Imaging Features of Therapeutic Drug–induced Musculoskeletal Abnormalities

Abstract

Increasing use of a wide variety of therapeutic drugs with known musculoskeletal side-effect profiles necessitates a rigorous understanding and approach when evaluating imaging features suggestive of drug-induced musculoskeletal abnormalities. The etiology of such abnormalities is diverse, and the clinical and imaging manifestations may be nonspecific. The recognition of adverse effects depends, first, on the physician's vigilant review of clinical information for relevant drug history and indicative signs, and second, on the radiologist's ability to detect musculoskeletal changes consistent with known potential effects of specific drugs. Musculoskeletal abnormalities induced by therapeutic drugs may be broadly categorized as embryopathic, juvenile, or postmaturation. Embryopathic skeletal abnormalities result from the teratogenic effects of drugs administered to pregnant women (eg, thalidomide, anticonvulsants). Other therapeutic agents characteristically lead to abnormalities during postnatal skeletal maturation (eg, high-dose vitamins or prostaglandin) either because they are used exclusively in children or because they have idiosyncratic effects on immature musculoskeletal structures. Many drugs (eg, statins) may have musculoskeletal side effects that, although independent of the stage of skeletal maturation, are most often seen in adults or elderly people because they are commonly prescribed for people in these age groups. Drug-induced musculoskeletal abnormalities may be further characterized according to the predominant skeletal manifestations as osteomalacic, proliferative, or osteoporotic and according to the involvement of soft tissues as musculotendinous or chondral.

Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis

“…Radiologically, the cyclical inhibition of osteoclast activity in the skeletally immature patient gives rise to dense metaphyseal bands migrating longitudinally from the zone of provisional calcification into the diaphysis, as previously described [5,6]. Additionally, undertubulation of the affected areas, as well a "bone within a bone" appearance can be seen [7].…”

Imaging of Multifocal and Diffuse Sclerotic Bone Lesions

“…In children, the characteristic radiographic fi nding is dense metaphyseal bands combined with widening of the zone of provisional cartilage in tubular bones. 6 In adults, calcifi cation typically occurs in the periarticular soft tissues, joint capsules, and synovial bursae. Treatment remains supportive, decreasing the elevated vitamin D levels by avoiding intake of vitamin D supplements.…”

“…Treatment remains supportive, decreasing the elevated vitamin D levels by avoiding intake of vitamin D supplements. 6 Fluoride. Chronic fl uorine intoxication results in skeletal abnormalities in patients of all ages, as 99% of fl uoride retained in the body is deposited in bone.…”

“…Chronic fl uorine intoxication results in skeletal abnormalities in patients of all ages, as 99% of fl uoride retained in the body is deposited in bone. 6 Fluorosis can result from industrial exposure (manufacturing of aluminum) or medical therapy with fl uoride-containing drugs. Fluorosis occurs endemically in South Africa and Asia, where there is a high natural fl uoride content in drinking water.…”

“…Increased fragility of the osteosclerotic bone predisposes patients to pathologic fracture. 6 With a predilection to involve the spine and pelvis, fl uorosis produces generalized osteosclerosis on radiographs.…”