Imaging Findings and Evaluation of Metabolic Bone Disease

Abstract

Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. For patients affected by these processes, radiologic imaging plays a central role in diagnosis, monitoring treatment, and risk stratification. Radiologists should be familiar with the diseases, intimately aware of the imaging findings, and possessive of multimodality expertise to wisely guide the best practice of medicine. The purpose of this paper is to review the imaging features and characteristics of the most common types of metabolic bone disease with highlights of clinically relevant information so that readers can better generate appropriate differential diagnoses and recommendations. For this review, a thorough literature search for the most up-to-date information was performed on several key types of metabolic bone disease: osteoporosis, osteomalacia, rickets, scurvy, renal osteodystrophy, hyperparathyroidism, Paget's disease, osteogenesis imperfecta, acromegaly, and osteopetrosis. Although they all affect the bone, these diseases have both shared characteristic features that can be discerned through imaging.

Radiographic evaluation of the forelimbs and hind limbs of marmosets (Callithrix spp.)

“…In human patients, bone deformities due to osteomalacia/rickets such as bowing can be bilateral and symmetric and observed in weight‐bearing bones . Skeletal alterations in marmosets, such as bowing, varus deformity, and decreased bone length, were also detected mainly in the long bones of the hind limbs.…”

Utility of Plain Radiographs in Metabolic Bone Disease – A Case-Based Pictorial Review from a Tertiary Centre

“…Predominant radiographic patterns of these conditions are decreased or increased bone density (osteopenia and osteosclerosis, respectively), and softening of bones leading to bowing, complete or incomplete fractures, as seen in rickets and osteomalacia [7]. Table 1 gives a comprehensive list of diagnostic radiographic signs of the various cases included in this series, which are commonly overlooked.…”

Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach

“…In patients with osteomalacia, loss of cortical definition and osteopenia or decreased bone mass with coarse and ill-defined trabecular bone are seen frequently as the inability to mineralize newly formed osteoid (35). Looser zones or pseudofractures from deposition of unmineralized osteoid are seen as bilateral and symmetric lucent bands that typically appear in locations similar to those of stress fractures (41). Cortical thinning, decreased trabeculation, and pseudofractures-seen as symmetric bandlike lucencies in relation to arteries-have been described at cone-beam CT. Associated periodontal disease due to aplasia or hypoplasia of the cementum, which provides anchorage of the tooth in its alveolus, may be seen (42).…”