Radiographic Changes in Rickets and Osteomalacia - Wheeless' Textbook of Orthopaedics

- Discussion:
- anatomical and pathological changes that occur with rickets or osteomalacia differ principally
according to the age of pt & severity of the disorder.
- children:
- physeal cupping / widening
- bowing of long bones;
- transverse radiolucent (Looser's) lines
- flattening of skull
- enlargment of the costal cartilages (rachitic rosary);
- dorsal kyphosis;
- adults:
- by definition, osteomalacia occurs only in adults and thus has no effect on the growth cartilage;
- osseous changes in osteomalacia are similar to those in children but are much less
evident because adult skeleton is metabolically less active.
- radiographs of bones show thin cortices & indistinct, fuzzy trabeculae that assume an almost
ground-glass appearance as a result of the prevalence of the widened osteoid seams;
- focal collections of osteoid may produce ribbon-like transverse zones of incomplete radiolucency,
particularly notable on concave side of the long bones, the medial side of the femoral
neck, the ischial and pubic rami, the ribs, the clavicles, and axillary border of the scapulae;
- these Milkman pseudofrxs or Looser lines usually show increased activity on bone scans and
may, under stress, propagate to become true fractures.
- in adults with osteomalacia, the osteopenic bone changes may dominate the picture; osteomalacic
alterations may be very subtle and, unless a Looser line is present, the picture can
be mistaken easily for osteoporosis;