ointment– apply under a compress for 10-15 minutes.
A mixture of lingonberry leaves and sweet clover herb, St. John's wort and flax seeds in equal proportions, infuse in water for 2 hours, treat the affected areas three times a day. The same mixture can be infused with alcohol and used as compresses for 10-15 minutes daily.
An elegant solution for cat owners – the warmth of an animal sitting on the sore area is comparable to physiotherapy. In addition, the purring of a cat increases the production of endorphins.

Sanatorium treatment of osteosclerosis involves walking and exercise in the fresh air, proper nutrition, and a therapeutic regimen. It is advisable to go to sea and mud sanatoriums, where there are unique natural factors that improve the condition of bones and joints.

Sanatorium treatment of osteosclerosis

Patients with chronic bone damage are recommended to go to sanatoriums 2 times a year, preferably in spring and autumn. If the patient does not have such an opportunity, it is necessary to find it at least once a year.

A ticket to a sanatorium is prescribed by the attending physician; if necessary, a certificate of incapacity for work can be issued for this time.

If your back, neck or lower back hurts, do not delay treatment unless you want to end up in a wheelchair! Chronic aching pain in the back, neck or lower back is the main sign of osteochondrosis, hernia or other serious disease. Treatment must begin right now...

Nutrition and diet

Diet is not the main treatment. However, some dietary adjustments are required. First of all, you should think about the amount of food - you should not overeat, food should completely cover a person’s energy needs, but not exceed them.

When the bones of the lower extremities and spine are affected, it is very important to normalize weight if there is excess weight.

Required and permitted products:

milk and dairy products, preferably low-fat;
dietary meat and offal – liver, heart;
fresh fruits - apples, grapes, pears, bananas;
cereals, primarily buckwheat and pearl barley.

These products contain calcium, which is necessary for the construction of normal bone tissue, supporting healthy regeneration processes and trabecular formation. Foods that should be limited are bread and pastries, especially white ones, sweets, alcohol and fatty foods.

Consequences and prognosis

When talking about the consequences, the cause of the pathology should be taken into account. If we are talking about physiological osteosclerosis, then there is nothing to be afraid of - this process must end in a timely manner, in accordance with the age norm. If this does not happen, treatment and diet are prescribed.

Post-traumatic osteosclerosis is part of the recovery process. This is normal. After fractures, trabeculae form chaotically, and in order to give them the desired direction, a measured load is required. If the exercises are performed in a timely manner, the prognosis is favorable.

If we are talking about pathological osteosclerosis, then the following complications are possible:

pathological bone fractures;
inflammatory process in cartilage and joints;
destruction of bone tissue;
osteomyelitis.

In severe stages of the disease, a deferment or complete exemption from military conscription is given. Disability is granted for complications of the disease.

Prevention of osteosclerosis

It is impossible to completely avoid osteosclerosis, so we can only talk about maintaining a fairly high quality of life:

The doctor's recommendations regarding treatment should be strictly followed., diet and exercise. It is also possible to reduce the rate of progression of the disease in a chronic course.
It is necessary to eat foods containing calcium and phosphorus compounds, primarily dairy products and fruits.

Doctors often diagnose osteosclerosis of the articular surfaces. During the pathological process, the structure of bone tissue is disrupted and its density increases, and bone trabeculae are damaged. Changes may affect the area of the ankle, shoulder joint, head and neck of the femur, and metatarsal bone. The progression of osteosclerosis occurs against the background of bone inflammation, neoplasms, severe intoxication of the body, arthrosis and other joint diseases.

Why it develops: the main reasons

An osteosclerotic lesion in the ribs and other bone structures can develop independently or be a consequence of previous diseases. Sclerosis occurs in the area of the vertebra, knee, pelvis, collarbone, and often the disease manifests itself on the tooth. The following reasons can influence its development:

increased stress on the body;
insufficiently active way of life;
unbalanced diet, which contains a lot of fatty and unhealthy foods;
excess weight;
permanent injuries to the femur or other structures;
underdeveloped muscle corset;
diseases of the musculoskeletal system, congenital or acquired;
deviations of rheumatological or vascular type;
impaired metabolism;
dysfunction of the endocrine system;
age-related changes.

The disease is caused by mycobacterium tuberculosis.

Osteosclerosis can manifest itself as a complication of the following diseases:

cancer tumors with metastases to internal organs;
Paget's disease;
osteochondrosis of the cervical spine;
inflammatory reactions in bone tissue;
melorheostosis, characterized by benign dysplasia.

Osteoporosis and osteosclerosis are interrelated, since they can manifest themselves simultaneously, acting as complications of each other.

Classification

Damage to the bones of the body can be of several types, taking into account different parameters. The table shows the main types of osteosclerosis:

Classification	View	Peculiarities
By form	Physiological	Appears in childhood
	Physiological	It is not a pathology and goes away on its own
	Pathological	Occurs against the background of other diseases
By the number and volume of compacted bones	Focal	Detected in a small area of bone
	Local	The area connecting healthy and damaged tissue is injured
	Common	Several bones of the arms and legs are damaged at once
	System	Associated with damage to all bone structures
For reasons of occurrence	Functional or physiological	Characterized by damage to growth plates when bone structures stop growing
	Idiopathic	Caused by bone malformations
	Post-traumatic	Worries after injuries of varying severity and location
	Inflammatory	Develops in the body against the background of inflammation
	Reactive	Manifests itself as a result of neoplasm or impaired supply of nutrients to the bone
	Toxic	Progresses after poisoning the body with heavy metals and chemical components

The disease develops against the background of decreased bone density.

The focus of osteosclerosis can occur in any movable joint and bone structures, but most often the following localization is noted:

damage to the heel bone and knee joint;
injury to the pelvic joint and femoral heads;
damage to the shoulder joint;
less often - osteosclerosis of the tooth root.

Clinical symptoms

Osteosclerosis of the knee joint and other moving joints makes itself felt with characteristic signs. The main symptom of a disorder in the vertebra is pronounced pain, which intensifies with physical activity. A common localization of osteosclerosis is the area of the calcaneus and talus, in which the patient complains of the following pathological manifestations:

curvature of the foot;
deformation processes of the phalanges of the fingers;
constant fatigue in the lower extremities, which occurs even with light loads;
soreness in the foot;
flat feet;
impaired leg activity.

Localization of pathology in the hip joint limits a person’s mobility.

An equally rare localization is osteosclerosis of the hip joint, in which the following symptoms are observed:

pain in the pelvic area, becoming permanent;
limited movements;
limping when walking.

With such a violation, there is a high probability of damage to the femoral neck, resulting in aseptic necrosis of the femoral head. The death of the patient cannot be ruled out. Sometimes sclerosis of the spinal column develops, in which the entire musculoskeletal function is disrupted. The discs become fragile, resulting in fractures even under light loads.

With a pathological process in the area of the shoulder or ilium, osteosclerosis may not make itself felt for a long time.

How is diagnosis carried out?

Hardware diagnostics will help determine the degree of damage to joint and bone tissue.

Before treating osteosclerosis, you need to consult a doctor and find out the causes and nature of the severity of the disorder. Radiological signs and other diagnostic procedures help confirm the diagnosis. Complex diagnostics includes the following manipulations:

laboratory tests of blood and urine;
biochemistry of blood fluid;
genetic testing;
ultrasound diagnostics of the brain;
determining the density of bone structures;
test for cancer markers;
MRI and CT.

How and with what to treat osteosclerosis?

Conservative treatment

Treatment of joint pathologies requires an integrated approach.

Or other types of disease must be eliminated comprehensively, using several methods. In the early stages, it is possible to cope with the pathology by adjusting nutrition, physiotherapy and medications. For osteosclerosis, the following groups of drugs are prescribed:

glucocorticoid medications;
chondroprotective agents;
NSAIDs;
medications that relieve pain.

The following physiotherapeutic procedures are performed during treatment:

electrophoresis with drugs;
magnetic therapy;
UHF therapy;
mud therapy;
massage.

When is surgery required?

In the final stages of the disease, complete destruction of the joint occurs.

If conservative treatment of osteosclerosis does not bring results, then surgical intervention is prescribed. The operation is necessary in the following cases:

stenosis of the bone marrow canals, which requires bone marrow transplantation;
the need to remove foci of osteosclerosis that contain necrotic tissue;
damage to a large area of bone.

What are the forecasts?

If osteosclerosis of the ilium or other parts of the body is associated with congenital anomalies of the musculoskeletal system, then regular prevention is required to maintain a normal life. At the early stages of detection, the prognosis for a favorable outcome is quite high. If the patient does not treat the deviation for a long time, then disability occurs, threatening the patient’s premature death.

It is possible to avoid osteosclerosis if you adhere to proper nutrition and control your weight. A rational sleep and wakefulness regime is important. Increasing physical activity requires the use of special braces and bandages. If an inflammatory reaction or infection develops, it is necessary to consult a doctor promptly and undergo treatment.

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.

Content:

Reasons for development

Subchondral osteosclerosis is not a disease, but a morphological, 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. The processes of bone formation begin to prevail over the physiological destruction of 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 irritation of the receptors of the 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. It is recommended to take modern drugs - selective cyclooxygenase inhibitors, 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 from different pharmacological groups that relieve joint pain.

Many of the listed medications are available not only in tablets, but also in the form of injection solutions. Intramuscular administration is 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 effect on the gastrointestinal tract remains.

It is useful to use ointments with anesthetic and vascular components (troxevasin, fastum-gel and others). Local treatment of 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 of spinal osteoarthritis. To relieve its symptoms, the following methods are used:

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

In severe cases, surgical treatment is possible: 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 there is excessive load on the 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.

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, and the pathology itself is accompanied by a number of unpleasant symptoms and changes in the internal organs. Mainly the long tubular bones of the limbs and the ilium are affected, but osteosclerosis of the spine and even the jaw is also possible.

Osteosclerosis - what is it?

Physiological and pathological osteosclerosis

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

In medicine, the term “osteosclerosis” usually refers to a pathological condition of the bone in which it has excess mass, which occurs as a result of certain hereditary, degenerative and oncological diseases.

Causes of osteosclerosis

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

osteopetrosis (Albers-Schönberg 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 of primary osteogenesis disorder itself 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 us consider in more detail the symptoms of each disease in which osteosclerosis of the spine is possible.

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;
Dental problems are often 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 bone areas, opaque to x-rays), 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 the end sections of the 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 a rare, serious stem cell pathology that usually first appears in old age, after 60 years.

Its causes are unknown, but the provoking factor may be partly irradiation and exposure to chemicals (for example, benzene).

Symptoms, in addition to the typical signs of osteosclerosis, for myelofibrosis are as follows:

abnormal enlargement of the spleen (splenomegaly): it is so large that it affects the size of the abdomen;
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 of 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 the intervertebral discs and hyaline cartilage of the 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 a patient has lung cancer, prostate cancer, lymphogranulomatosis, and is diagnosed with osteosclerosis of the vertebrae (especially the upper thoracic region), 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, this is purely symptomatic and preventive treatment with 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 treatments, swimming.

How to treat osteosclerosis in other cases

For melorheostosis, only symptomatic treatment is carried out, sometimes surgical treatment if the spinal nerve is compressed by the 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.
For osteoblastic metastases, either vertebral removal is performed (for single operable lesions) or palliative treatment is performed (radiation or chemical therapy).

Surgical treatment of osteosclerosis

Surgical treatment consists of either resection of part of the vertebra or its complete replacement with a graft. It is used when a spinal nerve is compressed by a deformed vertebra.

Forecast

The most favorable prognostic factors are melorheostosis, osteopoikilosis, and subchondral osteoarthrosis. Marble disease, and especially idiopathic chronic myelofibrosis, have a poor prognosis.

The high mortality rate in these pathologies is primarily due to a complication after bone marrow transplantation in the form of graft-versus-host disease, which occurs in approximately 30% of cases. Spinal osteosclerosis is especially unfavorable with myelofibrosis and marbled disease in old age: for young patients whose age is less than 45 years, the five-year survival rate is 60% or higher, and for the elderly it is only about 15%. The prognosis for osteoblastic metastases is also unfavorable, although timely radical surgery or targeted radiation therapy can significantly prolong the life of patients.

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Reasons for development
Symptoms of subchondral osteosclerosis
Treatment of osteosclerosis of the hip and other joints
Treatment of subchondral osteosclerosis of the spine

Reasons for development

Subchondral osteosclerosis is not a disease, but a morphological, that is, structural change. It is caused by osteoarthritis, 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 congenital weakness (dysplasia), trauma or an autoimmune inflammatory process (for example, rheumatoid arthritis).

Factors that increase the likelihood of pathology:

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

Symptoms of subchondral osteosclerosis

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.

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.

Treatment of osteosclerosis of the hip and other joints

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

Principles of treatment of osteoarthritis:

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. Joint endoprosthetics is the main method of treating osteoarthritis; it also helps to get rid of subchondral osteosclerosis.

Groups of medicinal substances used:

Based on this table, you can select drugs from different pharmacological groups that relieve joint pain.

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

Treatment of subchondral osteosclerosis of the spine

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

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

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

Osteosclerosis

Osteosclerosis is a condition that is characterized by increased bone density, an increase in bone trabeculae, compact and spongy substance per unit volume of bone tissue, while the size of the bone does not change.

It would seem, what’s wrong with bone becoming denser? The fact is that osteosclerosis leads to a significant decrease in the elasticity of the changed area of the bone, which significantly increases the risk of developing fractures even with a slight external force.

Osteosclerosis ranks second after osteoporosis among bone tissue diseases. It develops when the functions of osteoclasts and osteoblasts (cells that synthesize and destroy bone tissue) are impaired.

This condition is a symptom of a large number of diseases, including infectious, tumor lesions, genetic diseases, intoxication and degenerative diseases of the musculoskeletal system. Treatment of osteosclerosis takes place under the supervision of doctors of such specialties as orthopedists and traumatologists.

Types and reasons

There are several classifications of osteosclerosis. Highlight:

physiological - develops in areas of bone growth in children and is not considered a pathology;
pathological – accompanies diseases and various pathological conditions.

Depending on the time of appearance of the compaction, there are:

congenital,
acquired.

Depending on the location of the lesions and the extent of the lesion, osteosclerosis can be:

local (focal) – occurs in a small area, for example, at the site of bone fusion after a fracture;
limited (local) - most often has a reactive nature and is formed in the area that separates healthy and damaged bone tissue by a pathological process, for example, with osteomyelitis, bone tuberculosis, Brody's abscess, sclerosing sacroiliitis;
common - diagnosed when the pathological process spreads to several bones of the lower extremities, upper or other skeletal structures (meloreostosis, Paget's disease, metastatic skeletal tumors);
systemic - almost the entire bone mass is affected; this process has many causes, among which there may be severe genetic diseases.

Depending on the cause, the following types of osteosclerosis are distinguished:

Idiopathic - the cause of bone compaction remains unknown (melorheostosis, marble disease, osteopoikilia).
Post-traumatic – develops as a result of skeletal fractures.
Physiological – observed in children during the period of active growth.
Reactive – reaction of bone tissue to a pathological process inside (osteomyelitis, tuberculosis, syphilis, Brody’s abscess, tumors).
Toxic – occurs in response to the action of heavy metals and other toxic substances.
Hereditary – combined with genetic diseases.
Degenerative-dystrophic - osteosclerosis of the end plates of the articular surfaces is one of the radiological signs of arthrosis of the joints and osteochondrosis of the spine.

Osteosclerosis as a sign of osteoarthrosis and osteochondrosis

It is important to understand! Osteosclerosis is not a separate disease; it is only one of many signs of primary pathology, which led to bone remodeling and the risk of pathological fracture.

Most often, when using this term, both doctors and patients mean the compaction of the structure of the subchondral bone, that is, the area that is in close proximity to the joint affected by arthrosis. In such cases, this process acts only as an additional criterion for diagnosing osteoarthritis during radiography. Clinically, it does not manifest itself in any way, and all the symptoms present in the patient are caused by degenerative-dystrophic damage to the joints or spine.

Let's consider the main symptoms that arise as a result of osteosclerosis and other pathological changes in various joints with arthrosis.

Spine

When the spine is damaged, osteosclerosis occurs in the area of the vertebral bodies that is in direct contact with the intervertebral disc damaged by osteochondrosis.

Consolidation of the bone tissue of spinal structures does not have any separate symptoms, but is manifested by signs of primary pathology. Patient complaints depend on the location of the lesion (cervical, thoracic, lumbosacral), the severity of pathological changes and the presence of complications, for example, intervertebral hernia, deformation of the spinal column, narrowing of the spinal cord canal, pinched nerve roots, etc.

The danger of spinal osteosclerosis is that due to such changes the vertebrae become very fragile and prone to fractures. Therefore, minimal trauma or physical stress can cause the development of a compression fracture.

It is impossible to establish a diagnosis using only an x-ray; more detailed examination methods are needed here: magnetic resonance or computed tomography.

Hip joint

Osteosclerosis of this localization often complicates the course of coxarthrosis. Patients complain of constant pain in the femur area both when walking and at rest. Limitation of the range of motion in the hip joint gradually develops, and patients begin to limp.

The main danger is an increased risk of neck fracture and aseptic necrosis of the femoral head. These are very severe injuries and are associated with increased premature mortality and disability. Therefore, if you identify pain in the hip joint, you need to undergo diagnostic examinations and begin treating the pathology as early as possible in order to prevent complications.

Knee-joint

Osteosclerosis of the knee joint very often accompanies the development of gonarthrosis and is a diagnostic radiological criterion for the latter. Patients complain of pain in the knee during physical activity, limited mobility in the joint, and crunching noise when moving. Over time, a pronounced deformity of the lower extremities develops, such as valgus or varus (O- and X-shaped legs), and the function of the knee is almost completely lost. In this case, only knee replacement surgery can help.

Shoulder joint

This localization of the pathological process is quite common. The shoulder joint is the most mobile joint in our body, so it is susceptible to degenerative processes and the development of arthrosis.

Osteosclerosis of the shoulder does not pose a particular danger, but it becomes the culprit of chronic pain and limited mobility of the upper limb, which worsens the quality of life of such people.

Ilium

Osteosclerosis of this localization is rare and remains asymptomatic for a long time.

It is important to know! Sclerosis of the iliosacral joints (sacroiliitis) is one of the most important diagnostic criteria for ankylosing spondylitis. Therefore, if osteosclerosis of such localization is detected on an x-ray, it is imperative to undergo a detailed diagnostic examination for ankylosing spondylitis.

Foot bones

Osteosclerosis of the calcaneus and other structures of the foot skeleton occurs in many orthopedic and traumatological diseases. Here are some of them:

osteochondropathy of the scaphoid bone,
osteochondropathy of the metatarsal heads,
osteochondropathy of the sesamoid bone,
dissecting osteochondrosis of the talus,
osteochondropathy of the calcaneal tuberosity.

These pathologies, as a rule, affect children and manifest themselves with similar symptoms (foot pain, deformation, disruption of the normal structure, flat feet, changes in gait). Conservative treatment does not always provide a positive result, so sometimes it is necessary to resort to surgical intervention.

Osteosclerosis in genetic diseases

There are several genetic disorders that are accompanied by osteosclerosis. As a rule, it is widespread or systemic in nature, which leads to serious consequences. Let us consider the main diseases, the leading symptom of which is osteosclerosis.

Melorheostosis

This disease is also called Leri's disease. This is a congenital skeletal defect, which is manifested by an increase in the density of a certain segment of one limb or several adjacent zones. In some cases, foci of osteosclerosis are also found in the vertebrae, ribs, and lower jaw.

Main clinical symptoms: pain, weakness, increased fatigue, development of muscle contractures.

Treatment is symptomatic, which consists mainly of preventing contractures. The prognosis for life is favorable.

Marble disease

This genetic disease is also called osteopetrosis. This is a severe hereditary pathology that has 2 variants of its course. The first type appears immediately after birth. Patients experience hydrocephalus, enlarged liver and spleen, and malformations of the organs of hearing and vision.

Such children are lagging behind in mental and physical development, they have severe anemia, systemic osteosclerosis and multiple spontaneous fractures. On radiographs, the bones are dense, homogeneous, and there is no bone canal. The second variant of the disease has the same symptoms, but begins to manifest itself at about 10 years of age. The prognosis for life is unfavorable.

Osteopoikilia

This is a congenital skeletal disease, which is accompanied by multiple foci of osteosclerosis. It is asymptomatic and diagnosed accidentally during X-ray examination. The prognosis is favorable.

Dysosteosclerosis

This is a genetic pathology that manifests itself in children at an early age. Main features:

growth retardation,
systemic osteosclerosis,
violation of dental development,
blindness,
paralysis.

The prognosis for this pathology is unfavorable; as a rule, children die at an early age.

Pycnodysostosis

This is a severe genetic disorder that is detected in children at an early age. The pathology is characterized by:

retardation in physical development;
disruption of the normal structure of the facial skeleton and teeth;
shortening of the hands;
systemic osteosclerosis and multiple pathological fractures.

The prognosis is poor and there is no specific treatment.

Paget's disease

This disease is also called osteitis deformans. Unfortunately, the causes of the pathology are not known today. With Paget's disease, the process of normal synthesis is disrupted and bone tissue is destroyed. As a result, the bone becomes mosaic with foci of osteoporosis and osteosclerosis, very fragile and prone to fractures.

Osteosclerosis due to bone infections

Inflammatory lesions of bone tissue of an infectious nature are often accompanied by local osteosclerosis, which limits the healthy area from the damaged one. Most often, such an x-ray sign is detected in the following diseases:

chronic Garre's osteomyelitis,
Brody's abscess,
syphilitic gummas with tertiary syphilis,
bone tuberculosis.

Thus, osteosclerosis is not a separate disease, but only one of the manifestations of multiple pathologies, both acquired and congenital. However, this change in the normal structure of bones can significantly increase the risk of spontaneous fractures, and therefore must be diagnosed in time for therapeutic and preventive measures.