Among the causes tumors, infections, osteoporosis and everything that weakens the skeleton. Early diagnosis is essential because it allows planning the most suitable treatment ranging from drug therapies to targeted surgery
A reduction in the volume of the bone which can therefore break more easily. this, in essence, is the bone defect. A problem known to many especially for the gums and the consequent problems with the teeth, but which in reality can also affect other parts of the body, with no less serious consequences: from the increased risk of fractures to complications for those who already wear dentures or for those who need it. What to do? Most people discover the problem when the consequences are already evident, unfortunately,” he replies Vincenzo Salini, head of the Orthopedics and Traumatology Unit at the IRCCS San Raffaele in Milan and organizer of the congress of the university academy of orthopedics and traumatology held in recent days in the Lombard hospital -. This is why they are important, on the one hand, prevention and controls in those most at risk (for example cancer patients) and on the other timely treatment in experienced centers.
What exactly are bone defects?
Bone defects represent lack of substance in the skeletal tissue, which are responsible for a structural weakening of the bones – explains Salini, full professor of Orthopedics at the Vita-Salute San Raffaele University in Milan -. We have to imagine the skeleton as a resistant and compact structure on the outside and spongy on the inside. Bone defects can affect both of these fundamental components and cause several problems: from an increased risk of fractures to a lower mechanical strength of the prostheses that can be installed indoors.
What are the causes?
A number of factors may be responsible for skeletal bone defects,” he replies Mattia Alessio Mazzolamedical director in the Orthopedic Unit at San Raffaele -. Some cancers, for example, they cause an alteration of the bone tissue which is replaced by tumor tissue which weakens its structure. Fractures can also be responsible for extensive bone loss which makes treatment very difficult. Furthermore, joint replacements, such as hip and knee replacements, can alter the bone tissue that hosts them over time and cause bone defects that appear when the prostheses need to be replaced. It’s still: bone tissue infections they can create serious losses of substance that are difficult to treat. In the end osteoporosis it causes a progressive weakening of the bone, making it more exposed to fracture.
How are they treated?
The treatment of bone defects varies according to the cause of the defect itself and must be evaluated on a case-by-case basis – says Salini -. An essential and essential early diagnosis as it allows the specialist to plan the most suitable treatment ranging from pharmacological therapies to targeted surgical interventions. We currently have various diagnostic methods, which allow for a very accurate evaluation of both the extent of the defects and what the causes of the defect itself are.
How is the diagnosis reached?
The diagnosis of a bone defect depends on the cause and makes use of both basic and advanced radiodiagnostic examinations ranging from the radiographic examination of the affected segment, which allows the specialist to evaluate the skeletal system in 2D, to CT (computed tomography), with 3D reconstructions which allows the bone defect to be quantified more precisely in three dimensions in order to accurately plan the treatment strategies – clarifies Mazzola -. Finally, the DEXA examination (X-ray bone densitometry) is particularly useful for studying the bone density of subjects suffering from bone weakening on an osteoporotic basis and for implementing preventive or therapeutic strategies.
What are the current standard therapies?
Bone defects are treated with different methods. Pharmacological therapies they are effective in treating osteoporosis and improving bone quality. In extended cases, where required a surgical treatment, there is the possibility of transplanting the patient’s bone tissue from other sites (for example the pelvis or the fibula), to graft it in the segment where necessary. Finally, there is the possibility of using tissue from a human donor (allograft) to be able to engage it in the seats where it is necessary. These are very complex interventions that require highly specialized orthopedic team, with great experience in the sector and with extensive case studies. The healthcare structures that deal with these operations must also have the availability of a bone bank, a real biological archive where the bone tissues of the donors are stored and cryo-preserved. In case of need, in fact, the hospital must be able to supply the donor material with the characteristics suitable for transplantation and the choice must be carefully evaluated on a case-by-case basis.
What new therapies are on the way?
There are several innovative therapies for the treatment of bone defects. For instance synthetic bone substitutes, bioglass or biocements they represent the latest generation of engineered tissues created to compensate for bone defects. These materials, once implanted in the body, are able to interact with the patient’s cells, which are stimulated to produce new bone tissue of greater resistance. Some biomaterials, such as bone substitutes and biocements, are already available to patients today: being used in complex surgical procedures by highly experienced teams, they are the subject of continuous scientific research which will fully evaluate their potential and long-term results. The advantages are multiple and significant because these latest generation artificial fabrics possess the ability to integrate with the patient’s bone, in some cases they can also be reabsorbed over time to then be progressively replaced by mechanically more resistant bone tissue. In still other cases they are pre-loaded with drugs (antibiotics or growth factors) and these characteristics make them precious for patients with particularly complex situations.
December 5, 2022 (change December 6, 2022 | 1:01 pm)
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