What is the Difference Between Osteolytic and Osteoblastic Lesions

Osteolytic and osteoblastic lesions are two types of bone metastases. Cancer that starts in one part of the body and spreads to the bone is called bone metastasis. Moreover, it is sometimes called secondary bone cancer or metastatic bone disease. Bone metastases are mainly of two types: osteolytic and osteoblastic lesions.

The key difference between osteolytic and osteoblastic lesions is their cause. Osteolytic lesions are bone metastases that develop when metastatic cancer cells break down too much of the bone, while osteoblastic lesions are bone metastases that develop when metastatic cancer cells cause too many bone cells to form.

CONTENTS

1. Overview and Key Difference
2. What are Osteolytic Lesions  
3. What are Osteoblastic Lesions
4. Similarities – Osteolytic and Osteoblastic Lesions
5. Osteolytic vs Osteoblastic Lesions in Tabular Form
6. Summary – Osteolytic vs Osteoblastic Lesions
7. FAQ – Osteolytic and Osteoblastic Lesions

What are Osteolytic Lesions?

Osteolytic lesions are a type of bone metastase. These lesions develop when metastatic cancer cells break down too much of the bone, which makes it very weak. Osteolytic lesions may occur when breast cancer spreads to the bone. Moreover, osteolytic metastases are more common than osteoblastic metastases. Some signs and symptoms of osteolytic lesions include bone pain, osteoporosis, pathological fractures, nausea, confusion, myalgia (muscle pain), and arrhythmias.

Figure 01: Osteolytic Lesions

Osteolytic lesions can be diagnosed through physical examination, blood tests, and bone scans using radiotracers, X-rays, and CT scans. Furthermore, osteolytic lesions are treated with a combination of low-dose radiation and bisphosphonates.

What are Osteoblastic Lesions?

Osteoblastic lesions occur when cancer cells invade the bone and cause too many bone cells to form. In this condition, the bone becomes very dense. It often happens when prostate cancer spreads to the bone. Some signs and symptoms include thicker and less flexible bones and lesions on bones that appear as spots that are whiter than the bone around them on imaging.

Figure 02: Osteoblastic Lesions

Osteoblastic lesions can be diagnosed through physical examination, radiological images, such as X-rays, computed tomography (CT) scans, or bone scans. Furthermore, osteoblastic lesions can be treated through pain medications, chemotherapy, and respective surgeries.

Similarities Between Osteolytic and Osteoblastic Lesions

1. Osteolytic and osteoblastic lesions are two types of bone metastases.
2. Both are caused by primary tumors spread to the bone.
3. Both can trigger difficulties in mobility.
4. They can be treated through radiation, chemotherapy, targeted therapy, immune therapy, and surgeries.

Difference Between Osteolytic and Osteoblastic Lesions

Definition

1. Osteolytic lesions are a type of bone metastases that weaken bones.
2. Osteoblastic lesions are a type of bone metastases that increase bone cell production.

Commonness

1. Osteolytic lesions are more common.
2. Osteoblastic lesions are less common.

Causes

1. Osteolytic lesions can be caused by the spreading of breast cancer, non-small cell lung carcinoma, kidney cancer, thyroid cancer, multiple myeloma, non-Hodgkin lymphoma, and Langerhans cell histiocytosis to bones.
2. Osteoblastic lesions can be caused by the spreading of prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma, and medulloblastoma to bones.

Signs and Symptoms

1. Signs and symptoms of osteolytic lesions include bone pain, osteoporosis, pathological bone fractures, nausea, confusion, myalgia (muscle pain), arrhythmias (irregular heartbeat), and bone lesions that appear as dark holes in gray-white bone on imaging.
2. Signs and symptoms of osteoblastic lesions include thicker and less flexible bones, mobility issues, and lesions on bones that appear as spots that are whiter than the bone around them on imaging.

Diagnosis

1. Osteolytic lesions can be diagnosed through physical examination, mammography, blood tests, bone scans using radiotracers, X-rays, CT scans, and bone marrow biopsies.
2. Osteoblastic lesions can be diagnosed through physical examination, X-ray, CT scan, bone biopsy, transrectal ultrasound (TRS), and tumor markers.

Treatment

1. Treatments for osteolytic lesions are a combination of low-dose radiation (external and systematic), hormonal therapy, chemotherapy, immunotherapy, targeted therapy, giving medications such as bisphosphonates, denosumab, and usage of bone cement.
2. Treatments for osteolytic lesions are pain medications, radiation, immune therapy, targeted therapy, chemotherapy, and respective surgeries.

The following table summarizes the difference between osteolytic and osteoblastic lesions.

Summary – Osteolytic vs Osteoblastic Lesions

Bone metastasis is a secondary bone cancer that results from primary tumor invasions into bones. It is mainly divided into two types: osteolytic and osteoblastic lesions. In osteolytic lesions, osteoclasts break down bone cells faster than usual, which creates tiny holes in the bone, while in osteoblastic lesions, osteoblasts make too many new bone cells, which build up bone and have abnormal areas of bone formation. Furthermore, osteolytic lesions are normally caused by the spreading of breast cancer to bones, whereas osteoblastic lesions are normally caused by the spreading of prostate cancer to bones. This summarizes the difference between osteolytic and osteoblastic lesions.

FAQ: Osteolytic and Osteoblastic Lesions

1. What is bone metastasis?

• Bone metastasis develops when cancer cells spread from their original site to a bone. Almost all types of cancer can spread to the bones. However, some types of cancer are particularly likely to spread to bone, including breast cancer, prostate cancer, kidney cancer, medulloblastoma, etc.

2. What causes osteolytic lesions?

• Bone lesions are usually caused by an imbalance of regulatory factors in the bone remodeling. Osteolytic lesions are bone metastases that develop when metastatic cancer cells break down too much of the bone. Osteolytic lesions are normally caused by the spreading of breast cancer to bones.

3. Can osteolytic lesions be cured?

• Osteolytic lesions can cause pain, increased risk of bone fracture, and spinal cord compression. Osteolytic lesions can be treated using bisphosphonates or denosumab, radiation, hormonal therapy, chemotherapy, immunotherapy, targeted therapy, and bone cement.

4. What causes osteoblastic lesions?

• Osteoblastic metastases or lesions occur when cancer cells invade the bone and cause too many bone cells to form. The bone becomes very dense or sclerotic in this condition. Osteoblastic metastases often occur pen when prostate cancer spreads to the bone.

5. How does it treat osteoblastic metastases?

• Osteoblastic bone metastases can be treated through external and systemic radiation therapy, pain medications, immune therapy, targeted therapy, chemotherapy, and respective surgeries.

Reference:

1. Norman, Abby. “Why Bone Can Deteriorate with Certain Cancers.” Verywell Health.
2. “When Cancer Spreads to Your Bones (Bone Metastasis).” Cleveland Clinic.

Image Courtesy:

1. “Osteolytic lesion in tumor” By Sarindam7 at English Wikipedia (CC BY-SA 3.0) via Commons Wikimedia
2. “CT of osteoblastic lesions of multiple myeloma” By Mikael Häggström – Own work (CC0) via Commons Wikimedia

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