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Ostit
Last reviewed: 05.07.2025
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Osteitis (from the Greek osteon, meaning "bone") is a disease characterized by inflammatory processes in bone tissue.
Such inflammation can develop in it as a result of exposure to traumatic factors or infection, and is mainly associated with fractures or unsuccessful surgical intervention on the bone. This inflammation is non-specific. Specific bone inflammation occurs as a result of the hematogenous spread of tuberculosis, syphilis, etc. infection. In many cases, ostitis refers to bone lesions that occur with tuberculosis, in particular with tuberculous arthritis.
The course of ostitis is chronic or can take an acute form. In an acute state, the bone is subject to destruction, and in the case of a chronic disease, the prevalence of proliferation processes is noted. When congenital and tertiary syphilis occurs, they speak of syphilitic, ossifying and resolving ostitis.
Each of the above types of bone tissue damage requires treatment using certain appropriate measures. Thus, in the presence of specific ostitis, the focus of medical measures is primarily on the underlying disease. In other cases, it may be more appropriate to prescribe surgical treatment for the purpose of sanitizing the inflammatory process. Surgical intervention is accompanied by the use of antibacterial, desensitizing, and immunostimulating drugs.
When ostitis is diagnosed in a timely manner and the necessary rational treatment is started as soon as possible, the prognosis for its course is favorable with a high probability of complete recovery.
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Causes of osteitis
The causes of ostitis are represented by two main groups of factors that determine the occurrence of this disease.
The most common of these is a traumatic disruption of the integrity of the bone due to a blow, bruise, fracture (open or closed), as well as as a result of surgical intervention for the latter. Fractures pose a danger that purulent microflora may appear in the wound due to them.
Regarding microflora, it should be noted that specific types of it, such as syphilitic and tuberculous, can also provoke ostitis. They cause syphilitic and tuberculous ostitis, respectively. The explanation for this is that when a person has syphilis or tuberculosis, the infection can spread throughout the body through the bloodstream, affecting bone tissue, among other things.
Medical statistics also note a limited number of cases where ostitis occurred against the background of diseases such as brucellosis, gonorrhea, leprosy, paratyphoid fever and rheumatoid arthritis.
Thus, the causes of ostitis are mainly reduced to mechanical impact of traumatic nature on the bone, and in addition to this to various factors of infectious pathogenesis. Based on this, depending on what caused the bone inflammation characteristic of ostitis, the appropriate method of treatment is selected.
Symptoms of osteitis
The symptoms of ostitis and the degree of their severity are determined by the etiology, the extent of the pathological process, the objective general condition of the patient, and whether any concomitant diseases and dysfunctions of the body have appeared in connection with ostitis.
The progression of ostitis can often occur without giving away its presence with any noticeable manifestations until an exacerbation occurs at some point.
As a rule, acute ostitis is accompanied by the appearance of local pain symptoms. Subsequently, some swelling occurs, the functioning of the affected area of the limb or spinal column changes negatively. The possibility of pathological fractures, the formation of secondary deformations is not excluded. There are disturbances in the function of the nerves and spinal cord, which is typical for spondylitis, i.e. tuberculosis of the spine. If the periosteum and soft tissues are affected by inflammatory processes, fistulas and phlegmons occur.
Chronic ostitis can be essentially a further development of chronic periodontitis. In this case, the disease manifests itself as a thickening of the jaw bone, which is unilateral or bilateral. In this case, significant areas of the jaw can be involved in this process. Up to the point that the inflammation will cover its entire half on the right or left, depending on the localization of the ostitis.
The occurrence of exacerbations is noted under certain circumstances as a result of unfavorable conditions. These include colds, stressful conditions, etc. The clinical picture in this case is similar to the acute process. As for the time factor, it seems possible to identify it only on the basis of anamnesis and radiographs.
Symptoms of osteitis may be completely unobvious, and the presence of the disease is often determined only at the stage of its exacerbation. Based on this, early diagnosis of such bone inflammation is of great importance, since without appropriate treatment, osteitis may have a tendency to significantly spread the lesion in the human body.
Where does it hurt?
BCG osteitis
The BCG vaccine was first used in 1923. Subcutaneous administration of the drug has been practiced since 1962 and has remained the only means of vaccination against tuberculosis to this day. BCG is the Russian transcription of BCG, an abbreviation for Bacillum Calmette Guerin, as the culture is called by the names of its creators, who were the French scientists A. Calmette and C. Guerin.
Vaccination with BCG helps prevent the development of tuberculosis in its most severe forms, which include tuberculous meningitis and fulminant tuberculosis. Up to one hundred million children receive this vaccination each year.
However, with the use of this vaccine, one cannot be absolutely sure that it will not cause all sorts of post-vaccination complications. And although they are reflected in extremely insignificant numbers (0.004-2.5%), nevertheless, they do occur.
Along with the most common negative consequences, manifested in the defeat of regional supraclavicular and subclavian, axillary, cervical lymph nodes, it is also currently noted that osteitis often develops after BCG vaccination.
It is generally accepted that the main reasons for this are the possible dishonest attitude of the person performing the manipulation, in violation of the technique of its implementation. This may be too great a depth of introduction of the vaccine into the skin or a dose exceeding the prescribed norm. The consequences of such actions can cause various negative local reactions in the form of necrotic phenomena in tissues, the occurrence of ulcers, lymphadenitis, keloid and cold abscess, as well as lupus in the place where the vaccine was administered.
BCG osteitis can also be caused by vaccination without taking into account existing contraindications, when this vaccination is unacceptable due to the individual characteristics of the child’s immune system response.
BCG ostitis, as well as many other possible negative reactions of the child's body to vaccination, can be excluded only if the vaccination is entrusted to a qualified specialist.
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Tuberculous osteitis
Tuberculous ostitis is characterized by a specific type of inflammation, which mainly occurs in the human skeleton in those parts of it in which there is a large amount of red, hematopoietic, myeloid bone marrow.
The greatest damage occurs in the vertebral bodies, in the metaphyses of the tibia, femur and humerus. The bodies of the pubic, ilium and ischial bones are also susceptible to the development of such a disease.
The localization of inflammation is predominantly single, however, sometimes this type of damage can occur in several parts of the skeleton.
Regarding the age of a person at which there is a high probability of this disease appearing, the risk group includes the period of childhood and adolescence.
Inflammatory foci are most frequently observed in close proximity to joints, which, under certain circumstances, can become a factor causing the possibility of spreading to a nearby joint. In the absence of appropriate treatment, this can be aggravated by the appearance of inflammation in the synovial membrane of the joint capsule. On the other hand, if the inflammation focus in tuberculous ostitis is located far from the joint, then its encapsulation is possible, but this can only happen if the human body has good resistance.
Tuberculous ostitis is characterized by a long period of development and progression of the pathological process and in the early stages is not accompanied by any significant pain symptoms, due to which it often does not cause any anxiety in the patient. But here lies the main danger of this disease. After all, this is why many people delay the start of treatment for a long time, which ultimately leads to a very unfavorable result.
Osteitis of the jaw
Osteitis of the jaw is a disease in which inflammatory processes occur in bone tissue. A frequent concomitant phenomenon is also inflammation of the periosteum, which is called periostitis. In addition, phlegmons and fistulas can form, and inflammation of the bone marrow - osteomyelitis - can also join.
The occurrence of jaw ostitis may be indicated by the appearance of pain in some part of the jaw. Then, some swelling is observed in that place, which causes difficulties in the process of chewing food. And subsequently, pain is noted in the entire jaw.
This disease can be caused by severe mechanical damage from blows, injuries, bruises, which resulted in a fracture of the jaw bone. The consequences of an unsuccessful surgical intervention can also be the cause.
Osteitis can appear in the jaw due to the fact that with a number of diseases, for example tuberculosis and syphilis, the entire body is infected by hematogenous means.
Treatment is based on a comprehensive approach and consists of surgical intervention in combination with the prescription of antibacterial and immunostimulating drugs. The presence of a general infectious disease requires its primary treatment.
Osteitis of the jaw is a very unpleasant disease that can be caused by both traumatic and infectious factors, and its treatment requires the use of fairly radical medical measures.
Fibrous osteitis
Fibrous osteitis is one of the possible complications associated with the course of the disease hyperparathyroidism, in which the bones are subject to softening and deformation. Hyperparathyroidism is characterized by the fact that parathyroid hormone is produced in quantities significantly exceeding those necessary for the normal functioning of the body. As a result, calcium-phosphorus metabolism is disrupted, and osteoclastic processes are intensified, during which phosphorus and calcium are excreted from the bones. At the same time, as a result of the fact that tubular absorption decreases and phosphorus begins to be excreted with greater activity, the occurrence of hyperphosphaturia and hypophosphatemia is noted.
Changes affecting bone tissue include the appearance of osteomalacia and osteoporosis.
The bones become brittle, which causes an increased predisposition to fractures in the upper and lower extremities, as well as to spinal injuries.
According to the results of blood tests during this disease, high levels of calcium and alkaline phosphatase are recorded. Parathyroid hormone is also present in large quantities. Phosphorus levels are reduced. X-ray examination reveals thinning of bones, violation of their integrity in the form of cracks and fractures, and the formation of cysts is noted.
In most cases of fibrous osteitis, its course is not associated with the occurrence of any obvious specific symptoms; they may appear only in the case of complications. However, this should in no way inspire confidence that if fibrous osteitis does not bother and does not significantly affect well-being, it is something that does not pose a threat to health. It, like any other disease, must be treated.
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Condensing osteitis
Condensing ostitis is an inflammatory process that simultaneously affects all parts of the bone: the bone itself – ostitis, the periosteum, which is called periostitis, and myelitis – inflammation that develops in the bone marrow. Its specific feature is that it has a focal sclerosing character and its course occurs in a chronic form.
The etiology of condensing ostitis is associated with the occurrence of an atypical reaction of bone tissue in those patients who have high resistance or a low degree of infection, mainly at a young age.
This disease is most often localized in the area where the lower premolars are located. Tooth extraction does not lead to the disappearance of sclerotic change zones. The presence of minor rims of osteosclerosis sometimes occurs as a result of compensated occlusal overload, which is not due to a connection with previously occurring inflammatory processes in the periodontium.
The pathomorphological changes caused by condensing osteitis can be characterized as one of the successive stages by which the aseptic process develops, leading to osteoporosis, that is, the destruction of bone, and osteosclerosis, in which bone density increases.
Based on all of the above, we come to the conclusion that condensing ostitis is a chronic disease characterized by the spread of pathological progress in large areas with the involvement of both the bone itself and the bone marrow and periosteum in sclerosing processes. In view of this, its presence may require quite serious treatment and preventive measures.
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Diagnosis of ostitis
Diagnosis of ostitis is mainly carried out on the basis of information about the condition of the bones obtained as a result of an X-ray examination.
On radiographs, ostitis looks like foci of destructive changes in compact or spongy bone substance, which vary in shape. These foci have sizes of several millimeters and can be measured in centimeters. The edges are either clear or indefinite. Sometimes the presence of an osteosclerotic reaction in the surrounding bone tissue is revealed, and a shadow of sequestration is found inside the focus itself.
Tuberculous ostitis is characterized by the fact that bone tissue exhibits a predominantly weakly expressed productive reaction, which looks like a narrow sclerotic border surrounding the focus of destruction. With tuberculous ostitis, a spongy sequestrum is formed.
Bone inflammation originating in the metaphyseal region, with an eccentrically located focus, mainly in children, may be a prerequisite for the layered or linear periosteal reaction that characterizes tuberculous osteitis. In this case, tomography is used for accurate diagnosis.
Diagnostic measures for ostitis also include radionuclide examination to accurately identify the localization of inflammation when X-rays are inconclusive. This helps determine the location where a bone tissue biopsy should be performed.
Specific ostitis is diagnosed using immunological and microbiological methods.
Diagnosis of ostitis is necessary to differentiate this disease as much as possible from dystrophic-degenerative cystic formations, cortical lacuna, limited aseptic necrosis, osteoid osteoma, chondroblastoma, eosinophilic granuloma, etc. Establishing an accurate and unambiguous diagnosis is a positive factor for an effective treatment process and successful recovery.
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X-ray diagnostics of tuberculous osteitis of the hip joint
The hip joint is one of the most common places in the human body where bone and joint tuberculosis occurs. Based on this, it is important to identify the disease at the earliest possible stage of its development, which significantly facilitates the treatment process and minimizes subsequent complications. Diagnostic measures in many cases are carried out using X-ray examination. In particular, X-ray diagnostics of tuberculous ostitis of the hip joint is carried out.
According to X-ray data, the earliest examinations reveal signs of osteoporosis, and it is possible to detect them only by comparing images that cover both hip joints. Even at the stage preceding tuberculous osteitis, changes in soft tissues may be noted, manifested as enlarged shadows of intermuscular layers in the contours between the joint capsule and the middle and small muscles of the buttocks. An asymmetrical arrangement of the pelvic bones may be observed due to the fact that a person assumes an incorrect position due to muscle atrophy or thickening of the joint on the affected side, or due to a contracture of a painful nature.
After one and a half to two months, radiographs reveal the appearance of foci of destructive processes in bone tissue, the edges of which are uneven and unclear, and in which the presence of multiple spongy sequesters is noted.
Tuberculous osteitis occurs most frequently in those bones that form the acetabulum, to a lesser extent this disease is detected in the femoral neck, and extremely rarely in the femoral head. With regard to the latter, it should be noted that they are better visible on radiographs during which the femur is abducted outward. In the acetabulum, the detection of foci of bone tissue destruction is facilitated by obtaining posterior radiographs.
In some cases, the patient may exhibit early deformation of the nucleus, ossification and enlargement of the femoral head.
X-ray diagnostics of tuberculous osteitis of the hip joint is carried out at different stages of the disease, which allows us to identify the dynamics of the pathological process and, based on this, make certain adjustments to the treatment plan, which is aimed at improving the prognosis and increasing the possibility of effective treatment.
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Treatment of ostitis
Treatment of ostitis involves a set of medical measures that are selected in each specific case based on the etiology and the reasons that they cause the development of the disease. As a rule, surgical intervention is performed to remove the affected tissues that have undergone necrotic processes - necroectomy. This method of surgical treatment is indicated for tuberculous ostitis. In addition, sequestrectomy is performed to remove those bone fragments called sequesters that have separated from the bone due to the disease. Segmental and longitudinal resection of bones, treatment of their cavities with vacuum and ultrasound, and the use of inflow-suction drainage may also be advisable.
Therapeutic treatment measures for ostitis include antimicrobial therapy using antibiotics and sulfonamides. Chemotherapy includes effective antiseptics, including specific ones, intramuscularly and intravascularly, internally and locally. Proteolytic enzymes such as papain, chymotrypsin, etc. are widely used.
Passive and active immunization and physiotherapy procedures play an important role in the treatment of ostitis. The affected limb must also be immobilized.
Thus, treatment of ostitis is mainly carried out in a hospital setting and is prescribed based on the etiology and nature of the disease, as well as the general condition of the patient. Based on the combination of these factors, the doctor makes a choice in favor of certain methods and develops the most appropriate and effective scheme of medical measures.
Prevention of ostitis
Osteitis in its specific form often occurs due to the presence of a number of diseases in a person, such as syphilis, tuberculosis, etc. In this case, the entire body is exposed to infection by hematogenous route through the blood flow in the circulatory system. In particular, the infection gets into bone tissue, where it provokes inflammation.
Thus, prevention of ostitis in this case presupposes the primary need to take the necessary medical measures aimed at treating this main infectious disease. It is of great importance to start treatment as soon as possible after the person has been diagnosed with the corresponding infection. Early treatment significantly contributes to preventing its widespread spread.
To prevent ostitis of traumatic origin, this requires, first of all, primary treatment of the open fracture, as well as strict adherence to the principles of maintaining the strictest aseptic conditions during osteosynthesis of closed fractures.
To summarize what ostitis prevention should be, we will emphasize two main principles. First of all, this is the need for mandatory treatment of acute forms of diseases in order to prevent their transition to a chronic form. And another indispensable condition is the appropriate sanitary treatment in case of damage to the integrity of bones in cases of blows, injuries, bruises and fractures, especially open ones. To avoid the penetration of pathogenic microorganisms and infection.