link
Bookmarks
Metabolic Bone Disease
Fathima Fijula P. Manzil, MD; Umesh D. Oza, MD; Daniel G. Hampton, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
50
24
8

KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Metabolic bone disease
          • Bone diseases that result in bone strength or mineralization abnormalities
            • Commonly due to abnormalities in bone mass or imbalance of minerals (Ca, P) or vitamin D
            • Osteoporosis, osteomalacia, osteitis fibrosa cystica (OFC), Paget disease (PD)
            • Commonly reversible once underlying disorder is treated
          • Overlap of bone scan findings of osteomalacia, renal osteodystrophy, and hyperparathyroidism
          • Osteoporosis
            • Most common metabolic bone disease
            • Imbalance between bone resorption and formation
            • Bone density 2.5 standard deviations below that of young adult
              • Typically measured by dual-energy x-ray absorptiometry
            • Prone for fragility fractures
            • Common cause of fracture in elderly
          • Osteomalacia
            • Impaired bone mineralization due to low levels of Ca, P, or vitamin D or resorption of calcium
            • Most common cause is vitamin D deficiency
              • Vitamin D is normally derived from sunlight and, to lesser extent, from diet
              • Screening test for vitamin D is serum 25(OH) D level
          • OFC
            • Skeletal manifestation of advanced hyperparathyroidism (HPT)
              • Primary and secondary HPT, renal osteodystrophy
            • Loss of bone mass, paratrabecular fibrosis, and formation of cyst-like brown tumors in and around bones
          • PD
            • Dysregulated cellular bone remodeling, causing deformity of 1 or more bones
            • Pathogenesis described in 4 stages
              • Osteoclastic activity, mixed osteoclastic-osteoblastic activity, osteoblastic activity, malignant degeneration

      IMAGING

      • General Features

        • Radiographic Findings

          • Nuclear Medicine Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Natural History & Prognosis

                      • Treatment

                        Selected References

                        1. Dadra A et al: High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: A pilot study. J Clin Orthop Trauma. 10(6):1097-100, 2019
                        2. Prins JTH et al: Rib fractures after blunt thoracic trauma in patients with normal versus diminished bone mineral density: a retrospective cohort study. Osteoporos Int. ePub, 2019
                        3. Abdelrazek S et al: Bone scan in metabolic bone diseases. Review. Nucl Med Rev Cent East Eur. 15(2):124-31, 2012
                        4. Cook GJ et al: Miscellaneous indications in bone scintigraphy: metabolic bone diseases and malignant bone tumors. Semin Nucl Med. 40(1):52-61, 2010
                        5. Martin KJ et al: Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 18(3):875-85, 2007
                        6. Pour MC et al: Diffuse increased uptake on bone scan: super scan. Semin Nucl Med. 34(2):154-6, 2004
                        7. Peller PJ et al: Extraosseous Tc-99m MDP uptake: a pathophysiologic approach. Radiographics. 13(4):715-34, 1993
                        8. Spitz J et al: Scintimetric evaluation of remodeling after bone fractures in man. J Nucl Med. 34(9):1403-9, 1993
                        9. McAfee JG: Radionuclide imaging in metabolic and systemic skeletal diseases. Semin Nucl Med. 17(4):334-49, 1987
                        Related Anatomy
                        Loading...
                        Related Differential Diagnoses
                        Loading...
                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            TERMINOLOGY

                            • Definitions

                              • Metabolic bone disease
                                • Bone diseases that result in bone strength or mineralization abnormalities
                                  • Commonly due to abnormalities in bone mass or imbalance of minerals (Ca, P) or vitamin D
                                  • Osteoporosis, osteomalacia, osteitis fibrosa cystica (OFC), Paget disease (PD)
                                  • Commonly reversible once underlying disorder is treated
                                • Overlap of bone scan findings of osteomalacia, renal osteodystrophy, and hyperparathyroidism
                                • Osteoporosis
                                  • Most common metabolic bone disease
                                  • Imbalance between bone resorption and formation
                                  • Bone density 2.5 standard deviations below that of young adult
                                    • Typically measured by dual-energy x-ray absorptiometry
                                  • Prone for fragility fractures
                                  • Common cause of fracture in elderly
                                • Osteomalacia
                                  • Impaired bone mineralization due to low levels of Ca, P, or vitamin D or resorption of calcium
                                  • Most common cause is vitamin D deficiency
                                    • Vitamin D is normally derived from sunlight and, to lesser extent, from diet
                                    • Screening test for vitamin D is serum 25(OH) D level
                                • OFC
                                  • Skeletal manifestation of advanced hyperparathyroidism (HPT)
                                    • Primary and secondary HPT, renal osteodystrophy
                                  • Loss of bone mass, paratrabecular fibrosis, and formation of cyst-like brown tumors in and around bones
                                • PD
                                  • Dysregulated cellular bone remodeling, causing deformity of 1 or more bones
                                  • Pathogenesis described in 4 stages
                                    • Osteoclastic activity, mixed osteoclastic-osteoblastic activity, osteoblastic activity, malignant degeneration

                            IMAGING

                            • General Features

                              • Radiographic Findings

                                • Nuclear Medicine Findings

                                  • Imaging Recommendations

                                    DIFFERENTIAL DIAGNOSIS

                                      PATHOLOGY

                                      • General Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Natural History & Prognosis

                                            • Treatment

                                              Selected References

                                              1. Dadra A et al: High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: A pilot study. J Clin Orthop Trauma. 10(6):1097-100, 2019
                                              2. Prins JTH et al: Rib fractures after blunt thoracic trauma in patients with normal versus diminished bone mineral density: a retrospective cohort study. Osteoporos Int. ePub, 2019
                                              3. Abdelrazek S et al: Bone scan in metabolic bone diseases. Review. Nucl Med Rev Cent East Eur. 15(2):124-31, 2012
                                              4. Cook GJ et al: Miscellaneous indications in bone scintigraphy: metabolic bone diseases and malignant bone tumors. Semin Nucl Med. 40(1):52-61, 2010
                                              5. Martin KJ et al: Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol. 18(3):875-85, 2007
                                              6. Pour MC et al: Diffuse increased uptake on bone scan: super scan. Semin Nucl Med. 34(2):154-6, 2004
                                              7. Peller PJ et al: Extraosseous Tc-99m MDP uptake: a pathophysiologic approach. Radiographics. 13(4):715-34, 1993
                                              8. Spitz J et al: Scintimetric evaluation of remodeling after bone fractures in man. J Nucl Med. 34(9):1403-9, 1993
                                              9. McAfee JG: Radionuclide imaging in metabolic and systemic skeletal diseases. Semin Nucl Med. 17(4):334-49, 1987