Metabolic Bone Diseases: An Updated View – Part One

Metabolic bone disease represents a complex entity associated with genetic, biochemical, endocrine, and nutritional dysfunctions. Probably because of clinical, biochemical, and imaging inconsistencies, radiologists historically have tended to narrow their routine management, adopting only a few imaging techniques. However, recent epidemiological studies and advances in therapeutic and diagnostic approaches now offer newer perspectives.

In this special issue presented in two volumes, we have explored the cornerstones of metabolic bone disease with contributions from world-renowned experts.

This first volume embraces several aspects related to the management of osteoporosis beginning with the role of conventional radiography.

Subsequent articles offer a comprehensive overview on dual-energy X-ray absorptiometry (DXA), the most widely used technique for the assessment of bone mass, including practical recommendations for optimal DXA scan reporting in adults and children such as serial bone mineral density measurements and fracture risk assessment. Special focus is directed toward the wider concept of bone strength in terms of quantity and quality, taking into account advanced imaging techniques to measure architectural, textural, and mechanical parameters.

As a consequence of the emerging interest in bone fragility, Fotiadou et al provide an extensive overview of the imaging features of osteogenesis imperfecta, describing the distinctive aspects of bone alterations and the differential diagnoses of this complex and heterogeneous disease.

One of the cornerstones of metabolic bone disease is Paget's, which is common in the elderly population and can be detected incidentally on examinations performed for other clinical reasons. Although the imaging features of Paget disease are well known on X-ray and computed tomography, magnetic resonance imaging aspects are often subtle and nonspecific. Radiologists must become familiar with the various ways this disease appears on imaging.

Skeletal fragility has been recognized as an important feature of both type 1 and type 2 diabetes mellitus. Although it is well known that low bone mass is associated with type 1 diabetes, the mechanisms of bone strength impairment observed in type 2 are less understood. In their article, Heilmeier and Patsch offer a comprehensive overview of the pathophysiologic, clinical, and imaging features of diabetic bone disease.

The last contribution of this first volume arises from the observation of osteonecrosis of the jaw as an unexpected complication of prolonged use of antiresorptive drugs used to treat osteonecrosis. Mücke and colleagues provide a comprehensive review of all imaging features and treatment options, focusing on practical guidelines for preoperative assessment.

We would like to thank the authors for their excellent and comprehensive contributions on these very complicated topics.