Osteolysis

An occupation-related acro osteolysis has been recognized in workers exposed to polyvinylchloride or vapours of other synthetic materials during the manufacturing process. Initially a Raynaud's phenomenon-like disorder ensues, with the later appearance of drumstick fingers and watch-glass nails.

Post-traumatic osteolysis occurs in some patients after trauma; in such cases an excessive degree of bone resorption may appear, particularly in the distal end of the clavicle, pubic and ischial rami, distal portions of the radius or ulna, carpus, or femoral neck (see clavicle (III:1), Fig. 2). Sometimes fractures also ensue, and the radiographic findings simulate the appearance of a malignant process.

Osteolytic lesions are encountered in the tubular and flat bones in patients with leukaemia and in the axial skeleton in some cases of non Hodgkins lymphoma, the latter exhibiting a motheaten bone destruction or permeative bone destruction. In Brill Symmers disease, the trabeculae have a peculiar lacelike osteolytic pattern with bone expansion.

Pagets disease is characterized by an active osteolytic phase and an inactive osteosclerotic phase, most evident in the cranial vault, pelvis and long tubular bones. Osteolysis also occurs in numerous sites in scleroderma, and a forefoot osteolysis is described in patients with diabetes mellitus. Severe osteolysis may follow untreated or inadequately treated osteomyelitis.

In addition, a group of heterogeneous and idiopathic conditions exists that are characterized by significant and severe osteolysis (Table 1). These syndromes are discussed in more detail under their specific names.

Osteolysis, Table 1. Osteolysis syndromes

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