Bone is a living, growing tissue that mainly consists of collagen and calcium. Bones provide a rigid framework, known as the skeleton, which protects soft organs and supports the body. Certain conditions can affect bone strength and flexibility and result in health complications.

There are two types of bone in the body. Cortical bones are compact and dense and form the outer layer of the bones. Trabecular or cancellous bones make up the bones’ inner layer and are spongy with a honeycomb structure. The bones not only protect the organs from injury but also allow the body to move and provide support. Additionally, bones act as a reservoir for minerals such as calcium.

A person may have a condition or disease that affects the flexibility and strength of the bones. These conditions may arise from various sources, including genetics, environmental factors, diet, and infections.

In this article, we will explore some of the diseases that can affect the bones, as well as potential causes and symptoms.

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Some common bone conditions include:

Osteoporosis

Osteoporosis is a disease that results in a decrease in bone mass and mineral density. The quality and structure of the bone may also change. Osteoporosis can decrease bone strength and increase the risk of fracturing.

The risk of osteoporosis increases with age and affects people of all ethnic groups. It most commonly affects non-Hispanic white females and Asian females.

Osteopenia

Osteopenia refers to a decrease in bone mineral density below a normal level but not low enough for a doctor to classify it as osteoporosis.

A T-score is a measure of bone density. A person with a T-score between -1 and -2.5 will receive a diagnosis of osteopenia, whereas a doctor would classify a T-score lower than -2.5 as osteoporosis. The prevalence of osteopenia is 4 times higher in females compared with males.

Paget’s disease

Paget’s disease is a condition that affects the bone remodeling process. This refers to the action by which the body breaks down old bone tissue and replaces it with new bone tissue.

In people with this chronic condition, the process of rebuilding bones takes place at a faster rate, resulting in an unusual bone structure. This can either cause the bones to become softer or larger, making them more susceptible to complications such as bending or fractures.

Osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a disorder that causes the bones to fracture easily. Some people may also refer to OI as brittle bone disease. The condition results from a change or mutation in the genes that carry information for making a protein known as type I collagen. This protein is necessary for strong bones.

People with a family history of OI have a higher risk of having the disease as a person can inherit the gene mutation through one or both of their parents. There are different types of OI. The most common and mildest type is type I, while type II is the most severe.

Osteonecrosis

Osteonecrosis, also known as avascular necrosis or aseptic necrosis, occurs when there is a disruption to a bone’s blood flow, leading to bone tissue death. This can cause the bone to break down and the joint to collapse.

While osteonecrosis may occur in any bone in the body, it commonly affects the shoulders, hips, and knees. The condition occurs most often in people aged 20–50 years. These individuals also often have a history of trauma, corticosteroid use, or excessive alcohol intake.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. This condition affects the body’s joints by degrading cartilage, the tissue that covers the surface of joints. Osteoarthritis can also change the shape of bones. Osteoarthritis most frequently affects the hands, hips, and knees.

Osteomyelitis

Osteomyelitis describes an infection or inflammation of the bone, with myelitis referring to inflammation of the fatty tissues within the bone. It typically occurs when a bacterial or fungal infection enters a bone from the bloodstream or surrounding tissue. It can happen at any age but is more common in young children.

Fibrous dysplasia

Fibrous dysplasia occurs when abnormal fibrous tissue replaces healthy bone tissue. The unusual scar-like tissue makes the bone weaker. This can cause the bone to change shape and increase the risk of fractures.

Fibrous dysplasia typically occurs due to a gene mutation that results in bone cells producing an abnormal type of fibrous bone. While it can develop in any bone, it occurs most often in the thigh bone, shin bone, ribs, skull, humerus, and pelvis.

Bone cancer and tumors

Bone cancer is an uncommon type of cancer that begins when cells in a bone start to grow out of control. Any of the cells in the bone can develop into cancer.

Primary bone cancers are cancers that start in the bone. The most common types of primary bone cancers include osteosarcoma and Ewing sarcoma. Cancer cells can also spread to the bone from other areas of the body. Doctors refer to these as bone metastases. The most common site for bone metastases is the spine.

Osteomalacia

Osteomalacia, also known as bone softening, refers to a condition where the bone does not harden the way it should after forming. This metabolic bone disease occurs when there is incomplete mineralization of the bone. Mineralization refers to the process where minerals coat the inner layer of the bone, forming a hard outer shell. The incomplete formation of this shell leaves the collagen soft and vulnerable.

Rickets

Rickets is a childhood bone condition similar to osteomalacia, but it occurs due to imperfect mineralization.

It results in soft, weak bones, typically due to a vitamin D deficiency. Without sufficient vitamin D, the body cannot metabolize calcium and phosphorous, which are essential for proper bone development and growth. Vitamin D deficiency may result from inadequate nutrition, lack of sun exposure, or malabsorption.

Autoimmune conditions

An autoimmune condition occurs when the immune system attacks the body’s own cells, tissue, and organs. Bone diseases can develop secondary to some autoimmune diseases, increasing the risk of complications such as bone loss and fractures. These conditions include:

  • Type I diabetes: People with this condition produce minimal or no insulin, meaning the body cannot absorb sugar from food easily. People with type I diabetes have a higher risk of developing osteoporosis.
  • Systemic lupus erythematosus (SLE): This condition can result in widespread inflammation affecting many parts of the body. Some treatment options for SLE may put people at a higher risk of bone loss and fractures.
  • Rheumatoid arthritis (RA): This condition causes the body’s immune system to attack the membranes around the joints and causes the cartilage to degrade. There is an increased risk of bone loss and fractures in people with RA.
  • Celiac disease: This condition causes the body to develop an intolerance to gluten, a protein commonly present in food products such as wheat, rye, and barley. The immune system attacks and damages the lining of the small intestine. A person with untreated celiac disease may develop bone disease due to difficulty absorbing calcium, which is necessary for healthy bones.

Bone disease symptoms can vary depending on the condition, and some may present no symptoms at all. For example, osteoporosis is known as a “silent” disease because there are usually no symptoms until a broken bone occurs.

General symptoms of bone disease may include:

A person may also have symptoms specific to a type of bone disease. For example, someone with osteomyelitis may experience redness, swelling, and warmth at the infection site.

A person with bone cancer may also experience other symptoms, including weight loss and fatigue, or may have a lump in the area of the tumor.

A number of factors can cause bone disease. Some may be specific to a certain type of bone disease. Causes include:

  • Genetics: A person may have a higher risk of developing a type of bone disease due to a mutation or change in a gene or a history of bone disease in their family. A person may inherit a gene mutation from one or both parents.
  • Aging: As people age, the mineral content of their bones begins to decrease, resulting in the bones becoming less dense and more fragile.
  • Nutrition: A balanced diet is essential for healthy, strong bones. In particular, people need to consume sufficient levels of calcium and vitamin D.
  • Problems with bone remodeling: After age 20, a person may experience an imbalance where the body breaks down old bone tissue quicker than it can replace it. This can result in a loss of bone strength and quality.
  • Hormonal changes: Imbalances of certain hormones may increase the risk of developing osteoporosis. For example, low estrogen levels during menopause or low levels of testosterone can increase a person’s risk of osteoporosis.
  • Medications: Certain medications can increase the risk of bone disease development. For example, corticosteroids, thyroid medicines, and drugs that reduce levels of sex hormones can harm bone health.
  • Lifestyle factors: Lifestyle factors including low physical activity levels, smoking, and excessive alcohol consumption can predispose a person to osteoporosis.

A person will need to contact a doctor to receive a diagnosis of a bone condition. The doctor will normally start by taking a person’s medical history. This may include questions about how long they have been experiencing any symptoms and whether they have a family history of bone disease.

The doctor may also carry out a physical examination to check for:

  • loss of height or weight
  • change in posture
  • changes in balance or the way a person walks
  • changes in muscle strength
  • any redness or swelling, such as occurs with osteomyelitis

The doctor may also order tests to diagnose the type of bone disease a person has, including:

  • X-ray imaging: The most common type of X-ray imaging a doctor may use is a dual-energy X-ray absorptiometry scan. This uses a low amount of X-rays to measure the body’s bone mineral density.
  • MRI scans: This test uses a magnet to create an image of the body and provides detailed images of bones and other tissues, including cartilage and ligaments.
  • Blood tests: A doctor may order blood tests to help confirm a bone cancer diagnosis and provide information on the stage of cancer.
  • Biopsy: A doctor may take a small amount of bone tissue from the affected area to examine it under a microscope for an accurate diagnosis.

The most appropriate treatment option will depend on the type of bone disease and how serious the condition is.

For example, with osteoporosis and osteopenia, the goal of treatment is to stop further bone loss and prevent fractures from occurring. Therefore, treatment may include:

  • recommending nutritional guidance
  • making lifestyle changes such as performing more physical activity and quitting smoking
  • putting measures in place to reduce the risk of falls to prevent fractures
  • prescribing medication

Some conditions, such as OI, do not currently have effective treatments. Therefore, the goal of treatment is to prevent or control symptoms and improve muscle strength and bone mass. In addition to taking medication, a person with OI may have physical therapy to improve muscle strength and mobility.

Certain conditions may require surgical options. For example, a person with osteonecrosis will generally require surgery to preserve the joints. A person with a bone tumor may require surgery for its removal.

People with bone cancer may also need additional therapies, such as chemotherapy or radiation therapy, depending on how advanced the bone cancer is.

It is advisable for a person to contact a doctor if they fracture a bone or experience symptoms such as bone pain. They should also contact a doctor if they notice a change in their posture, height, weight, or movement when walking.

This is important as early detection can prevent the disease from progressing further.

Bone diseases refer to conditions that alter the strength or flexibility of bones. They can result in symptoms such as bone pain, difficulty moving, and a higher risk of bone fractures. These conditions can have many potential causes, including aging, genetics, hormonal changes, and nutritional deficiencies. Lifestyle factors such as low levels of physical activity, smoking, and alcohol consumption can also increase the risk of bone disease.

A doctor can perform tests to identify bone diseases. After diagnosis, a doctor can suggest a suitable treatment plan, which may include medication, lifestyle changes, and surgery.