Recent advance in metabolic bone disease and an overview of clinical and imaging findings
1. General practitioner, Kermanshah University of Medical Sciences
Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs. some of these disorders are rare, but some present public health concerns (for instance, rickets) that have been well known for many years but still persist. osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic looser zones. hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and rugger jersey spine. hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. the findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. vitamin c deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. 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.
Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. 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.
: metabolic bone disease is a diverse spectrum of pathology affecting bone homeostasis. imaging is essential for the diagnosis, evaluation, and treatment of these patients. knowledge of the diseases, recognition of the imaging findings, and expertise to appropriately guide the imaging evaluation and treatment are fundamental to the role of the radiologist.
Bone disease, metabolic, clinical and imaging finding