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Semin Musculoskelet Radiol 2023; 27(04): 439-450
DOI: 10.1055/s-0043-1769776
Review Article

Brittle Bone Imaging: Diagnostic Procedures in Adults

Catherine Cyteval
1   Department of Radiology, CHU, Montpellier, France
,
Paulina Szafors
2   Department of Rheumatology, CHU, Montpellier, France
,
Maxime Pastor
1   Department of Radiology, CHU, Montpellier, France
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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

© 2023. Thieme. All rights reserved.

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