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Radiographic Changes in Rickets and Osteomalacia

- Discussion:
    - anatomical and pathological changes that occur with rickets or osteomalacia differ principallyaccording to the age of pt & severity of the 
    - 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 
           - 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