Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Frequently Asked Questions

Osteolytic lesions, also called osteoclastic or lytic lesions, are areas of damaged bone that most often occur in people with certain cancers, such asmultiple myelomaandbreast cancer. On an X-ray, osteolytic lesions appear as tiny holes, giving the bone a “moth-eaten” or “punched-out” appearance.

Osteolytic lesions weaken bone, leading to pain,bone fractures, and other potentially serious complications. Treatment is necessary to ease symptoms and stave off further bone deterioration.

This article discusses osteolytic lesions, the symptoms they cause, and why they occur. It also explains how lytic lesions are diagnosed and treated.

sittithat tangwitthayaphum / Getty Images

Film X-ray shoulder radiograph show Aneurysmal bone cyst disease (ABC) which benign tumor of bone (osteolytic bone neoplasm). Highlight on bone lesion and painful area. Medical oncology concept

Symptoms and Complications

Osteolytic lesions can cause a range of symptoms and complications whether they are cancerous or not.

Some of the symptoms and conditions that arise from lytic lesions include:

What Causes Osteolytic Lesions?

Osteolytic lesions occur when the biological process that breaks down and replaces old cells in bone with new ones becomes imbalanced.

Known as bone remodeling, this cycle involves two types of cells:

Certain types of cancer can disrupt the production of new cells. For example, when myeloma invades bone tissue, it inhibits the osteoblasts from forming new bone while, at the same time, stimulating osteoclasts to increase cell breakdown.

Osteolytic lesions are also common in metastatic cancers that have spread beyond the site of the original tumor, including:

In cases of metastatic (spreading) cancer, the osteolytic lesions are most often found in larger bones, such as the skull, spine, pelvis, ribcage, and long bones of the legs.

Osteolytic vs. Osteoblastic Lesions

Osteolytic lesions are not the same as osteoblastic lesions. Both terms describe the cellular pathways that lead to bone issues, but they are opposites of one another.

A cancer usually results in one or the other, and certain lesions are more common with particular cancers than others. Though not as common, some cancers can even cause both types of lesions.

Osteolytic LesionsWeaken bonesMake bones prone to fractureAppear as dark holes in gray-white bone on imagingMore common with myeloma, kidney, lung, thyroid cancers, melanomas, and non-Hodgkin lymphomaOsteoblastic LesionsIncrease bone cell productionMake bones thick and less flexibleAppear as spots that are whiter than the bone around them on imagingMore common with prostate cancer and some types of lung and brain cancer

Osteolytic LesionsWeaken bonesMake bones prone to fractureAppear as dark holes in gray-white bone on imagingMore common with myeloma, kidney, lung, thyroid cancers, melanomas, and non-Hodgkin lymphoma

Weaken bones

Make bones prone to fracture

Appear as dark holes in gray-white bone on imaging

More common with myeloma, kidney, lung, thyroid cancers, melanomas, and non-Hodgkin lymphoma

Osteoblastic LesionsIncrease bone cell productionMake bones thick and less flexibleAppear as spots that are whiter than the bone around them on imagingMore common with prostate cancer and some types of lung and brain cancer

Increase bone cell production

Make bones thick and less flexible

Appear as spots that are whiter than the bone around them on imaging

More common with prostate cancer and some types of lung and brain cancer

Healthcare providers will monitor patients with cancer, especially multiple myeloma, for signs and symptoms of bone damage. Multiple myeloma is the most common cancer affecting bone, with 70% of people having bone lesions at diagnosis.

There are a few different types of tests used to detect bone changes with cancer, including:

Because your blood cells are formed in thebone marrow, this tissue is involved with myelomas and blood-related cancers, like leukemia.

Abone marrow biopsyis used to diagnose and monitor these cancers. Osteolytic lesions in bone marrow are common with myeloma but less often may be found in other conditions, including lymphoma and certain leukemias.

Possible Causes of Bone Pain

Treatment of Osteolytic Lesions

Treatment of lytic lesions depends on their cause and whether or not they are benign.

Many osteolytic lesions are cancer-related and treated with a combination of low-dose radiation andbisphosphonates, a class of drug commonly used in people with osteoporosis.

Bisphosphonatesare given intravenously approximately every four weeks. The medication is often given alongside cancer treatment such as chemotherapy. Bisphosphonates can have potentially serious side effects, including reduced kidney function and, in rare cases, osteonecrosis of the jaw (where the bone of the jaw begins to deteriorate).

Side Effects of Bisphosphonate Medications

Patients with cancer may also be prescribed medications such as Reclast (zoledronic acid) to prevent worsening of bone lesions or XGEVA (denosumab) to inhibit the protein that tells osteoclasts to destroy bone.

Other medications or treatments may be recommended depending on the cause of the osteolytic lesions and a person’s symptoms, as well as the stage of cancer and goals of the treatment.

Frequently Asked QuestionsYes. For example, it’s common for a lytic lesion in the femur (large leg bone) to be benign. Overall, however, most osteolytic lesions are cancerous.The life expectancy of a person with multiple myeloma who receives treatment, based on five-year survival rates, is 55%.Keep in mind, though, that many factors contribute to an individual prognosis.

Yes. For example, it’s common for a lytic lesion in the femur (large leg bone) to be benign. Overall, however, most osteolytic lesions are cancerous.

The life expectancy of a person with multiple myeloma who receives treatment, based on five-year survival rates, is 55%.Keep in mind, though, that many factors contribute to an individual prognosis.

8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhutani, M.; Turkbey, B.; Tan, E,; et al. “Bone marrow abnormalities and early bone lesions in multiple myeloma and its precursor disease: A prospective study using functional and morphologic imaging.“Leukemia & Lymphoma. 2015:57(5):1114-21. doi:10.3109/10428194.2015.1090572Reagan, M.; Liaw, L.; Rosen, C.; et al “Dynamic interplay between bone and multiple myeloma: emerging roles of the osteoblast.“Bone. 2015;75:161-9. doi:10.1016/j.bone.2015.02.021Maltzman, JD.Bone Metastasis Treatment With Medications. OncoLink.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.Chambers I, Truong P, Kallail KJ, Palko W.Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.Cureus. 2016 Jun 13;8(6):e639. doi:10.7759/cureus.639.Macedo F, Ladeira K, Pinho F, et al.Bone Metastases: An Overview.Oncol Rev. 2017;11(1):321. doi:10.4081/oncol.2017.321American Cancer Society.Survival Rates for Multiple Myeloma.Additional ReadingRajkumar, S. “Myeloma today: Disease definitions and treatment advances.“American Journal of Hematology. 2015;91(1):90-100. doi:10.1002/ajh.24236

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhutani, M.; Turkbey, B.; Tan, E,; et al. “Bone marrow abnormalities and early bone lesions in multiple myeloma and its precursor disease: A prospective study using functional and morphologic imaging.“Leukemia & Lymphoma. 2015:57(5):1114-21. doi:10.3109/10428194.2015.1090572Reagan, M.; Liaw, L.; Rosen, C.; et al “Dynamic interplay between bone and multiple myeloma: emerging roles of the osteoblast.“Bone. 2015;75:161-9. doi:10.1016/j.bone.2015.02.021Maltzman, JD.Bone Metastasis Treatment With Medications. OncoLink.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.Chambers I, Truong P, Kallail KJ, Palko W.Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.Cureus. 2016 Jun 13;8(6):e639. doi:10.7759/cureus.639.Macedo F, Ladeira K, Pinho F, et al.Bone Metastases: An Overview.Oncol Rev. 2017;11(1):321. doi:10.4081/oncol.2017.321American Cancer Society.Survival Rates for Multiple Myeloma.Additional ReadingRajkumar, S. “Myeloma today: Disease definitions and treatment advances.“American Journal of Hematology. 2015;91(1):90-100. doi:10.1002/ajh.24236

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Bhutani, M.; Turkbey, B.; Tan, E,; et al. “Bone marrow abnormalities and early bone lesions in multiple myeloma and its precursor disease: A prospective study using functional and morphologic imaging.“Leukemia & Lymphoma. 2015:57(5):1114-21. doi:10.3109/10428194.2015.1090572Reagan, M.; Liaw, L.; Rosen, C.; et al “Dynamic interplay between bone and multiple myeloma: emerging roles of the osteoblast.“Bone. 2015;75:161-9. doi:10.1016/j.bone.2015.02.021Maltzman, JD.Bone Metastasis Treatment With Medications. OncoLink.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.Chambers I, Truong P, Kallail KJ, Palko W.Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.Cureus. 2016 Jun 13;8(6):e639. doi:10.7759/cureus.639.Macedo F, Ladeira K, Pinho F, et al.Bone Metastases: An Overview.Oncol Rev. 2017;11(1):321. doi:10.4081/oncol.2017.321American Cancer Society.Survival Rates for Multiple Myeloma.

Bhutani, M.; Turkbey, B.; Tan, E,; et al. “Bone marrow abnormalities and early bone lesions in multiple myeloma and its precursor disease: A prospective study using functional and morphologic imaging.“Leukemia & Lymphoma. 2015:57(5):1114-21. doi:10.3109/10428194.2015.1090572

Reagan, M.; Liaw, L.; Rosen, C.; et al “Dynamic interplay between bone and multiple myeloma: emerging roles of the osteoblast.“Bone. 2015;75:161-9. doi:10.1016/j.bone.2015.02.021

Maltzman, JD.Bone Metastasis Treatment With Medications. OncoLink.

David Roodman G, Silbermann R.Mechanisms of osteolytic and osteoblastic skeletal lesions.Bonekey Rep. 2015 Oct 28;4:753. doi:10.1038/bonekey.2015.122.

Chambers I, Truong P, Kallail KJ, Palko W.Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.Cureus. 2016 Jun 13;8(6):e639. doi:10.7759/cureus.639.

Macedo F, Ladeira K, Pinho F, et al.Bone Metastases: An Overview.Oncol Rev. 2017;11(1):321. doi:10.4081/oncol.2017.321

American Cancer Society.Survival Rates for Multiple Myeloma.

Rajkumar, S. “Myeloma today: Disease definitions and treatment advances.“American Journal of Hematology. 2015;91(1):90-100. doi:10.1002/ajh.24236

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