Measurement of bone mass is important in determining the risk for fracture and in following the course of patients undergoing therapy for osteoporosis. Bone mineral densitometry (BMD) is a good predictor of fracture risk, but there is considerable overlap in BMD measurements between individuals with fracture risk and those without. In this study, computerized texture analysis of the trabecular pattern on conventional spine radiographs was used to evaluate bone structure as a determinant of fracture risk. Standard lumbar spine radiographs of 43 individuals were analyzed and compared with BMD measurements obtained with dual-photon absorptiometry. This method was more effective than BMD in differentiation of patients with fractures elsewhere in the spine from those with no fracture. These preliminary results suggest that this method of bone structure analysis, combined with BMD, may lead to a more sensitive and specific predictor of osteoporosis and risk of fracture.

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Patients referred to the authors' hospital for evaluation on suspicion of a bone or soft-tissue malignancy frequently present to the Orthopaedic Oncology Clinic with magnetic resonance (MR) images that show typical features of nonmalignant or nonneoplastic entities. The purpose of this article is to review the benign entities that may be mistaken by the radiologist for a malignancy and thus lead to needless referral to an orthopedic oncologist. Normal hematopoietic marrow and marrow edema due to a stress reaction may mimic a neoplasm at MR imaging, but knowledge of the typical patterns and locations of these features allows an accurate radiologic interpretation. The MR imaging appearance of osteonecrosis, Paget disease, benign bone lesions, and rheumatologic conditions may be confusing; in such circumstances, radiographic findings may help formulate a correct diagnosis. Knowledge of the common locations and appearances of bursae and ganglia is necessary so that radiologists do not misinterpret these benign entities as soft-tissue sarcomas. Soft-tissue trauma and inflammation also may mimic tumors at MR imaging, but a familiarity with the imaging patterns of nonneoplastic change in muscle allows the avoidance of misinterpretation. The clinical history, as always, is an important component of proper diagnosis. The radiologist can be especially useful to both the clinician and the patient by recognizing entities that are highly unlikely to represent malignancy and by confidently reporting those entities as benign, thereby sparing the patient an unnecessary trip to the orthopedic oncologist.

SUMMARY BackgroundInflammatory bowel disease is associated with non-adherence to treatment with oral medications.

This study suggests that RTA of densitometer-generated calcaneus images provides an estimate of bone fragility independent of and complementary to BMD measurement and age.