Lytic Lesions: Causes, Symptoms, Diagnosis and Treatment

Lytic lesions are the area of bone damage that can occur in any section of the bone.⁽¹⁾ It occurs as the cells in the bone start dividing and multiplying uncontrollably. This can lead to a lump or mass of atypical tissue that can harm or destroy the healthy tissue and also weaken the bone.

Bone lesions mostly are benign, which means they are not life-threatening as they do not spread to other parts of the body.⁽²⁾ However, if malignant, which means cancerous, they can spread or metastasize or spread to other body parts.

Lytic lesion leads to holes in the body parts making the bone likely to break in the slightest injury. Lytic lesion commonly affects the bones of the pelvis, spine, ribs, skull, and long bones of arms and legs. Bone disease is the main feature of multiple myeloma and it was found in research that 80% of people with multiple myeloma have a lytic lesion at the time of diagnosis.⁽³⁾

Bone tissue is capable of remodeling, which means old bone tissue breaks down and is replaced by new bone tissue. This process is known as remodeling and it helps in managing the skeleton. This balance of remodeling is disrupted by multiple myeloma resulting in lytic lesions.

Osteoclast and osteoblast are the two bone cells that keeps the bone healthy.⁽⁴⁾ Osteoclasts play a role in breaking down the cells in the body and osteoblasts play a role in the formation of new bone tissue. Multiple myeloma disrupts this balance and leads to osteoclast-activating factors that signal the osteoclast cells to break the bone uncontrollably. Multiple myeloma also inhibits the formation of osteoblast, preventing bone repair. This leads to too much bone breakdown causing the bone to weaken and lytic lesions to form.

Lytic lesions weaken the bones and make them prone to break or experience bone pain.

As the bone break easily in people with lytic lesions the blood content of calcium increase. This results in hypercalcemia.⁽⁵⁾

People with hypercalcemia experience kidney problems, dehydration, extreme thirst, excessive urination, confusion, pain in the abdomen, loss of appetite, fatigue and constipation.

If multiple myeloma affects the bones of the spine it can cause severe backache, numbness, weakness in the legs, and muscles weakness. It can sometimes press the nerves and can cause peripheral neuropathy, a condition that causes a pin and needle feeling.

Bone diseases such as lytic lesions and multiple myeloma can be detected with the help of imaging tests including X-rays, CT scans and MRI scans. They help in taking images of the bones that help in determining the presence of lytic lesions.

The treatment of lytic lesion involves treating the underlying condition and supportive treatment for bone. As multiple myeloma has lytic lesion as its symptom, its treatment is very important. Multiple myeloma can be treated by:

• Chemotherapy: This treatment involves using drugs to kill the cancer cells. This therapy prevents the cells from growing and making more cancer cells.
• Stem Cell Therapy: During stem cell therapy, a person first receives chemotherapy to kill the cells in the bone marrow. This also kills the cancer cells. Then stem cells are transplanted that can produce new healthy blood-forming cells.
• Medications: A doctor prescribes medications including corticosteroids, biologic therapies, and targeted therapies that can be helpful in treating multiple myeloma.

Bone-modifying agents are prescribed by doctors and they play a role in correcting and preventing hypercalcemia.

Sometimes surgery is recommended to strengthen bones. In surgery, rods and plates are inserted into fragile bones to provide additional support.

Along with treating the underlying cause, treatment may be required to reinforce and stabilize the bones and prevent fractures.