In hyperostosis, bone tissue increases. The culprit is usually increased activity of osteoblasts. Drug treatment options are now available for treatment in addition to curettage.
What is hyperostosis?
In hyperplasia, a tissue or organ enlarges by increasing its cell count. This increase in cell number is usually a response to functionally increased stress or hormonal stimulation. Hyperplasias are reversible. Once the causative stimulus is removed, the affected tissue normalizes. Different subgroups of hyperplasia exist depending on the type of tissue affected. Hyperostosis corresponds to hyperplasia of bone tissue. In the phenomenon, excess bone tissue is formed in excess. The so-called osteoblasts are responsible for the formation of bone tissue. Their excessive activity also underlies the pathological proliferation of bone substance in the sense of hyperostosis. Hyperostosis is also called bone hypertrophy or bone hyperplasia. Bone hypertrophies, as distinguished from hyperplasias, are not caused by a proliferation of cells but by an increase in the size of individual cells. Hyperostosis is either inward or outward. In the case of the former phenomenon, the term endostal hyperostosis is also used. The outward direction is described by the term exostosis or cortical hyperostosis. In its narrower definition, the term hyperostosis describes a bone disease characterized by an increase in bone density, thus affecting primarily the ratio of bone mass to bone volume.
Causes
All hyperostoses are caused by increased activity of bone-forming osteoblasts. The increased activity results in either compaction of bone mass or appositional bone growth. Especially the latter phenomenon results in a change of shape and size of the affected bone. Hyperostoses can also result when the bone resorbing osteoclasts are impaired in their function. Human bone mass is affected by remodeling work throughout life, which consists of an interplay between bone formers and osteoclasts. Thus, when the interplay is out of balance, hyperostoses are conceivable. A main trigger for increased bone formation is hormonal irritation or particular stresses on a bone. This is how localized hyperostoses develop. A hormonal imbalance may play a role in this context. Apart from this, metabolic disorders such as the consequences of chronic kidney failure can be causally involved in increased bone formation. In addition, poisoning with fluorides, lead, vitamin A, bismuth, arsenic, strontium, phosphorus or beryllium may play a role. Altered bone cell activities also underlie hereditary diseases such as juvenile Paget’s disease, [Van Buchem syndrome]], or osteopetrosis, with mutations usually being the original trigger in this context. In addition, causes such as rheumatoid diseases in the sense of SAPHO syndrome or Forestier’s disease are conceivable triggers. In addition, chronic infections such as tuberculosis, tumors such as meningiomas, and paraneoplastic syndromes in the context of pachydermoperiostosis of bronchial carcinoma may be causative.
Symptoms, complaints, and signs
Patients with hyperostosis suffer from increased bone tissue formation, which is characterized by increased osteoblast activity and may be accompanied by decreased osteoclast activity. Moderate hyperostosis usually does not present with severe pain. However, severe hyperostosis may well be accompanied by pain. For example, if the affected bone is involved in articular connections, then movement disorders or other deficits may develop as a consequence of the increase in size. All other symptoms of hyperostosis depend, in addition to the affected body part, primarily on the primary cause of the disease. In the case of hormonal disorders, there is an imbalance in the hormone balance accompanying the hyperostosis, which can have completely different effects depending on the hormones involved. Causes from the rheumatoid form are usually accompanied above all by severe pain conditions, which can periodically bring the affected person to pain-related immobility.In causative infections, the accompanying symptoms usually correspond to general signs of infection, such as fever, chills, lassitude, or similar symptoms. When hyperostosis has a hereditary basis, the abnormal activity usually persists from birth, with all bones of the body often affected by the phenomenon.
Diagnosis and disease progression
Hyperostosis is diagnosed with the aid of imaging techniques such as radiographic imaging or MRI. A biopsy of the affected tissue can confirm the tentative diagnosis. Laboratory chemistry is used to determine values such as calcium in particular. Because hyperostosis is merely a symptom of an overriding disease, diagnosis includes elucidation of the primary cause.
Complications
Hyperostosis does not necessarily result in pain or other unpleasant symptoms. In most cases, the resulting complications depend on the extent of the disease, which is why no general prediction is possible. If the disease is severe, it can cause pain in the bones and thus restrict movement. These limitations lead to psychological discomfort and sometimes depression in many patients. However, they can be treated relatively well with the help of a psychologist. Furthermore, there is an unbalanced hormone balance. This also leads to various complaints, which depend on the respective hormone deficiencies. As a rule, patients also suffer from chills and high fever. The patient’s ability to cope with stress decreases enormously and those affected no longer take an active part in life. The patient also continues to be fatigued. The quality of life is extremely reduced by the complaints. The treatment of hyperostosis does not lead to further complications or discomfort. However, in most cases, bone marrow transplantation is necessary to relieve the discomfort. Life expectancy is usually not reduced by hyperostosis.
When should you see a doctor?
If unusually severe pain is noticed over a long period of time, a doctor should be consulted. Hyperostosis is also manifested by increasing movement disorders and nonspecific pressure sensations in the area of the bones – these should also be clarified quickly. If other complaints arise, medical advice is required. Any accompanying symptoms such as fever, chills or fatigue must be examined and treated if necessary if they persist for more than two to three days. If other symptoms of a serious illness are added, medical advice must be sought the same day. People who have hormonal imbalances or metabolic disorders are particularly at risk. Chronic kidney failure and poisoning are also possible triggers. People who belong to these risk groups should go to their family doctor with the symptoms mentioned. Other contacts are specialists in internal medicine or an orthopedist. In the case of severe symptoms, the emergency medical service can be contacted first, who will recommend further measures. In case of doubt, a visit to the hospital is indicated.
Treatment and therapy
Treatment of hyperostosis depends on the primary cause and the pattern of involvement. Depending on this, therapy may encompass surgical, orthopedic, or neurosurgical interventions. In addition to invasive procedures, conservative drug treatments are available. For example, the administration of calcitriol can increase the activity of osteoclasts that break down bone. In addition, allogeneic bone marrow transplantation can stimulate bone tissue resorption. Invasive treatment options also include curettage, in which the bone is surgically removed. Nevertheless, the treatment of the underlying disease is the focus of therapy in hyperostoses, since only with an improvement or cure of the cause can a permanent normalization of the bone tissue be achieved. Mutation-related underlying diseases cannot be cured, but in most cases they can be mitigated and delayed. Above all, the progression of hyperostosis is prevented in this way. In the case of causative hormonal imbalances, hormonal substitution may stimulate osteoclast activity and downregulate osteoblast activity.In the case of poisoning, the aim is to eliminate the toxins, which is primarily brought about by diuresis. Thus, supporting renal function is the focus in this case.
Outlook and prognosis
The prognosis of existing hyperostosis depends on the particular cause. Acromegaly (giant growth), exostosis, or endostosis may occur. On the growing skeleton, excess formation of bone tissue leads to increased length growth in addition to an increase in bone thickness. In addition to the enlargement of the hands, feet, chin, nose and ears (acromegaly), increased growth up to giant size also takes place. There are also forms of hyperostosis associated with short stature. In the context of exostosis, permanent outgrowths are formed on the bone surface. Exostosis leads to deformation of bones, limitation of movement and pain. Nerve compression is also possible. Asymptomatic courses, apart from minor bone deformities, may also occur. Bone may also grow inward (endostosis), narrowing the medullary canal. Often the bone mass thickens (osteosclerosis). Very often, hyperostosis occurs in the context of certain hereditary diseases. In these cases, healing is not possible. After the removal of exostoses, the results are often not satisfactory either, because recurrences often form. In the case of hereditary underlying diseases, generalized osteosclerosis is often seen. This means that a compression of the bone mass takes place on the entire skeleton. However, there are also diseases with local osteosclerosis. This occurs in both benign and malignant bone tumors, among others.
Prevention
Hyperostosis can have innumerable causes. Not all, but individual causes can be prevented. Prophylactic steps include avoiding local irritation from overuse.
Aftercare
In the case of hyperostosis, only very limited options and measures of aftercare are available to the affected person. First and foremost, a quick and, above all, early diagnosis must be made so that no further complications or complaints occur. The earlier the disease is detected, the better the further course of the disease usually is. No general prediction can be made about the further course or about the life expectancy of the affected person. The disease is usually treated with the help of drugs. In doing so, the patient must pay attention to the correct intake and dosage. A doctor should always be consulted first if there are any questions or if anything is unclear. A doctor should also be contacted first in the event of interactions or side effects. As a rule, the underlying disease must first be properly treated in order to completely alleviate the symptoms of hyperostosis. During treatment, the internal organs of the affected person should be examined regularly to prevent further damage. In particular, the kidneys must be examined regularly. However, in some cases, surgical intervention is necessary, after which the affected person must rest in any case.
What you can do yourself
Hyperostosis represents a serious condition that is often associated with chronic discomfort. What self-help measures can be taken by those affected depends on how far the causative disease has already progressed and what symptoms are manifested. In principle, individual action can be taken against the individual symptoms. In the case of fever and chills, bed rest and rest are recommended first and foremost. In addition, the affected person should pay attention to a gentle diet and monitor the body temperature. If the fever rises above 40 degrees, a doctor must be consulted. Fatigue and exhaustion can be alleviated by means of various homeopathic remedies, for example belladonna and devil’s claw. Acutely, moist compresses and moderate exercise help. If the symptoms do not subside as a result, medical advice is needed. In the case of hormonal disorders, exercise and a change in diet also help. However, if pain is added, medications must be used. The medical preparations may be supplemented by natural remedies such as St. John’s wort or calendula ointment, provided the doctor gives his consent. Accompanying the above-mentioned measures, close medical supervision is always indicated to ensure a positive course of the disease.
