Hyperostosis 101

Bone tissue increases in hyperostosis . This is usually due to increased activity of the osteoblasts. In addition to curettage, drug treatment options are now also available for treatment.

What is hyperostosis?

Severe hyperostosis can be associated with pain. If the affected bone is involved in articulated connections, for example, movement disorders or other deficits can occur as a result of the increase in size. See AbbreviationFinder for abbreviations related to Hyperostosis.

In hyperplasia, a tissue or organ enlarges by increasing its cell count. This cell count increase is usually a reaction to functionally increased stress or hormonal stimulation. Hyperplasia is reversible. Once the causative stimulus is removed, the affected tissue returns to normal.

Depending on the type of tissue affected, different subgroups of hyperplasia exist. 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 is also the basis of the pathological proliferation of bone substance in the sense of hyperostosis.

Hyperostosis is also known as bone hypertrophy or bone hyperplasia. In contrast to hyperplasia, bone hypertrophy is not caused by cell proliferation but by an increase in the size of the individual cells. Hyperostosis is either inward or outward. The former phenomenon is also referred to as endosteal hyperostosis.

The outward direction is described by the term exostosis or cortical hyperostosis. In its narrower definition, the term hyperostosis describes a bone disease that is characterized by the increase in bone density and thus primarily affects the ratio of bone mass to bone volume.

Causes

All hyperostoses are caused by increased activity of the bone-forming osteoblasts. The increased activity results in either densification of bone mass or appositional bone growth. The latter phenomenon in particular results in a change in shape and size of the affected bone.

Hyperostosis can also result if the function of the bone-degrading osteoclasts is disrupted. The human bone mass is affected throughout life by remodeling work that consists of an interaction of bone formers and osteoclasts. So if the interaction gets out of balance, hyperostosis is conceivable.

A main trigger for increased bone formation is hormonal irritation or particular stress on a bone. This is how localized hyperostosis occurs. A hormonal imbalance may play a role in this context. Apart from that, metabolic disorders such as the consequences of chronic kidney failure can be causally involved in increased bone formation.

Poisoning with fluorides, lead, vitamin A, bismuth, arsenic, strontium, phosphorus or beryllium can also play a role. Changed activities of the bone cells are also the basis of hereditary diseases such as juvenile Paget’s disease, [Van Buchem syndrome]] or osteopetrosis, whereby mutations are usually 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 a bronchial carcinoma can be the cause.

Symptoms, Ailments & Signs

Patients with hyperostosis suffer from an increased build-up of bone tissue, which is characterized by increased osteoblast activity and can be associated with reduced osteoclast activity. With moderate hyperostosis, there is usually no severe pain.

However, severe hyperostosis can be accompanied by pain. If the affected bone is involved in articulated connections, for example, movement disorders or other deficits can occur as a result of the increase in size. All other symptoms of hyperostosis depend not only on the affected part of the body, but above all on the primary cause of the disease.

In the case of hormonal disorders, there is an imbalance in the hormonal balance accompanying hyperostosis, which can have completely different effects depending on the hormones involved. Causes from the rheumatoid type are usually associated with severe pain conditions, which can lead to pain-related inability to move at regular intervals for those affected.

In the case of causative infections, the accompanying symptoms usually correspond to general signs of infection such as fever, chills, exhaustion or similar symptoms. When hyperostosis has an underlying hereditary basis, the abnormal activity is usually present from birth, often involving all bones of the body with the phenomenon.

Diagnosis & course of disease

The diagnosis of hyperostosis is made with the help of imaging methods such as X-ray imaging or MRI. A biopsy of the affected tissue can confirm the suspected diagnosis. Values ​​such as calcium are primarily determined in the laboratory. Since the hyperostosis is merely the symptom of a higher-level disease, the diagnosis includes the elucidation of the primary cause.

Complications

Hyperostosis does not necessarily have to lead to pain or other unpleasant symptoms. The resulting complications depend in most cases on the severity of the disease, which is why no general prediction is possible. If it spreads too far, it can cause pain in the bones and thus restricted movement.

In many patients, these restrictions lead to psychological problems and sometimes to depression. However, they can be treated relatively well with the help of a psychologist. There is also an imbalance in hormone levels. Here, too, there are various symptoms that depend on the respective hormone deficits. As a rule, the patients also suffer from chills and a high fever.

The patient’s resilience drops enormously and those affected no longer actively participate in life. The patient continues to feel exhausted. The quality of life is extremely reduced by the symptoms. There are no further complications or complaints in the treatment of hyperostosis. In most cases, however, a bone marrow transplant is necessary to relieve the symptoms. Life expectancy is usually not reduced by hyperostosis.

When should you go to the 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 unspecific feelings of pressure in the bone area – these must also be clarified quickly. If other symptoms appear, 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 there are other symptoms of a serious illness, medical advice must be sought on the same day. People with a hormonal imbalance 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 orthopaedist. In the case of severe symptoms, the medical emergency service can be contacted first, and they will recommend further measures. If in doubt, a visit to the hospital is indicated.

Treatment & Therapy

Treatment of hyperostosis depends on the primary cause and the pattern of involvement. Depending on this, the therapy can include surgical, orthopedic or neurosurgical interventions. In addition to invasive procedures, conservative drug treatment procedures are available.

With the administration of calcitriol, for example, the activity of the bone-degrading osteoclasts can be increased. In addition, allogeneic bone marrow transplantation can stimulate the resorption of bone tissue. Invasive treatment options also include curettage, in which the bone is surgically removed.

Nevertheless, in the case of hyperostosis, the treatment of the underlying disease is the focus of therapy, since permanent normalization of the bone tissue can only be achieved if the cause is improved or cured. Mutation-related underlying diseases cannot be cured, but can be alleviated and delayed in most cases. Above all, the progression of hyperostosis is prevented in this way.

In the case of disruptions in the hormonal balance that are the cause, hormonal substitution can stimulate the activity of the osteoclasts and down-regulate the activity of the osteoblasts. In the case of poisoning, the aim should be to eliminate the toxins, which is primarily brought about by diuresis. In this case, the focus is on supporting kidney function.

Outlook & Forecast

The prognosis of an existing hyperostosis depends on the respective cause. Acromegaly (giant growth), exostosis or endostosis can occur.

In the growing skeleton, excess formation of bone tissue leads not only to an increase in bone thickness but also to increased growth in length. In addition to the enlargement of hands, feet, chin, nose and ears (acromegaly), there is also increased growth up to giant growth. There are also forms of hyperostosis associated with short stature. In the course of an exostosis, permanent growths form on the bone surface. An exostosis leads to deformation of the bones, restricted movement and pain. Nerve compressions are also possible. Asymptomatic courses, apart from minor bone deformities, can also occur. The bone can also grow inwards (endostosis) and thus narrow the marrow cavity. Bone mass often thickens (osteosclerosis).

Hyperostosis occurs very often in the context of certain hereditary diseases. In these cases, healing is not possible. After exostoses have been removed, the results are often unsatisfactory because recurrences often develop. Generalized osteosclerosis often occurs in the case of hereditary underlying diseases. This means that there is a densification of the bone mass over the entire skeleton. However, there are also diseases with local osteosclerosis. This occurs, among other things, in both benign and malignant bone tumors.

Prevention

Hyperostosis can have numerous causes. Not all, but individual causes can be prevented. Prophylactic steps include avoiding local irritation from overload.

Aftercare

In the case of hyperostosis, the person affected only has very limited options and measures for aftercare. First and foremost, a quick and, above all, early diagnosis must be made so that there are no further complications or symptoms. The earlier the disease is detected, the better the further course is in most cases. 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 drugs. The patient must pay attention to the correct intake and the correct dosage. If you have any questions or are unclear, you should always consult a doctor first. A doctor should also be contacted first in the event of interactions or side effects. As a rule, the underlying disease must first be treated correctly in order to completely alleviate the symptoms of hyperostosis.

During treatment, the patient’s internal organs should be examined regularly to prevent further damage. The kidneys in particular must be examined regularly. In some cases, however, an operation is necessary, after which the person concerned must rest in any case.

You can do that yourself

Hyperostosis is a serious condition that is often associated with chronic symptoms. Which self-help measures those affected can take depends on how far the causative disease has progressed and what symptoms appear.

In principle, the individual symptoms can be treated individually. In the case of fever and chills, bed rest and rest are recommended in the first place. 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 with various homeopathic remedies, such as belladonna and devil’s claw. Moist compresses and moderate exercise help acutely.

If the symptoms do not decrease as a result, medical advice is required. Exercise and a change in diet also help with hormonal imbalances. However, if pain is added, medication must be used. Under certain circumstances, the medical preparations can be supplemented with natural remedies such as St. John’s wort or marigold ointment, provided the doctor gives his consent. In addition to the measures mentioned, a close medical check-up is always indicated in order to ensure a positive course of the disease.