What does bone destructive changes mean? Center of destruction

Bone destruction is not only the main sign of a pronounced pathology in a person, but also a complication of a number of diseases. For example, such a disorder is observed in myeloma or as one of the signs of Paget's disease. What influences the development of the symptom?

As the pathological process progresses, a decrease in bone density is observed, and as a result, their fragility increases. IN normal conditions(that is, in a healthy person) until the age of 20, a natural balance between the formation and degradation of bone tissue is constantly maintained. Then the process of bone tissue formation slows down, and the destruction process intensifies.

Change chemical composition tissue leads to a decrease in density. That is why in old age any bone injuries are much more difficult to heal than in young age. Weak bones are much easier to break, even with minor bruises.

This is what happens in principle. But there are a number of factors that influence the acceleration of this process.

What leads to accelerated bone destruction

A disease that leads to the destruction of bones from the inside is called osteoporosis. Literally, the bone elements of the skeleton become more porous. The acceleration of the process of changes in bone tissue density can be affected by:

Many people do not pay due attention to the disease and do not undergo prevention and treatment, which significantly increases the risk of disability and even mortality. And all because of the asymptomatic course of the pathological process. No pain or discomfort, no discomfort. Therefore, many people are in no hurry to go to the doctor, explaining their reluctance by the absence of pronounced symptoms of deterioration in well-being. In most cases, it is the fracture that becomes the reason for going to a medical institution, where bone disease is detected during diagnosis.

Advanced forms of osteoporosis are much more difficult to treat. Therefore this great importance Experts emphasize prevention rather than therapy.

Which bones are more likely to break?

The thinner and smaller the bone, the more it is subject to pressure normal conditions human life, the greater the likelihood of damage due to the presence of signs of osteoporosis. The following localization zones are distinguished:

• wrist;
• vertebrae;
• hips.

Injury can occur during a fall, with minor loads, or even spontaneously.

Injury occurs during a fall, with minor loads, and even spontaneously. Feels like sharp pain. Skeletal deformation occurs. Motor functions are impaired. Note that the disease develops much more actively in women than in men. This is mainly due to the hormonal background of the body, as well as the peculiarity of the body constitution.

Disease prevention

It is better to prevent any disease than to treat it later. But what to do with a disease that does not manifest itself in any way in the initial stages? There is a special diagnostic method, thanks to which it is possible to identify changes in bone tissue density with maximum accuracy.

An ultrasound technique called densitometry detects a decrease in density as low as 3-5%. Other hardware techniques, unfortunately, are ineffective for early response. For example, an x-ray will indicate a problem when the density decrease reaches 25-30%.

There are several more signs that can indirectly indicate the occurrence of a pathological process in the bones:

• reduction in height by more than 10 mm;
• rachiocampsis;
• pain in the lumbar and thoracic spine (increases during physical activity or prolonged stay in one position);
• fast fatiguability;
• decreased performance;
• there were several injuries with broken bones.

It is better to consult a doctor or fitness instructor about a set of exercises. An improvement in the condition is noted after the first month of preventive measures - an increase in inert mass by a couple of percent.

Treatment

The pathological restructuring of the bone structure, which is observed in osteoporosis, is accompanied by a uniform decrease in the amount of inert substance per unit volume of bone. The disease goes through two stages of development: spotty and uniform. That is, small foci appear first, which alternate with areas of normal density.

Gradually, the foci grow and merge, filling the entire space. Osteoporosis is classified according to its prevalence:

• local – limited localization area;
• regional – covers an entire anatomical region;
• common - involves several bones of one area, for example, all the bones of a limb;
• systemic - affects the bones of the entire skeleton.

By the way, bone destruction is also classified as a process with a violation of the inert structure. But unlike osteoporosis, where the disappeared bone tissue is replaced by fat, osteoid tissue and blood, destructive replacement occurs due to pus, granulation or tumor tissue.

Therapeutic measures in the treatment of osteoporosis are similar to preventive measures, but are more targeted. The therapy itself is a long and labor-intensive process. You need to follow a therapeutic diet and regularly perform a set of exercise therapy exercises. It is recommended to spend more time in the fresh air and take sunbathing in doses.

Two important natural food supplements should be included in your diet every day. These are fish oil (one of the sources of vitamin D) and eggshell powder (the most easily digestible source of natural calcium).

Provided and drug therapy. Choice medicines This pharmaceutical group is quite large today. The prescription for a complex of treatment and prevention is made by the doctor individually for each case.

You should not self-medicate and take mineral complexes uncontrollably. After all, the task is not just to replenish calcium deficiency, but to “retain” it in the body, that is, to promote the absorption of the substance and suppress the process of leaching it from the bones.

A disease caused by the destruction of bones can become quite an unpleasant phenomenon, creating not only temporary discomfort, but also causing serious damage to the body. Patients are forced to lead an inferior lifestyle. It’s not for nothing that doctors tirelessly repeat: preventing the development of a disease is the best method of treating it.

Osteogenic sarcoma (osteosarcoma) occupies the second place in frequency in this group of tumors (after myeloma) and is characterized by high malignancy and a tendency to metastasize to the lungs. It can occur at any age, but is most common between 10 and 20 years of age. About half of all osteosarcomas are localized in the area knee joint(although they can appear in any bones).

Common symptoms are pain and the presence of a mass. Radiological changes vary significantly: they can be predominantly sclerotic or lytic, character traits are missing. For an accurate diagnosis, a fairly typical sample of tumor tissue obtained by biopsy is required.

Once the diagnosis is established, consultation with an oncologist is necessary to select treatment tactics, including the question of whether the patient needs preoperative (non-adjuvant or postoperative (adjuvant) chemotherapy. If preoperative chemotherapy is performed, the subsequent course of the disease is assessed by the dynamics of radiological data, pain syndrome (which usually decreases) and the level of alkaline phosphatase (it usually decreases). After several sessions of chemotherapy, surgery is performed. Modern surgical techniques make it possible to remove many tumors without amputation of the limb, which was very common in the past. After preoperative chemotherapy and resection of the tumor, the degree of its necrosis can be assessed, caused by a chemical agent.In cases of almost complete necrosis, the results of subsequent surgery are most favorable.

Some oncologists, however, prefer postoperative (adjuvant) chemotherapy. Regardless of the type of chemotherapy, the 5-year survival rate is 75%. There is a lot going on right now clinical trials aimed at further increasing survival.

Fibrosarcoids are similar in their properties and problems of therapy to osteogenic sarcoma.

Malignant fibrous histiocytoma clinically similar to osteosarcoma and fibrosarcoma. Treatment is the same as for osteosarcoma.

Chondrosarcomas- malignant tumors of cartilage tissue - according to clinical manifestations, treatment tactics and prognosis differ from osteogenic sarcomas. They develop in more than 10% of patients with multiple benign osteochondromas; however, 90% of chondrosarcomas are primary, i.e. arise de novo.

Diagnosis can only be determined by biopsy. Histologically, many chondrosarcomas can be divided into four groups. Group 1 is slow growing and has a good chance of cure. Group 4 is characterized by rapid growth and a much greater tendency to form metastases. All chondrosarcomas are characterized by the ability to seed surrounding soft tissues.

Treatment consists of total surgical resection. Neither radiation nor chemotherapy is effective, whether used as primary or adjunctive treatment. Due to the fact that these tumors are capable of seeding, the wound must be sutured after the biopsy, and surgical removal of the tumor must be done very carefully. During the operation, one should diligently avoid introducing the instrument into the tumor and subsequent introduction of tumor cells into the soft tissue of the surgical wound: in such cases, tumor recurrence is inevitable. If this can be avoided, the cure rate is >50% and depends on the tumor type. When radical removal of the tumor while preserving the limb is not possible, amputation is necessary.

Mesenchymal chondrosarcoma- a rare, histologically independent type of chondrosarcoma with a high ability to metastasize. The cure rate is low.

Ewing's tumor (Ewing's sarcoma)- round cell bone tumor, sensitive to radiation. It occurs more often in men than in women. Compared to all other primary malignant bone tumors, this sarcoma develops at a younger age, most often between 10 and 20 years. It affects mainly the bones of the extremities, although it can occur in any other bones. The tumor consists of densely located small round cells. Most persistent symptoms- pain and swelling. Ewing's sarcoma tends to spread significantly and sometimes involves the entire diaphysis of a long bone. The pathologically changed area is usually more extensive than is visible on radiographs. The boundaries of the tumor can be more accurately determined using CT and MRI. Most characteristic change - lytic destruction bone, however, multiple “onion-shaped” layers of newly formed bone tissue under the periosteum may also be noted (this was previously considered a classic diagnostic sign).

Diagnostics should be based on biopsy data, since a similar radiological picture is possible with many other malignant bone tumors.

Treatment consists of using various combinations of surgical, chemotherapy and radiation methods. Currently, this combined approach can cure more than 60% of patients with primary local Ewing sarcoma.

Malignant bone lymphoma- a tumor with small round cells that occurs in adults, usually between the ages of 40 and 50. It can occur in any bone. Although this tumor can be considered reticulocellular sarcoma, it usually consists of a mixture of reticular cells with lymphoblasts and lymphocytes. When a patient has malignant bone lymphoma, three options are possible:

1. it may be a primary bone tumor without any signs of its presence in other tissues;
2. in addition to damage to this bone, signs of lymphoma can be found in other bones or soft tissues;
3. a patient with primary soft tissue lymphomatosis may subsequently develop bone metastases.

Common symptoms are pain and tissue swelling. Signs of bone destruction predominate on radiographs. Depending on the stage of the disease, changes in the affected bone can be small or large-spotted, and in advanced cases, sometimes the outer contour of the bone is almost completely lost. Pathological bone fractures are common.

When malignant lymphoma is localized only in bone tissue, the 5-year survival rate is at least 50%. The tumor is sensitive to radiation. A combination of radiation therapy and chemotherapy is as effective as surgical removal of the tumor. Amputation is indicated only if limb function is lost due to a pathological fracture or extensive soft tissue damage.

Multiple myeloma formed from hematopoietic cells; it is the most common of the bone tumors. The neoplastic process usually involves the bone marrow so diffusely that aspiration is of diagnostic value.

Malignant giant cell tumor is rare. Even its very existence is questioned. It usually forms at the very end of a long bone. X-rays show classic signs malignant destruction bone tissue: predominantly lytic changes, destruction of the cortical layer, spread of the process to soft tissue, pathological fractures. To be confident in the diagnosis, it is necessary to ensure the presence of areas of a typical benign giant cell tumor among the malignant tissue (or have evidence that such a benign tumor was in this place previously). Sarcoma that developed from a previous benign giant cell tumor is characterized by resistance to radiation therapy. The treatment uses the same principles as for osteogenic sarcoma (see above), but the results are worse.

There are many other types of primary malignant bone tumors, most of which are medical rarities. For example, from the remains of the embryonic notochord it can develop Chordoma. This tumor is most often located at the end of the spine, usually in the sacrum or near the base of the skull. In the first case, an almost constant complaint is pain in the sacrococcygeal region. With chordoma at the base of the occipital region, symptoms of damage to any cranial nerves, most often the oculomotor ones, are possible. It usually takes several months or even years before the correct diagnosis is made.

On x-rays, chordoma is revealed as widespread destructive bone changes, which may be accompanied by a mass formation in the tissues. Hematogenous sites of stasis are not typical. More serious problem than metastasis, represents a tendency to local relapses. Chordoma in the occipital and sphenoid bones of the skull is usually not accessible to surgical removal, but can be treated with radiation therapy. If the tumor is located in the sacrococcygeal region, it can be radically removed in one block.

Ed. N. Alipov

"Primary malignant bone tumors, diagnosis, treatment" - article from the section

In medicine, this process is known as bone destruction. In the process of destruction (destruction), the integrity of bone tissue is disrupted, which is replaced by pathological formations such as tumor growths, lipoids, degenerative and dystrophic changes, granulations, hemangiomas of the vertebral bodies. This condition leads to a decrease in bone density, increased fragility, deformation and complete destruction.

Characteristics of bone destruction

Destruction is the process of destruction of the bone structure with its replacement by tumor tissue, granulations, and pus. Bone destruction occurs only in rare cases at an accelerated pace; in most cases, this process is quite long. Destruction is often confused with osteoporosis, but despite the constant fact of destruction, these two processes have significant differences. If, during osteoporosis, bone tissue is destroyed and replaced with elements similar to bone, that is, blood, fat, osteoid tissue, then during destruction, replacement with pathological tissue occurs.

X-ray is a research method that allows you to recognize destructive changes in the bone. In this case, if with osteoporosis in the pictures you can see diffuse spotty clearings that do not have clear boundaries, then the destructive foci will be expressed in the form of a bone defect. In the photographs, fresh traces of destruction have uneven outlines, while the contours of old lesions, on the contrary, look dense and smooth. Destructions of bone tissue do not always occur in the same way; they differ in shape, size, contours, reaction of surrounding tissues, as well as the presence of shadows inside the destructive foci and the number of foci.

In the human body, destruction of tooth bone, vertebral bodies and other bones is often observed as a result of poor nutrition, poor hygiene, the development of hemangioma, and other concomitant diseases.

Why does the tooth bone deteriorate?

Dental diseases are a pathology that is accompanied by the destruction of bone tissue. Among various dental diseases that cause destructive changes in bone tissue, periodontal disease and periodontitis are considered the most common.

With periodontitis, destruction of all periodontal tissues occurs, including the gums, bone tissue of the alveoli, and the periodontium itself. The development of pathology is caused by pathogenic microflora, which enters the plaque of the tooth and the gum surrounding it. The infection lies in dental plaque, where gram-negative bacteria, spirochetes and other microorganisms live.

The activity of negative microflora is provoked by the following factors:

• bite problems;
• bad habits;
• dental prosthetics;
• poor nutrition;
• shortening of the frenulum of the tongue and lips;
• poor oral hygiene;
• carious cavities located near the gums;
• violations of interdental contacts;
• congenital periodontal pathologies;
• general diseases.

All of the above factors are the causes of the development of periodontitis and contribute to the activation pathogenic microflora, which especially negatively affects the attachment of the tooth to the gum.

The process of tooth destruction during periodontitis

Periodontitis is a disease in which the destruction of the connections between the tooth and gum tissue occurs with the formation of a periodontal pocket.

Pathology causes destructive changes in periodontal bone tissue and alveolar processes. The development of the acute form of the disease is caused by enzymes that negatively affect the intercellular communication of the epithelium, which becomes sensitive and permeable. Bacteria produce toxins that harm cells, ground substance, and connective tissue formations, while humoral immune and cellular reactions develop. Development inflammatory process in the gums leads to the destruction of alveolar bone, the formation of serotonin and histamine, which affect the cell membranes of blood vessels.

A periodontal pocket is formed as a result of the destruction of the epithelium, which grows into the connective tissues located at a level below. With further progression of the disease connective tissue around the tooth begins to gradually deteriorate, which simultaneously leads to the formation of granulation and destruction of the bone tissue of the alveoli. Without timely treatment, the tooth structure can completely collapse, which will lead to the gradual loss of all teeth.

Destructive changes in the spine

Bone destruction is a dangerous process, further development which must be warned at the first signs of pathology. Destructive changes affect not only the bone tissue of the tooth; without appropriate treatment, they can spread to other bones in the body. For example, as a result of the development of spondylitis, hemangiomas, destructive changes affect the spine as a whole or the vertebral bodies separately. Spinal pathology can lead to undesirable consequences, complications, partial or complete loss of mobility.

Spondylitis is a chronic inflammatory disease that is a type of spondylopathy. As the disease develops, pathology of the vertebral bodies and their destruction are noted, which threatens spinal deformation.

There is specific and nonspecific spondylitis. Specific spondylitis is caused by various infections that enter the blood and, with its help, spread throughout the body, affecting bones and joints along the way. Infectious pathogens include microbacteria:

• tuberculosis;
• syphilis;
• gonorrheal gonococcus;
• coli;
• streptococcus;
• Trichomonas;
• Staphylococcus aureus;
• pathogens of smallpox, typhoid, plague.

Sometimes the disease can be triggered by fungal cells or rheumatism. Nonspecific spondylitis occurs in the form of hematogenous purulent spondylitis, ankylosing spondylitis or ankylosing spondylitis.

Regardless of the cause of the disease, treatment must begin immediately after diagnosis.

Spondylitis is the cause of destruction of the vertebral bodies

With tuberculous spondylitis, damage to the vertebral bodies of the cervical and thoracic spine is noted. Pathology leads to the development of single purulent abscesses, cuts, and often irreversible paralysis upper limbs, formation of a pointed hump, deformation chest, inflammation of the spinal cord.

With brucellosis spondylitis, damage to the lumbar vertebral bodies is noted. X-ray photographs show fine focal destruction of the vertebral bone bodies. Serological testing is used for diagnosis.

Syphilitic spondylitis is a rare pathology that affects the cervical vertebrae.

In the typhoid form of the pathology, damage occurs to two adjacent vertebral bodies and the intervertebral disc connecting them. The process of destruction in the thoracolumbar and lumbosacral sector occurs quickly, with the formation of multiple purulent foci.

Damage to the periosteum of the vertebral bodies in the thoracic region occurs with actinomycotic spondylitis. As the pathology develops, purulent foci and punctate fistulas form, the release of whitish substances, and destruction of bone tissue are noted.

As a result of spinal trauma, aseptic spondylitis can develop, in which inflammation of the spinal bodies is noted. The pathology is dangerous because it can occur long time asymptomatic. In this case, patients may learn about the destruction of the spine with a delay, when the vertebra takes on a wedge-shaped shape and foci of necrosis appear in the spine.

What is a spinal hemangioma?

Destruction is a pathology that can affect both soft tissues and bones; patients often experience hemangiomas of the vertebral bodies.

Hemangioma is a benign tumor neoplasm. The development of hemangioma can be observed in humans regardless of age. Pathology often occurs in children due to improper development of blood vessels in the embryonic period.

Usually, no obvious disturbances are observed from the newly formed tumor, since it does not manifest itself with any symptoms, but this depends on its size and location. Discomfort, some disturbances in work internal organs, various complications can be caused by the development of hemangioma in the auricle, kidneys, liver and other organs.

Despite the fact that the tumor is a benign neoplasm, children experience accelerated growth in width and depth of soft tissue without metastasis. There are hemangiomas of the mucous membrane, internal and bone tissues (vertebral hemangioma).

Hemangiomas of the vertebral bodies are extremely rare in children. They develop as a result of congenital defects in the structure of blood vessels. When an increased load falls on the affected vertebra, hemorrhage occurs, activating the work of cells that destroy bone tissue, and this is how the destruction of the vertebral bodies occurs. Thrombi (blood clots) form at the site of the lesion, and in place of the destroyed bone tissue, new vessels appear, again defective. With a new load on the damaged area of ​​the spine, they burst again and hemorrhage occurs. All these processes, one after another, lead to the formation of hemangioma of the vertebral bodies.

Treatment of hemangioma

In children, hemangioma of the external integument is more common than of internal organs or the spine. Depending on the structure of the tumor, the pathology can be:

The tumor does not affect the further development of the child in any way; it looks like a cosmetic defect. But since tumors tend to grow quickly, doctors recommend constantly monitoring its condition; if it grows actively, immediate treatment will be required. For these purposes it is used:

• cryodestruction;
• sclerosis;
• cauterization;
• surgical intervention.

One of the most effective methods is cryodestruction - removal of capillary superficial hemangiomas, which are most common in children. This method can be used when the tumor is actively growing. It should not be used to treat cavernous or combined hemangiomas, since traces of ugly scars may remain on the skin. Cryodestruction is a method of removing a tumor using liquid nitrogen, which destroys its structure. For complete removal neoplasms must undergo three treatment sessions, after which the damaged skin tissue will begin to regenerate.

Destructive changes in bone tissue are a pathology that requires timely diagnosis and proper treatment. This approach to pathology will help to avoid many diseases of the skeletal system and complications in the future.

Osteoblastic and osteolytic metastases

Cancer is one of the most serious and severe diseases of our century. These are malignant tumors that consume organs in the human body one by one, which has a very negative impact on health and can be fatal.

Today we will talk about such a phenomenon as bone metastases, we will name the reasons for their appearance, diagnosis, prognosis, and so on.

Causes of bone metastases

In order to better understand why metastases form in the human body, it is necessary to fully describe the mechanism of the disease and the reasons for its occurrence.

Malignant neoplasms appear in the human body due to the formation of atypical cells in tissues. Medicine knows that atypical cells appear in the body every day. Our immune system successfully destroys them every day.

Unfortunately, there are situations when the immune system for some reason it misses one of these cells. This reason has not yet been established by modern doctors. This cell begins to divide uncontrollably, turning into a tumor.

After the formation of a tumor, a change in the circulatory system occurs. Now the nutrients go directly to the tumor. After reaching the third or fourth stage, metastases form. The mechanism of their occurrence is quite simple. Atypical cells break off from the site of the disease and move throughout the body in the blood, lymph, or are transmitted from organ to organ, which leads to the appearance of secondary foci of malignancy. Let's look at the ways of developing metastases in more detail:

1. hemolytic (through the blood). Atypical cells even travel to distant organs and affect them;
2. lymphatic. Elements of a malignant neoplasm travel through the lymph and affect the lymph nodes;
3. contact. A malignant tumor invades neighboring organs.

But why do bone metastases occur? Malignant elements move to the bones through the blood or lymph.

Features of metastases in bone tissue

Bone tissue, despite its apparent simplicity, is quite complex. It consists of two main types of cells:

The first of them are necessary for the destruction of bone. This process is necessary for the permanent remodeling of bones. Osteoblasts take part in recovery. Thus, we can say that a person’s bones grow throughout life.

Among other things, it is important to consider that approximately 10% of the blood from the heart flows to the bone tissue, which explains the nature of the occurrence of metastases with such localization. This is why bone lesions are so common. As a rule, metastases affect tubular bones. There are only two types of bone tissue damage by a malignant tumor: osteoblastic and osteolytic.

Osteoblastic metastases affect growth cells in such a way that they begin to grow and their number increases rapidly. This leads to bone growth and thickening. Osteolytic metastases, on the other hand, activate cells that are responsible for bone breakdown, resulting in bone destruction.

Another feature of such metastases is the appearance in those bones that are better supplied with blood than others. These include: spine, skull, ribs, pelvis. Pain with this diagnosis is usually constant, disturbing during movement and at rest.

Types of cancer that metastasize to bones

Modern medicine identifies several different types of cancer that can metastasize to bone tissue. Among patients, such secondary malignant neoplasms most often occur in the following pathological conditions:

1. prostate cancer;
2. malignant lesions of the mammary glands;
3. thyroid tumors;
4. Bone metastases are slightly less common with lung cancer, kidney;
5. sarcoma;
6. lymphoma.

The ribs, bone tissue of the pelvis and limbs are affected. Very often the bone marrow is involved in the malignant process. It is important to know that osteolytic metastases occur much more often than osteoblastic ones.

Most often, bone tissue is destroyed rather than grown when bone metastases are detected. Typically, bone growth is characteristic of prostate cancer.

What is the danger?

Secondary cancerous tumors in bones are extremely dangerous. The gradual destruction of bones causes multiple fractures and severe pain. They significantly reduce life expectancy and worsen its quality. Patients with this diagnosis often become disabled and rarely survive at all.

It should be understood that in the case of metastases, doctors are dealing with the third or fourth stage of cancer. At such stages, the disease is extremely difficult to treat. Unfortunately, in the vast majority of Russian specialized medical institutions, patients with stage 4 cancer are treated as hopeless patients. Therefore, doctors very often in such cases cancel radical treatment and try to improve the patient’s quality of life and increase its duration.

Another danger is that when bone tissue breaks down, large amounts of calcium are released into the blood. This leads to serious heart disease and renal failure. Symptoms of intoxication appear.

Diagnostics

Before prescribing treatment, it is necessary to make a correct diagnosis. Today there are quite a large number diagnostic measures that help to do this. It is important here to take into account not only the information obtained during instrumental studies, but also on the clinical picture. We are talking about the symptoms that the patient himself feels:

• severe pain that is constant;
• deterioration of the nervous system;
• swelling at the site of localization of secondary malignant neoplasms;
• depression;
• frequent fractures;
• loss of appetite;
• nausea;
• the skin becomes dry;
• significant and quick loss body weight;
• temperature increase;
• deterioration in performance;
• sleep disorders.

It should be understood that all these symptoms rarely appear all together. The patient may feel only part of them or not feel them at all. It all depends on the stage of development of the disease, the size of the primary lesion, the number of metastases, as well as the individual characteristics of each patient.

In the first stages, cancer practically does not detect itself at all. This is his main danger. If doctors learn to detect malignant tumors at the first stage of development in 100% of cases, this will mean victory over this terrible disease.

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The materials on the site are for informational purposes only, consultation with a doctor is required!

What is bone destruction?

The process of destruction in the bone structure, which gradually leads to its replacement with malignant tissue, granulation, pus - this is bone destruction. The progressive pathological process is accompanied by a decrease in bone density and an increase in their fragility. Harmony in the development of bone tissue up to the age of twenty occurs normally and naturally. After this age limit, the formation of such tissues becomes slower, and the destructive process only worsens.

Bones are a solid organ in our body, their functions are to provide musculoskeletal and protective function. They consist of hydroxyapatite, a mineral substance, about 60-70% of the bone's weight, and organic type I collagen, about 30-40%.

When this composition changes, bone density decreases. This is one of the reasons why it is more difficult for older people to recover from any injuries than for a person at a young age. Small negative external factors can easily lead to injury, because weak bones are more susceptible to impact. A number of factors can speed up this process.

8 important reasons

The internal source of bone tissue destruction is osteoporosis. This disease is systemic and progressive. Is it an exchange or clinical syndrome, characterized by a decrease in density and an increase in fragility. The metabolism of this tissue decreases, it becomes less durable, and the rate of fractures increases.

This disease was first found among Indians North America, about years BC. Also, the characteristic posture of this disease can be seen in the paintings of artists of Ancient China and Greece.

The degree of risk is determined based on objective medical history and examination results.

Osteoporosis leads to porous bone tissue. Several factors can also negatively affect this process. Causes of bone destruction:

1. diseases caused by a disorder of one or more endocrine glands - endocrine, chronic diseases;
2. flaw nutrients, these are bone builders in our body - magnesium, potassium, vitamin D, main reason deficiency is an unbalanced diet;
3. the last independent menstruation, that is, the period of menopause;
4. lack of weight indicator;
5. the presence of bad habits, aggravation of their progressiveness;
6. heredity, fall threatens people who have blood relatives under the age of fifty who were diagnosed with this disease;
7. past injuries that were aggravated by fractures;
8. professional athletes are also at risk, a large part of physical activity is the cause of the onset of this disease;

Important! Osteoporosis in advanced forms is more difficult to treat. It is worth paying more vigilance to prevention.

This will reduce the risk of disability and can save you from death. The risk lies in the absence of obvious symptoms, pain, severe discomfort, or unpleasant sensations. Most often, they are in no hurry to go for help, due to the “lack of severe symptoms" And when there is a fracture, and therefore contacting a specialist, unpleasant news is discovered.

Destruction of the skull bones

The most common lesion. After a long period of time, some bone lesions are replaced by completely different ones. X-ray examination will help identify bone tissue defects.

Foci of destruction can be ten centimeters in size and larger in diameter. In such cases, people feel a strong headache, ear pain. Pain sensations are observed mainly at night in people with affected long bones.

Children show great passivity during this period. It manifests itself in reduced mobility, refusal to lift any object with hands, or simply to walk.

The shape of the lesions is oblong, elongated along the length of the bone. Complication in the spine area, the person stops moving.

Destruction of the frontal bone

The air space inside it, due to an inflammatory disease, is made pathological - by the contents of the element. The filling is serous or purulent, edematous mucosa, or cyst. It is also possible that the harmonious state of the walls may be disrupted due to fractures or tumor damage. Particularly doubtful cases require the use of iodolipol and mayodil injected into the axillary part.

Destruction of the jaw bone

It manifests its effect repeatedly due to the germination of tumors. They develop from epithelial tissue into the oral mucosa. Up to ten percent is sarcoma, a larger percentage is cancer. Adenocarcinoma of the breast, thyroid, and prostate glands are some of the causes of metastases.

Important! It is X-ray intervention that will help to see isolated defects and various types of lesions.

Destruction of the femur

A consequence of blood flow disturbances and necrotic elements. This disease is aggravated by increased alcohol consumption, cordiosteroid use, joint injuries, and pancreatitis. Opportunity early diagnosis possible with the use of tomography.

Destruction of the temporal bone

It is best diagnosed using computed tomography and magnetic resonance imaging. Such methods are the most informative, they are accessible to most people, and this allows you to limit the size of the search.

Tumors are often found in the pyramidal part of such a bone: neuritoma, fibroma, glomus, osteoma. The ear areas are most often affected.

Metastatic lesions are possible with cancerous tumor mammary glands, lungs, kidneys.

Important! Radiologically, it is possible to anticipate the manifestation of a tumor in a given area, with an appropriate size. It is necessary to know the structural features of bone, the basics of anatomy in order to timely detect the first signs of a different nature and approaches to eliminate them.

Destruction of the humerus

It is a serious disease that affects the bone element with the appearance of dead areas. Then it changes to adipose tissue. This disease is called ischemic necrosis. The pathology is based on a change in the normal state of blood supply to the bones. As a result, this tissue is deprived of 100% nutrition - it slowly dies.

The worst thing is that this disease leads to irreversibility in the condition of the bones. The minimum percentage of restoration of the structural part of the bones.

Important! The patient goes through all stages of the pathology within a period of several months to 1-1.5 years. Once the destruction of the humerus has begun its effect, this process can no longer be stopped. The patient goes through all stages, as a result of which, most likely, he ends up in a wheelchair.

Destruction of the pelvic bones

Accompanied by long-term asymptomatic treatment. Most often this is the wing iliac bones next to the sacroiliac joint. The first sign is a change in the bones, swelling. Children and adolescents are most susceptible to this disease. The pain threshold is moderate, the sensation is aching in nature. From a pathological point of view, there are no fractures. Treatment can only be surgically - bone resection. Big sizes form a defect and are shown by autoplastic and alloplastic replacements.

Prevention measures

Because of special method diagnostics, greater accuracy in detecting changes in density is possible.

There is an ultrasound technique called densitometry. Thanks to this technique, even minimal indicators of density reduction can be determined. Other hardware interventions are ineffective in the early stages. For comparison: an X-ray machine will show a result of twenty-five to thirty percent.

Experts discuss some signs that indicate the progression of this disease: a decrease in height of more than ten millimeters, the vertebral part is curved, the lower back and thoracic part hurt, especially during active physical activity, you get tired quickly, and your performance is minimal.

An active life is the best preventative measure for the development of this disease. This:

• balanced diet: correct ratio of proteins, fats, carbohydrates, large amounts of fresh vegetables and fruits;
• walking in clean air;
• morning exercises, physical training, not for wear and tear;
• minimizing bad habits such as cigars, alcoholic beverages and drinking coffee drinks;
• relaxing and toning massages.

Note! Before selecting exercises, approach it consciously; it would not be superfluous to consult a doctor or a fitness instructor. Over the course of several months of combining a balanced diet with moderate physical activity, inert mass increases by several percent.

Medical therapy

Similar preventive measures therapeutic methods of treatment. The difference lies in the greater direction of action. The disease itself is characterized by duration and labor intensity.

Note! A person should consume fish oil and eggshell powder daily; it is easier to digest.

Bone destruction is treated with drug therapy. You are provided with a wide range of medicines. The specialist prescribes treatment individually.

Self-medication is useless; the disease leads to a deterioration in the quality of life.

To minimize the occurrence of the disease, it is better to use preventive measures.

Method for treating osteolytic metastases

The incidence of malignant tumors is steadily increasing. Thus, over the past 10 years, for example in Russia, the number of annually registered patients with malignant tumors has increased by 16%.

Malignant tumors that tend to increase in incidence include breast cancer, kidney cancer, prostate gland and etc.

Malignant tumors are often accompanied by bone damage. The most common cancers that metastasize to the bones are breast, prostate and kidney cancer. Thus, the frequency of damage to skeletal bones in breast cancer (BC) is 47-85%, in kidney cancer (RC)%, in prostate cancer (PC) the osteoarticular apparatus is the predominant site of metastasis. In this case, metastases mainly affect the spine, the proximal part of the femur and humerus, pelvic bones, ribs, sternum.

Bone tissue is not dead, as was previously believed, it is highly vascularized and is characterized by constant restructuring (destruction and formation). Restructuring of bone tissue occurs constantly and, on average, complete renewal of the skeleton in an adult occurs every 10 years, and the phase of bone resorption necessarily precedes the phase of bone formation. Bone is formed by so-called osteoblasts and destroyed by osteoclasts.

With metastasis to the bones, a disruption of the normal process of bone formation is observed. At the same time, it is based on the activation of resorptive processes.

Bone metastases can be osteolytic, osteoblastic, or mixed.

With the development of osteoblastic metastases, new bone tissue is formed by osteoblasts activated by substances secreted tumor cells. Moreover, as a result of this process, bone formation is “abnormal” in nature, and the density of the resulting bone tissue may be higher than normal. Such an increase in density can radiographically simulate osteosclerosis. Osteoblastic metastases cause a marked increase in alkaline phosphatase and may be accompanied by hypocalcemia.

In the presence of osteolytic lesions, bone destruction (osteolysis) occurs mainly due to increased activity of osteoclasts stimulated by tumor tissue, which is accompanied by an increase in their number, i.e., practically the bone is destroyed by the patient’s own normal cells. Osteolytic metastases, due to their increased bone destruction, may be accompanied by hypercalcemia and hypercalciuria, which is an objective diagnostic sign of them. In this case, the serum level of alkaline phosphatase is normal or slightly elevated.

General in clinical picture These and other bone metastases are the presence of pain, deformities and pathological fractures. It is extremely rare that metastatic bone lesions are asymptomatic.

Traditional methods of treating pain from bone metastases include the use of analgesics, narcotics, radiation and/or chemotherapy or hormonal therapy. However, non-narcotic analgesics are effective only for minor pain; drugs have well-known side effects. Radiation therapy is effective in some cases, but its possibilities are limited due to the frequent need for repeated irradiation, significant dissemination of lesions, and the migrating nature of pain. In addition, most patients are unable to tolerate the side effects associated with external beam radiation therapy. With the help of chemotherapy, the disappearance of metastases or their reduction by more than 50% can be achieved in twice as many patients as with hormone therapy. However, analysis of the results of treatment through radiation and/or chemotherapy or hormonal therapy does not allow us to draw a conclusion about the possibility of prolonging the life of patients.

The disease at the stage of clinical dissemination is incurable. For example, average duration Life from the moment of detection of metastases in breast cancer varies from 2 to 3.5 years, 25-35% live more than 5 years and only 10% live more than 10 years. The statistics are approximately the same for PCa and RP.

Treatment of such patients is palliative. Its main goal is not to cure the patient (which, unfortunately, is impossible today), but to relieve symptoms and prolong life.

At the same time, survival rates for bone metastases are significantly higher and are a favorable prognostic sign compared with lesions of visceral organs. Thus, in a study based on an analysis of 489 patients with breast cancer, the median survival for bone metastases was 24 months, and for liver metastases - only 3 months.

The relatively long survival of these patients makes it highly relevant to carry out effective palliative treatment aimed at improving the “quality of life” of patients.

The present invention relates to the treatment of osteolytic metastases, characterized by the presence of pain, deformities and pathological bone fractures.

Since osteolysis is based on the activation of resorptive processes in bone tissue, last years The possibility of using drugs for therapeutic purposes is being studied, which have the ability to influence not so much the metabolism of the tumor itself, but rather the bone metabolism disturbed by the tumor process. This treatment is not cytotoxic and is not directed directly against cancer cells, but it is one of the real ways to improve the quality of life of patients.

Mithramycin, gallium nitrate, inhibitors of prostaglandin synthesis (aspirin, indomethacin), calcitonite and bisphosphonates have a similar mechanism of action. Since bisphosphonates have the ability to inhibit bone resorption for a long time, they have found the most widespread use for this purpose in medical practice.

As a prototype, we have chosen a method for treating osteolytic metastases using bisphosphonates, in particular clodronate (Bonefos) or pamidronate (Aredia) [Moiseenko V.M. and others. Modern drug treatment of locally advanced and metastatic breast cancer, St. Petersburg. Ed. "Griffin", 1997, p.].

The method consists of intravenous (IV) administration of a bisphosphonate (90 mg of pamidronate in 200 ml of saline as a 4-hour infusion monthly or 300 mg of clodronate in 500 ml of saline daily for 5-10 days, followed by oral administration of 1600 mg/day - for prostate cancer, 3200 mg/day for 1 month, and then 1600 mg/day - continuously for 4-6 months.

Bisphosphonates are indicated for cancer patients with osteolytic bone metastases for the palliative purpose of improving quality of life for:

Treatment and prevention of hypercalcemia,

Treatment and prevention of pain syndrome,

Prevention of deformities and pathological bone fractures.

Bisphosphonates are not an alternative to antitumor treatment (radiation, chemotherapy and/or hormonal therapy) and are used independently of it.

The technical result of the present invention consists of simultaneous analgesic and antitumor effects due to the use of Sr-89 chloride in the treatment regimen.

This result is achieved by the fact that in the known method of treating osteolytic metastases by intravenous drip administration of clodronate in an amount of 300 mg daily for 5-10 days or pamidronate in an amount of 90 mg once, followed by external beam radiation therapy and/or chemotherapy or hormonal therapy depending on the primary source of the tumor, according to the invention, clodronate or pamidronate is administered no more than once every 6 months, 4-5 weeks after their administration, 150 MBq (megabequerel) of strontium-89 chloride is injected intravenously and its injections are repeated no earlier than in 3 months

The administration of clodronate or pamidronate, which has the unique ability of bisphosphonates to inhibit the activity of osteoclasts that cause bone resorption, prevents deformations and pathological bone fractures and reduces pain, which improves the quality of life of cancer patients. Since bisphosphonates are deposited in the mineral part of the bone matrix, they have a long-lasting activity that persists for a long time even after stopping their administration [Moiseenko V.M. et al., 1997]. The mechanism of their analgesic effect is not clear enough.

The introduction of Sr-89 chloride into the treatment regimen by integrating it into the rarefied mineral structure of the affected area of ​​the bone provides the effect of local radiation therapy, i.e. has an antitumor effect. Since, as stated above, bisphosphonates are deposited in the mineral part of the bone matrix for a long time, they contribute to the long-term retention of Sr-89 chloride in it.

We explain the introduction of Sr-89 chloride 4-5 weeks after the bisphosphonate by the fact that this time is necessary for the incorporation of the bisphosphonate into the mineral part of the bone tissue, since the restructuring of bone tissue does not occur simultaneously.

Administration of a bisphosphonate once every 6 months ensures its constant content in the mineral part of the bone matrix, since its half-life is several months.

Injections of Sr-89 chloride no more often than after 3 months avoid unnecessary radiation exposure to the patient, since it remains in the metastases for about 100 days.

The essence of the method is illustrated by examples

Example 1. B. P., 87 years old, I/b N 1417, was admitted to the TsNIRRI clinic on 06/04/98 with a diagnosis of prostate cancer, T 2 N 0 M 1.

From the anamnesis: I first noticed frequent, difficult urination in the fall of 1997. I was treated at my place of residence for prostate adenoma - I took 4 mg of Dalfaz daily for 3 months. In the spring of 1998, pain appeared in the lumbar spine. In May 1998, based on a rectal examination, a prostate tumor was suspected and he was sent to the city oncology clinic. Biopsy results revealed poorly differentiated adenocarcinoma. The patient was sent to the Central Scientific Research Institute of Rural Infectious Diseases.

Upon admission: complaints of intense lower back pain, weakness, difficulty urinating.

Survey results. Blood: Hb-116 g/l, Er.-3.8 10 12 /l, L-5.8 10 9 l, Tr.-206 10 9 /l, ESR-45 mm/hour, Ca-2.8 mmol/l, total alkaline phosphataseau/l.

X-ray (Rg) of bones - osteoblastic metastases in L III and osteolytic - in Th VIII-x and IV, IX ribs. These data are confirmed by skeletal scintigraphy and MRT (magnetic resonance imaging) data.

The patient was prescribed hormone therapy: Androcur-depot IM 300 mg once every 10 days. Starting from 06/06/98, the patient underwent intravenous drip administration of clodronate 300 mg per injection (in 400 ml of 0.9% NaCl) for 10 days. At night, for pain, 1.0 Tramal was administered intramuscularly.

07/20/98 - Metastron (Sr-89 chloride) was administered intravenously in an amount of 150 MBq, after which the patient was discharged from the clinic under the supervision of an oncologist at the place of residence with a recommendation to continue the course of hormone therapy.

10/20/98 - re-hospitalization of the patient. Upon admission: Hb-105 g/l, Er. - 3.4 /l, L-5.6 10 9 /l, Tr.-195 10 9 /l, ESR-25 mm/hour, Ca-2.3 mmol/l, total alkaline phosph.u/l.

Rg of the skeleton - reduction in the size of metastatic foci, sclerosis of osteolytic metastases. The patient noted a decrease in pain in the spine 10 days after discharge from the clinic; every other day he took 1 t of Tramal at night.

10.22.98 - repeated injection of 150 MBq of metastron with continuation of outpatient hormone therapy in the same dosages with a visit to the clinic in a month.

11.20.98 - according to the results of the control examination: blood without visible changes, Rg copy of the skeleton bones without changes compared to the data from 10.20.98. The pain syndrome was relieved - the patient refused analgesics. I feel good.

01/29/99 - the patient came to the clinic with complaints of pain in the spine.

Examination results: blood: Hb-92 g/l, Er.- 3.8 10 12 /l, L-4.5 10 9 /l, ESR-15 mm/hour, Ca-2.2 mmol/l, total alkaline phosph. 220 u/l.

02/01/99 - the patient was administered 300 mg of clodronate per 400 ml of physiological solution intravenously (over 2 hours). 5 such injections were performed. A course of external beam radiation therapy was carried out on large foci of metastases (with the Rokus device) of 2 Gy daily up to a total dose of 30 Gy. The pain syndrome has been relieved.

03/09/99 - 150 MBq of metastron was administered intravenously and the patient was discharged under the supervision of a district oncologist.

06/07/99 - the patient’s health is satisfactory. Another injection of 150 MBq of metastron was performed.

09.13.99 - hospitalization of the patient for a control examination. Blood; Hb - 90 g/l, Er. - 2.9 10 12 /l, L - 4.0 10 9 /l, ESR - 18 mm/h, Rg-scopy practically did not change compared to the data from October 20, 1998. The process is stabilized. The patient's health is satisfactory.

To date, the life expectancy of a patient with prostate cancer with multiple bone metastases is 1 year 4 months. from the moment of diagnosis with a satisfactory quality of life.

Example 2. B. G., 43 years old, I/b N 1753, was admitted to the TsNIRRI clinic on July 10, 1998 with a diagnosis of RP, T 2 N x M 1.

From the anamnesis: 4 months ago pain appeared in the lumbar region. At the local clinic, an ultrasound examination (ultrasound) revealed a tumor in the right kidney. Hormone therapy was prescribed - tamoxifen 30 mg 3 times a day for 3 months, for pain - tramal tablets at night, and last month due to increased pain - promedol 2% -1.0. Due to the deterioration of the patient's condition, he was sent to the Central Scientific Research Institute of Rural Infectious Diseases.

Upon admission: complaints of intense pain in the lumbar spine, radiating to the right lower limb. Weakness.

Examination results: blood: Hbg/l, Er. - 4.0 10/l, ESR - 35 mm/hour, Ca - 3.0 mmol/l, total alkaline phosphate - 95 u/l.

According to ultrasound and Rg - a formation of 8.0x4.0 cm in the right kidney and osteolytic metastases in L IV and the right ischium.

On July 13, 1998, the patient received an intravenous injection of pamidronate in the amount of 90 mg per 400 ml of saline drip (over 4 hours).

07/16/98 - chemoembolization was performed right kidney with 60 mg doxirubicin.

From 08/17/98 - external beam radiation therapy of 2 Gy daily up to a total dose of 24 Gy. The pain has decreased somewhat.

08/16/98 - intravenous administration of 150 MBq of metastron. The patient was discharged from the clinic with a recommendation to continue hormone therapy. Appear at the clinic for a follow-up examination after 3 months.

11/30/98 - re-hospitalization. The pain in the lumbar region is significantly less, the blood is normal, the Rg of the kidneys showed a decrease in the tumor node to 6.0x3.0 cm. 150 MBq of metastron was reintroduced.

A month after discharge, the patient’s general condition improved, and he noted a decrease in bone pain.

03/01/99 - 60 mg of pamidronate per 400 ml of saline solution was administered dropwise. External beam radiation therapy of 2 Gy to 24 Gy was administered to the area of ​​metastases.

04/05/99 - another injection of 150 MBq of metastron. The patient was discharged under the supervision of a district oncologist.

A month later, the condition was satisfactory; the patient noted an almost complete disappearance of pain in the bones. An Rg study revealed a decrease in the size of metastatic foci and their sclerosis.

07/12/99 - another injection of metastron was performed - the patient continues to be observed by the district oncologist.

The life expectancy of the patient to date from the moment of diagnosis is 1 year and 3 months.

Example 3. B-ya K., born in 1943, was admitted to the TsNIRRI clinic on December 18, 1997 with a diagnosis of breast cancer, multiple metastases.

From the anamnesis: in February 1976 she underwent surgery - radical mastectomy on the left regarding breast cancer. Since August 1995 - metastases to the lungs - 5 courses of polychemotherapy (PCT) were carried out according to the regimen: cyclophosphamide, methotrexate, 5-fluorouracil. Since February 1997 - bone metastases: Th V-VIII, hip joint, pathological fracture of the third rib on the right. Completed 11 courses at the oncology center in Moscow various schemes PCT.

Upon admission to the CNIRRI clinic: Rg-grams of the skull, ribs, pelvis, cervical, thoracic and lumbosacral spine revealed multiple metastases, predominantly osteolytic in nature. On Rg-grams of the chest organs there are no focal or infiltrative changes in the lungs, multiple metastases in the ribs.

Clinical blood test dated December 26, 1997: Hbg/l, Er. - 3.8x10 9 /l, L-4.55 10 9 /l, Tr.-197 10 9 /l, ESR-14 mm/hour.

From 01/05/98, the patient was administered intravenous drips of 5 ml (300 mg) of clodronate in 200 ml of saline for 10 days, then external beam radiation therapy of 3 Gy daily up to a total dose of 24 Gy.

02/20/98 - blood and Rg practically unchanged. 02.24.98 150 MBq of metastron was administered intravenously - a moderate skin reaction in the form of redness was noted, which self-limited. The patient was further observed by an oncologist at her place of residence.

05.25.98 - repeated injection of 150 MBq of metastron.

07/09/98 - second hospitalization at the Central Scientific Research Institute of Radiological Research. According to osteoscintigraphy, metastases are in the Th VI-VIII, VIII rib, L III-IV vertebrae.

From 13.07 - 300 mg of clodronate was administered daily intravenously, N 10, then radiation therapy was carried out at L III-IV, 3 Gy to 30 Gy. Radiographs of the thoracic, lumbar spine and pelvis did not reveal any fresh destructive lesions. In old lesions there is moderate reparation. Blood test: Hb-116 g/l, Er. - 3.7 10 12 /l, L-3.3 10 9 /l, Tr.-133 10 9 /l, ESR-6 mm/hour.

08/31/98 - intravenous drip administration of 150 MBq of metastron. The patient was discharged from the clinic under the supervision of an oncologist at her place of residence.

12/01/98 - another injection of 150 MBq of metastron. Report to the clinic for a follow-up examination after 2 months.

02/15/99 - third hospitalization. X-rays of the ribs, thoracic, cervical spine, pelvis and shoulder girdle did not reveal destructive lesions in the bones. On radiographs of the thoracic and lumbar spine, the X-ray picture is fully consistent with the data dated July 27, 1998. In the lumbar region, destruction of the osteolytic type of body L IV with a tendency to compression and osteosclerotic foci in L III were detected.

Blood test dated 02.24.99 - Hb-116 g/l, Er-3.86 10 12 /l, L-4.1 10 9 /l, ESR-8 mm/hour.

02/26/99 - administration of 300 mg of clodronate N 10, then external beam radiation therapy at L III-IV, 3 Gy to 30 Gy.

03/29/99 - IV 150 MBq of metastron and for 3 months under the supervision of an oncologist at the place of residence.

06/28/99 - fourth hospitalization. According to the results of bone scintigraphy of the skeleton with 99 Tc-pyrophosphate, there is pronounced hyperfixation in the body of the Th IV thoracic vertebra, in the body of the Th VI and L V. Rg-grams of the pelvis and skull did not reveal destructive lesions. In the chest and lumbar regions also without visible changes. The process has been stabilized.

07/05/99 and 10/15/99 - intravenous administration of 150 MBq of metastron. The patient's condition and well-being are satisfactory.

Her life expectancy from the moment of detection of metastases is 2.5 years with a satisfactory quality of life. The patient continues to be observed.

To date, about 100 patients with breast cancer, prostate cancer and prostate cancer with metastases of osteolytic or mixed type have been treated using the proposed method.

The method has a number of advantages compared to the known ones.

1. Through the use of systemic radiation therapy with Sr-89, the method provides both analgesic and antitumor effects, which increases the life expectancy of patients with a satisfactory quality of life.

2. The method provides effective palliative care practically without the use of analgesics, primarily narcotic ones. In the absence of metastases in visceral organs The life expectancy of patients is 2-3 years.

3. The method reduces the hospital stay of patients to a minimum - after injection of metastron, patients are under the supervision of an oncologist at their place of residence.

The method was developed at TsNIRRI and was clinically tested in about 100 patients with breast and prostate cancer and kidney cancer with bone metastases of osteolytic or mixed type.

Claim

A method of treating osteolytic metastases by intravenous drip administration of clodronate in an amount of 300 mg daily for a day or pamidronate in an amount of 90 mg once, followed by external beam radiation therapy and/or chemotherapy or hormonal therapy, depending on the primary source of the tumor, characterized in that clodronate or pamidronate administered no more than once every 6 months, a week after their administration, an additional 150 MBC of Sr-89 chloride is injected intravenously and its injections are repeated no earlier than 3 months later.

Hyperostosis- this is osteosclerosis plus an increase in volume, thickening of the bone. This condition is exactly the opposite of atrophy. Hyperostosis is a thickening of the bone due to periosteal bone formation; it is observed in chronic osteomyelitis, syphilis, and Paget's disease.

Distinguish hyperostosis one or more bones, for example, with syphilis, Paget's disease and generalized hyperostosis, when there is damage to all long bones of the skeleton with chronic diseases lungs: chronic abscess, long-term chronic pneumonia, lung cancer.
There are also hormonal hyperostosis, for example, an increase in bone volume with acromegaly.

Enostosis is an increase in bone mass due to endosteal sclerosis.

Bone destruction- this is the destruction of bone with its replacement by some pathological tissue, which appears on an x-ray as clearing of varying severity. Depending on the nature of the pathological tissue replacing the bone, destruction is divided into inflammatory, tumor, degenerative-dystrophic and destruction from replacement with a foreign substance. All these pathological structures are a “soft tissue” substrate that determines the general symptom complex - clearing. Various expressions the latter on radiographs depends on the size of the focus of destruction and the thickness of the overlying mass of the rest of the bone and all surrounding muscles, as well as other soft tissues.
Thorough Analysis skialological data, characterizing the symptom complex of lucency in the bone, often allows us to establish its pathomorphological essence.

Inflammatory destruction. There are specific and nonspecific inflammatory destruction. The basis of nonspecific inflammatory destruction is pus and granulation tissue, which characterizes the essence of purulent osteomyelitis. At the beginning of the process, the contours of the lesion are unclear and blurred; Subsequently, the bone tissue around the site of destruction becomes denser, sclerotized, and the site of destruction itself turns into a cavity with thick, dense, well-formed walls, often with sequestral contents. The periosteum is involved in the process, and extensive periosteal growths occur.

Direct radiograph of the pelvis and hip joints.
A sharp deformation of the pelvic ring is determined. The right one is normal. Pronounced changes in the left hip joint: the articular cavity is deepened, the articular space cannot be traced, the head is deformed with multiple foci of destruction. Regional osteoporosis, femoral atrophy. Left-sided tuberculous coxitis.

Specific inflammatory destruction- this is tuberculosis, syphilis, etc., in which bone tissue is replaced by a specific granuloma. Destruction in these diseases differs in localization, shape, size and nature of the lesions, as well as the peculiarity of the reaction from the surrounding bone tissue and periosteum. The focus of destruction in tuberculosis, as a rule, is located in the spongy substance of the epiphysis; it is small in size, round in shape, without or with a very slight sclerotic reaction around. The reaction of the periosteum is often absent.

Gummous syphilis, on the contrary, is characterized by multiple small foci of destruction of an oblong shape, located in the cortical layer of the diaphysis and accompanied by significant reactive thickening of the cortical layer due to endosteal and periosteal bone formation.

Tumor destruction. Destruction due to a malignant tumor is characterized by the presence of continuous defects due to the destruction of the entire bone mass of both the spongy and cortical layers due to its infiltrating growth.

With osteolytic forms destruction usually starts from the cortex and spreads to the center of the bone, has blurry, uneven contours, and is accompanied by breakage and splitting of the marginal compact bone. The process is mainly localized in the metaphysis of one bone, does not spread to another bone and does not destroy the end plate of the articular head, although the epiphysis or part of it may be completely melted. The preserved free end of the diaphysis has an uneven, corroded edge.

Destruction in osteoblastic or mixed type osteogenic sarcomas characterized by a combination of areas of bone destruction, which are characterized by the presence of a chaotic bone structure with excessive atypical bone formation; manifested as a round or spindle-shaped shadow around the slightly destroyed base of the bone. The main sign indicating the malignant nature of these tumors remains the absence of a sharp boundary between the areas of destruction and unchanged bone, as well as destruction of the cortical layer.

They have a lot in common osteolytic metastases and myeloma according to the picture of destructive clearing, which manifests itself in the form of rounded, sharply defined bone defects and is characterized by multiplicity and polymorphism (of different sizes) of the lesion.

Benign tumors, anatomically and morphologically constructed from a soft tissue substrate (chondromas, hemangiomas, fibrous dysplasia, etc.), radiographically also manifest as a destructive symptom complex. However, there is no direct and immediate destruction of the bone by pathological tissue, but there is essentially atrophy from pressure by the tissue of the bone itself (fibrous, cartilaginous, vascular). Therefore, for these diseases, it is legitimate to use the term “areas of clearing”, this thereby emphasizes the benign quality of the existing process.

Areas of enlightenment for benign tumors of this type have an oval-round regular shape, a uniform pattern structure, smooth and clearly defined contours, clearly demarcated from the bone. The tumor cortex is a continuation of the compact bone of healthy areas; there are no reactive bone changes in the form of osteoporosis in the tumor circumference and periosteal layers. The cortical layer of bone in the area of ​​the tumor may be sharply thinned, but it always maintains its integrity. If a gap or interruption is detected, this is often evidence of a malignant transition and then it is legitimate to assume true tumor destruction.

The word "destruction" has Latin roots. Literally this concept means "destruction". Actually, in a broad sense, destruction is a violation of integrity, normal structure or destruction. This definition can be understood narrowly. For example, we can say that destruction is the direction or component(s) of human behavior and psyche that are destructive in nature and related to subjects or objects. Where and how is this concept used? More on this later in the article.

general information

The initial ideas about the presence of forces and elements in a person that have a destructive focus on external objects or oneself were formed in ancient mythology, philosophy, and religion. These concepts subsequently received some development in different areas. The 20th century saw some updating of understanding. Many researchers associate this surge with various phenomena in society, psychoanalytic problems, and various disasters social nature. These issues were dealt with quite closely by various thinkers of that time. Among them are Jung, Freud, Fromm, Gross, Reich and other theorists and practitioners.

Human work activity

What is personality destruction in the career field? In the process of work activity, a transformation of a person’s individual characteristics is observed. The profession, on the one hand, contributes to the development and formation of personality. On the other hand, the work process has a destructive effect on a person in a physical and psychological sense. In this way, it is possible to note what is happening in directions opposite to each other. In the field of career development management, the most effective tools are those that contribute to the conscious strengthening of the first tendency while minimizing the second. Professional destruction represents gradually accumulated negative changes in personality and methods of activity. This phenomenon occurs as a result of performing monotonous work of the same type over a long period. As a result, undesirable work qualities are formed. They contribute to the development and intensification of psychological crises and tension.

This is what destruction is in the career field.

Medicine

In some cases, destructive processes can help eliminate certain undesirable phenomena. In particular, this effect is observed in medicine. How can destruction be useful? This phenomenon, caused intentionally, is used, for example, in gynecology. When treating certain pathologies, doctors use different methods. One of them is radiofrequency destruction. It is used for diseases such as cysts on the walls of the vagina, condylomas, erosion, and dysplasia. Radio wave destruction of the cervix is ​​a painless and quick way effects on the affected areas. This method of treating pathologies can be recommended even for nulliparous women.

Oncology

Many pathologies are accompanied by tissue destruction. These diseases include cancer. One of the special cases is a tumor. This round cell bone tumor is sensitive to radiation. Compared to others malignant neoplasms This pathology occurs at a fairly young age: between 10 and 20 years. The tumor is accompanied by damage to the bones of the extremities, but can also develop in other areas. The neoplasm includes densely arranged round cells. To the most characteristic symptoms include swelling and pain. Sarcoma tends to spread significantly and in some cases covers the entire central part of long bones. On an x-ray, the affected area does not appear as extensive as it actually is.

Using MRI and CT, the boundaries of the pathology are determined. The disease is accompanied by lytic bone destruction. This change is considered the most characteristic of this pathology. However, in a number of cases, “onion-like” multiple layers formed under the periosteum are also observed. It should be noted that previously these changes were classified as classic clinical signs. Diagnosis must be made on the basis of a biopsy. This is due to the fact that a similar picture x-ray examination can also be observed against the background of other malignant bone tumors. Treatment involves the use of various combinations of radiation, chemotherapy and surgical methods. The use of this complex of therapeutic measures allows eliminating pathology in more than 60% of patients with a primary local form of Ewing's sarcoma.

Chemical destruction

This phenomenon can be observed under the influence of various agents. In particular, these include water, oxygen, alcohols, acids and others. Physical influences can also act as destructive agents. For example, among the most popular are light, heat, and mechanical energy. Chemical destruction is a process that does not occur selectively under the condition of physical influence. This is due to the comparative similarity of the energy characteristics of all bonds.

Destruction of polymers

This process is considered the most studied to date. In this case, the selectivity of the phenomenon is noted. The process is accompanied by the rupture of the carbon-heteroatomic bond. The result of destruction in this case is the monomer. Significantly greater resistance to chemical agents is observed in carbon-carbon bonds. And in this case, destruction is a process that is possible only under harsh conditions or in the presence of side groups that help reduce the strength of the bonds in the main chain of the compound.

Classification

In accordance with the characteristics of the decomposition products, depolymerization and destruction are divided according to a random law. In the latter case, we mean a process that is the reverse of the polycondensation reaction. During this process, fragments are formed whose sizes are larger than the size of the monomer unit. During the depolymerization process, monomers are presumably detached sequentially from the edge of the chain. In other words, a reaction occurs that is opposite to the addition of units during polymerization. These types of destruction can occur either simultaneously or separately. In addition to these two, there is probably a third phenomenon. In this case, we mean destruction by a weak bond present in the center of the macromolecule. During the process of destruction through a random bond, a fairly rapid drop in the molecular weight of the polymer occurs. With depolarization, this effect occurs much more slowly. For example, for polymethyl methacrylate, which has a molecular weight of 44,000, the degree of polymerization of the residual substance remains almost unchanged until depolymerization is 80%.

Thermal destruction

In principle, the splitting of compounds under the influence of heat should not differ from hydrocarbon cracking, the chain mechanism of which has been established with absolute certainty. In accordance with the chemical, their resistance to heat, the rate of decomposition, as well as the characteristics of the products formed in the process are determined. The first stage, however, will always be the formation of free radicals. An increase in the reaction chain accompanies the breaking of bonds and a decrease in molecular weight. Termination can occur through disproportionation or recombination of free radicals. In this case, a change in the fractional composition, the formation of spatial and branched structures may occur, and double bonds may also appear at the ends of macromolecules.

Substances affecting the speed of the process

During thermal destruction, as with any chain reaction, acceleration occurs due to components that can easily disintegrate into components. Deceleration is noted in the presence of compounds that are acceptors. So, for example, an increase in the rate of conversion of rubbers is noted under the influence of azo and diazo components. In the process of heating polymers at temperatures from 80 to 100 degrees in the presence of these initiators, only destruction is observed. With increasing concentration of the compound in solution, a predominance of intermolecular reactions is observed, leading to gelation and the formation of a spatial structure. During the thermal decomposition of polymers, along with a decrease in the average molecular weight and a structural change, depolymerization (monomer separation) is observed. At temperatures above 60 degrees, during the block decomposition of methyl methacrylate, if present, the chain breaks off mainly through disproportionation. As a result, half of the molecules must have a terminal double bond. In this case, it becomes obvious that a macromolecular rupture will require less activation energy than a saturated molecule.