Brittle Bone Imaging: Diagnostic Procedures in Adults

Abstract

This article concentrates on generalized disorders causing bone fragility. The most frequent cause of brittle bone disease is osteoporosis, only diagnosed by elimination. First, malignant osteopathy must be ruled out: fracture on metastasis or multiple myeloma, which mimics osteoporosis when presenting as diffuse demineralization. Second, patients should be screened for signs of hyperparathyroidism or osteomalacia. Much more rarely, many other pathologies can lead to brittle bone by demineralization or associated increased bone density.

The radiologist needs to know the clinical context and notably the patient's age (childhood or adulthood) at discovery, and known pathologies and ongoing or previous treatments: corticotherapy, bisphosphonates, denosumab, or prior radiotherapy in the affected region. Diagnostic hypotheses are guided by the type of demineralization and the presence of lytic, mixed, or densifying areas. Lastly, the aspect and location of fractures and association with other bone abnormalities refine the diagnosis.

Keywords

brittle bone - osteoporosis - malignant osteopathy - hyperparathyroidism - osteomalacia

Publication History

Article published online:
25 September 2023

• References

• 1 Dargent-Molina P. Epidemiology and risk factors for osteoporosis [in French]. . Rev Med Interne 2004; 25 (Suppl. 05) S517-S525
• 2 Chappard D, Alexandre C, Riffat G. Relations between trabecular bone mass and the configuration in the space of the trabeculae of bone. Histomorphometric study of a population of 145 osteoporotic women [in French]. Rev Rhum Mal Osteoartic 1988; 55 (01) 19-25
• 3 Guglielmi G, Muscarella S, Bazzocchi A. Integrated imaging approach to osteoporosis: state-of-the-art review and update. Radiographics 2011; 31 (05) 1343-1364
• 4 Burckhardt P. The various forms of osteoporosis and their treatment [in French]. Schweiz Med Wochenschr 1989; 119 (50) 1797-1805
• 5 Younes M, Ben Hammouda S, Jguirim M. et al. Discordance between spine and hip bone mineral density measurement using DXA in osteoporosis diagnosis: prevalence and risk factors [in French]. Tunis Med 2014; 92 (01) 1-5
• 6 Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8 (09) 1137-1148
• 7 Sillence DO, Rimoin DL, Danks DM. Clinical variability in osteogenesis imperfecta-variable expressivity or genetic heterogeneity. Birth Defects Orig Artic Ser 1979; 15 (5B): 113-129
• 8 Glorieux FH, Ward LM, Rauch F, Lalic L, Roughley PJ, Travers R. Osteogenesis imperfecta type VI: a form of brittle bone disease with a mineralization defect. J Bone Miner Res 2002; 17 (01) 30-38
• 9 Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging findings of metabolic bone disease. Radiographics 2016; 36 (06) 1871-1887
• 10 Phan CM, Guglielmi G. Metabolic bone disease in patients with malabsorption. Semin Musculoskelet Radiol 2016; 20 (04) 369-375
• 11 Kanberoglu K, Kantarci F, Cebi D. et al. Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis. Clin Radiol 2005; 60 (01) 105-111
• 12 Nunes ME. Hypophosphatasia. GeneReviews. Accessed May 18, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK1150/
• 13 Wendling D, Jeannin-Louys L, Kremer P, Fellmann F, Toussirot E, Mornet E. Adult hypophosphatasia. Current aspects. Joint Bone Spine 2001; 68 (02) 120-124
• 14 Hardy DC, Murphy WA, Siegel BA, Reid IR, Whyte MP. X-linked hypophosphatemia in adults: prevalence of skeletal radiographic and scintigraphic features. Radiology 1989; 171 (02) 403-414
• 15 Vélayoudom-Céphise FL, Vantyghem MC, Wémeau JL. Hereditary hypophosphatemia in adults [in French].. Presse Med 2005; 34 (22 Pt 1): 1720-1726
• 16 Yuh WT, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging. Radiology 1989; 172 (01) 215-218
• 17 Gerrand C, Griffin AM, White LM, Rosen IB. Musculoskeletal images. Early bone changes in hyperparathyroidism detected on magnetic resonance imaging. Can J Surg 1999; 42 (05) 330
• 18 Yang Q, Sun P, Li J. et al. Skeletal lesions in primary hyperparathyroidism. Am J Med Sci 2015; 349 (04) 321-327
• 19 Wen HY, Schumacher Jr HR, Zhang LY. Parathyroid disease. Rheum Dis Clin North Am 2010; 36 (04) 647-664
• 20 Rivas-Prado L, Morales-Ortega A, Allodi-de la Hoz S, Bernal-Bello D. Hyperparathyroidism shows its hand: findings of osteitis fibrosa cystica. Lancet 2021; 397 (10288): 1914
• 21 Lee G, Cotton T, Tucci J, Aaron RK. Hyperparathyroidism in a fracture population. R I Med J (2013) 2022; 105 (08) 34-39
• 22 Murphey MD, Sartoris DJ, Quale JL, Pathria MN, Martin NL. Musculoskeletal manifestations of chronic renal insufficiency. Radiographics 1993; 13 (02) 357-379
• 23 Alexander AJ, Jahangir D, Lazarus M, Sprague SM. Imaging in chronic kidney disease-metabolic bone disease. Semin Dial 2017; 30 (04) 361-368
• 24 Spinnato P, Pedrini E, Petrera MR. et al. Spectrum of skeletal imaging features in osteopetrosis: inheritance pattern and radiological associations. Genes (Basel) 2022; 13 (11) 1965
• 25 Sidhu HS, Venkatanarasimha N, Bhatnagar G, Vardhanabhuti V, Fox BM, Suresh SP. Imaging features of therapeutic drug-induced musculoskeletal abnormalities. Radiographics 2012; 32 (01) 105-127
• 26 Matusiewicz R, Stempniak M, Lebiedowski K, Czajkowski M. The most frequent complications during long-term corticotherapy [in Polish].. Wiad Lek 1989; 42 (05) 273-277
• 27 Chung YK, Lee YK, Yoon BH, Suh DH, Koo KH. Pelvic insufficiency fractures in cervical cancer after radiation therapy: a meta-analysis and review. In Vivo 2021; 35 (02) 1109-1115
• 28 Black DM, Kelly MP, Genant HK. et al; Fracture Intervention Trial Steering Committee, HORIZON Pivotal Fracture Trial Steering Committee. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 2010; 362 (19) 1761-1771
• 29 Shane E, Burr D, Abrahamsen B. et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014; 29 (01) 1-23
• 30 Wang Y, Yin Y, Gilula LA, Wilson AJ. Endemic fluorosis of the skeleton: radiographic features in 127 patients. AJR Am J Roentgenol 1994; 162 (01) 93-98