Osteolytic lesion

Bone disease is a common manifestation of multiple myeloma. Bisphosphonates should be initiated in symptomatic patients with bone lesions to slow osteopenia and reduce the fracture risk associated with the disease. Pamidronate and zolendronic acid have equivalent efficacy in the management of osteolytic lesions, but because of relative ease of administration, zolendronic acid is used most frequently.43 The use of zolendronic acid decreases pain and bone-related complications and improves quality of life. The suggestion that bisphosphonates have direct antimyeloma activity, based on the ability to inhibit NF-kB signaling, remains controversial. Recent cases of osteonecrosis of the jaw have been a major concern. Risk factors are unclear, but osteonecrosis of the jaw is more common in patients receiving intravenous administration of bisphosphonates and having dental procedures performed. It is recommended that patients... 

Metastatic bone disease (MBD) is characterized by very high levels of bone turnover in regions proximal to the tumour [33]. Bone resorption inhibitors such as bisphosphonates represent the current standard of care for the treatment of bone metastases primarily due to breast or prostate cancer and multiple myeloma. It has been proposed that other strong anti-resorptives such as a Cat K inhibitor could be useful in the treatment of bone metastases. Evidence for this has been presented in the form of a preclinical MBD model in which human breast cancer cells are implanted into nude mice. Treatment with a Cat K inhibitor gave a significantly lower area of breast cancer-mediated osteolytic lesions in the tibia [34]. In a separate study, the efficacy of a Cat K inhibitor in the reduction in tumour-induced osteolysis was found to be enhanced in the presence of the bisphosphonate zolendronic acid [35,36]. When prostate cancer cells were injected into the tibia of SCID mice, treatment with a Cat K inhibitor both prevented and diminished the progression of cancer growth in bone [37]. 

E. Therapeutic response In prostate cancer, a complete response is considered to be disappearance of tumor masses, normalization of elevated acid phosphatase, disappearance of osteoblastic lesions, recal-cihcation of osteolytic lesions, and normalization of hepatomegaly and abnormal... 

Light chains are filtered readily through the glomeruli and can be detected in urine, when the reabsorption capacity of the proximal tubule is exceeded. In addition to hypercalcemia, the clinical features of multiple myeloma include anemia, renal insufficiency, and osteolytic lesions revealed during radiologic examination. These lesions weaken the bone matrix and are prone to fractures. Patients are subject to recurrent infections. 

The possibilities that cryptic prostatic carcinoma may coexist with other diseases or that a high serum alkaline phosphatase activity possesses some residual activity at pH 5.0 tend to be negated by an analysis of these five patients. One female with carcinoma of the breast and osteolytic metastases of the femur, pelvis, and spine had an elevated serum acid phosphatase activity of 4.2 K.A. units, and a second female with an unknown primary but with osteolytic lesions of the ribs and scapula had an activity of 4.1 K.A. units. The serum alkaline phosphatase activities were 17.8 Bodansky units in the first case and 5.2 Bodansky units in the second case, both above 4.2 Bodansky units, the upper limit of normal values by this method. 

AL amyloidosis is the most common form of these disorders. Bone marrow plasmacytosis and excess plasma cell production of antigenicaHy identical monoclonal light chains are common to primary amyloidosis and multiple myeloma. Thus a clear distinction between these two conditions is not possible chemically. They appear to differ only in the presence or absence of osteolytic lesions. AL deposits may occur in the tongue, heart, lymph nodes, spleen, joints, peripheral nerves, and skin. 

IgD (1.5% myelomatosis) paraproteins are harder to find and usually are associated with heavy Bence Jones (90%L) proteinuria. Severe immune paresis and infection are not so common, but hypercalcemia (47%), osteolytic lesions (77%), extraosseous tumor (63%), and renal failure (52%) are common, as is presentation under 50 years of age (H36). 

Bone Toxicity. Beta emissions from radiostrontium bound to bone resulted in various bone lesions (trabecular osteoporosis, sclerosis, osteolytic lesions), particularly in animals that were exposed chronically (Book et al. 1982 Clarke et al. 1972 Momeni et al. 1976). In young rats and rabbits exposed orally to 90Sr, necrotic effects on the vasculature of developing bone secondarily disrupted the process of osteogenesis (Casarett et al. 1962 Downie et al. 1959). Disruption in the metaphyseal microvasculature disorganized the transformation of cartilage into bone, so that chondrocytes inappropriately resumed active proliferation. 

Abe, M., K. Hiura, J. Wilde, K. Moriyama, T. Hashimoto, S. Ozaki, S. Wakatsuki, M. Kosaka, S. Kido, D. Inoue, and T. Matsumoto. 2002. Role for macrophage inflammatory protein (MlP)-lalpha and MIP-lbeta in the development of osteolytic lesions in multiple myeloma. Blood 100 2195. 

Role of CCR1 and CCR5 in homing and growth of multiple myeloma and in the development of osteolytic lesions a study in the 5TMM model. Clin Exp Metastasis 23 291. 

Pamidronate, a second-generation bisphosphonate, is 100-fold more potent than etidronate (Fig. 35.7) (6). It has been approved for the treatment of hypercalcemia of malignancy, for Paget s disease, and for osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma. When used to treat bone metastases, pamidronate decreases osteoclast recruitment, decreases osteoclast activity and increases osteoclast apoptosis (53). Erosive esophagitis has been reported with the use of pamidronate sodium. 

Fig. 3 (A) Bioluminescent image of nude mouse 4 weeks after intratibial inoculation of osteosarcoma cells carrying a luciferase reporter gene. (B) Radiograph taken at 4 weeks shows the formation of osteolytic lesions in the corresponding region. Tc]MIBI images acquired at early (5 min) and delayed times (60 min) in the absence (C) and after treatment with PSC833 (D). The treatment with 50 mg/kg PSC833 increased both the uptake and the retention of [ Tc]MIBI in the tumor region...

Example of an osteolytic lesion in the pelvis, located superior to the metal-backed acetabular component. (Courtesy of Av Edidin, Ph.D., Drexel University.)... 

Osteolysis in the knee on A-P and lateral radiographs. A large osteolytic lesion is present in the lateral and anterior... 

The procedure is completed when the osteolytic lesion within the vertebral body is completely or partially filled (Fig. 38.5a-0 or when the anterior two thirds of the fractured, osteoporotic vertebral body is filled and/ or the cement is homogenously distributed between both endplates. It has to be taken into account that the cavity of the needle contains an additional 1-2 cc of cement. While the stylet of the needle is pushed forward, this cement is also injected into the vertebral body. This should be done under fluoroscopic control to avoid... 

To date, the mechanical properties of the metastatic spine and the mechanisms of collapse have not been fuUy elucidated. Moreover, the correlation between vertebral body coUapse and the location and extent of the metastatic tumor is not fully understood. Taneichi et al. (1997) evaluated 100 thoracic and lumbar vertebrae (53 patients) with osteolytic lesions, determined risk factors for vertebral coUapse, and estimated the probability of coUapse under various states of metastatic vertebral involvement. The most important risk factor leading to vertebral coUapse in the thoracic region was involvement of the costovertebral joint. Tumor size within the vertebral body was the second most important risk factor. In-... 

Wear of conventional UHMWPE has historically been recognized as the primary culprit responsible for inflammatory bone loss and late revision of hip replacements. Researchers have estimated that for each day of patient activity, around 100 million microscopic UHMWPE wear particles are released into the tissues surrounding the hip joint [19]. This particulate wear debris can initiate a cascade of adverse tissue response leading to osteolysis (bone death) and ultimately aseptic loosening of the components [20-23]. The radiograph in Figure 5.3 (provided courtesy of Av Edidin, PhD, Drexel University) shows an example of an osteolytic lesion in the pelvis located superior to the historical, gamma-sterilized acetabular component... 

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