What Are the Different Causes of Bone Pain?

Osteodynia refers to the pain and discomfort of the whole body or a local bone due to various causes. It is a clinical symptom, such as acute bone injury, rheumatism, chronic strain, infection, tumor, etc. There are many diseases that cause bone pain and their clinical manifestations vary. Treatment should find the primary disease causing bone pain, and treat the cause.

Basic Information

English name

osteodynia

Visiting department

orthopedics

Common locations

skeleton

Common causes

Blood diseases, fractures, bone tumors, bone tuberculosis, etc.

Common symptoms

General or local bone pain and discomfort

Causes of bone pain and common diseases

Hematological bone pain

(1) Increased osteoclast activity of multiple myeloma , causing bone decalcification, osteoporosis, osteolysis and pathological fracture, resulting in bone pain. In addition, tumor cells infiltrate from the bone marrow and invade the bone cortex and periosteum can also cause bone pain.

(2) Acute leukemia (including slow-growth abrupt changes) is more common in children with acute lymphocytic leukemia. Presented as sternal tenderness and pain in the bones and joints, which can involve elbow, wrist, knee, hip and other joints of migratory pain. Bone pain is mostly faint pain, which occurs when the slow-granular abrupt change or bone infarction occurs, the bone pain is very severe.

(3) Malignant lymphoma occurs when non-Hodgkin's lymphoma affects the bones. Such patients often see bone pain as the first symptom. Imaging examination shows bone damage, and the main invasion sites are thoracic spine, lumbar spine, ribs, and pelvis , Femur and cervical spine can also cause bone pain.

(4) Langerhans cell histiocytosis (LCH) bone lesions are found in almost all patients with LCH, and the mild ones are isolated painless bone lesions. Bone lesions are most common in the skull, followed by lower extremity bones, ribs, pelvis and spine.

(5) Other hematogenous macroglobulinemias, malignant histiocytosis, and myelodysplastic syndromes that can cause bone pain, but are rare.

2. Non-hematological bone pain

( 1) Fracture

(2) Bone tumor

(3) Bone tuberculosis

(4) Purulent osteomyelitis, spondylitis

(5) Bone (medulla) metastatic carcinoma in situ is mostly located in the prostate, thyroid, breast, lung, and kidney. A large number of tumor cells cause increased pressure in the bone marrow cavity and bone destruction, leading to bone pain.

(6) Renal osteodystrophy includes fibrotic osteitis, renal osteomalacia, renal osteoporosis, and renal osteosclerosis.

(7) Primary hyperparathyroidism (hyperparathyroidism) causes extensive bone resorption and decalcification in hyperparathyroidism, and forms fibrocystic osteitis in severe cases. Skeletal deformities and pathological fractures can occur, causing bone pain .

(8) Osteoporosis When excessive bone resorption or inadequate formation can result in a decrease in bone mass and destruction of the fine structure of the bone emblem, the formation of osteoporosis. Fractures are the main complication of osteoporosis. They are more common in hip and vertebral fractures. In addition to the pain caused by fractures, systemic bone pain can occur during bone loss, especially low back pain, followed by knee joints. Shoulder and back.

Bone pain examination

Urine test

Leukocyte urine alone indicates urinary tract infection, and red blood cell urine with or without leukocyte urine indicates urinary tract infection, renal tuberculosis, and urinary tract stones. Proteinuria with cast urine suggests chronic nephritis, myeloma, kidney, etc., a week of urine protein-positive suggests multiple myeloma.

2. Routine blood test

Whole blood cell reduction is seen in acute leukemia, multiple myeloma, bone marrow metastatic cancer, and malignant histiocytosis. More than half of the patients with acute leukemia had increased white blood cell counts, and a large number of primary leukocytes in peripheral blood smears suggested acute leukemia, and a small number of plasma cells suggested multiple myeloma.

3. Bone marrow smear

Smears can be diagnosed as acute leukemia when 30% of primordial cells are seen; multiple myeloma can be diagnosed when plasma cells> 10% and varying numbers of primary or juvenile plasma cells; Hodgkin can be diagnosed by seeing Reese cells Lymphoma; seeing abnormal histiocytic cells or macropolygonal histiocytic cells can help diagnose malignant histiocytosis; seeing tumor cells can be diagnosed as bone marrow metastatic cancer.

4. Lymph node or lesion tissue biopsy

Biopsies, including rashes, masses, and bone lesions, can help diagnose malignant lymphoma, malignant histiocytosis, Langerhans cell histiocytosis, and bone tumors.

5. X-ray of bones

Including x-rays of the head and spine, the ribs, the collarbone, the pelvis, the humerus and the femur, it is a screening test for almost all patients with back pain and limb pain. It is useful for the diagnosis of spinal deformity, recessive spina bifida, lumbar vertebralization, pedicle nonunion, asymmetric sacroiliac joints, vertebral fractures, pedicle and accessory fractures, spinal tuberculosis, osteoporosis, multiple myeloma , Bone eosinophilic granulomatosis, bone primary or metastatic cancer and other diseases are of great significance, if necessary, CT or MRI examination of the diseased bone is added.

6. Checks to choose

(1) Chest x-rays, ESR, and PPD should be performed for suspected spinal tuberculosis .

(2) Leukocyte count, blood and pus culture should be performed for suspected purulent spondylitis .

(3) In addition to the above tests, suspected multiple myeloma should also be determined for serum immunoglobulin determination, hematuria immunofixation electrophoresis, EsR, cRP, 2-MG, and serum calcium determination.

(4) Blood calcium and serum alkaline phosphatase should be checked for bone marrow metastatic cancer . If bone marrow metastasis of prostate cancer is suspected, serum acid phosphatase and PSA should be measured.

(5) Bone mineral density and serum calcium and phosphorus should be determined for osteoporosis .

(6) A spinal CT or MRI scan, spinal angiography, and cerebrospinal fluid examination should be performed for a tumor in the spinal canal.

(7) If renal osteodystrophy is suspected , renal function should be checked, and the diagnosis should depend on bone biopsy.

(8) Blood calcium, blood phosphorus, serum alkaline phosphatase, urine calcium, and parathyroid hormone (PTH) should be measured for bone pain suspected of hyperparathyroidism . If necessary, renal tubular phosphorus reabsorption rate and cortisol inhibition test can also be checked.

Differential diagnosis of bone pain

Multiple myeloma

Bone imaging examinations of the pain site (including bone x-rays, CT or MRI examinations, and radionuclide bone scans) suggest osteolytic destruction, pathological fractures, or extensive osteoporosis.

2. Acute leukemia

Patients with AML and ALL often have symptoms of fever, anemia, and hemorrhage. Red blood cells and thrombocytopenia are reduced in peripheral blood tests, and white blood cell counts are increased, normal, or decreased. Bone marrow smear examination of blast cells 30% (non-red) is the basis for the diagnosis of acute leukemia.

3. Malignant lymphoma

Bone pain caused by extranodal lymphoma of the bone or bone pain caused by malignant lymphoma infiltrating the bone, biopsy of the diseased bone is the only evidence to confirm the diagnosis.

4. Langerhans cell histiocytosis

X-ray examination of the affected bone revealed osteolytic bone destruction, and the flat bone lesions were insect-like to huge defects. The spine is mostly vertebral body destruction, showing flat vertebra, but the intervertebral space is not narrow. Long bones are mostly cystic defects without dead bone formation.

5. Renal osteodystrophy

The patient had a long history of hemodialysis in uremia.

6. Primary hyperparathyroidism

Clinically, there are bone pain and recurrent urinary stones. X-ray of the bone showed subperiosteal absorption, cyst-like changes, multiple fractures or deformities.

7. Osteoporosis (OP)

Has a family history of OP, a history of OP fractures, amenorrhea and menopause, long-term malnutrition, long-term bed rest, long-term use of steroids and chronic diseases.

8. Non-bone-damaging low back pain

Common diseases include acute lumbar sprain, chronic cumulative lumbar muscle strain, lumbar fibrous tissue inflammation, rheumatic polymyositis, acute myelitis, lumbosacral neuritis, proliferative spondylitis (for thoracolumbar degenerative changes), ankylosing spine Inflammation, sciatica, and various visceral diseases can cause back pain or lumbosacral pain.

Bone pain treatment principles

Find the primary disease that causes bone pain and treat the cause.