Disuse osteoporosis: Mimic of neoplastic disease

Abstract

Disuse osteoporosis, a common sequela to immobilization, consists of bony changes that may mimic neoplastic disease. This paper describes the different types of cortical and medullary demineralization that can be manifested radiologically and the histopathologic basis for these alterations. Six cases are included that exemplify these changes, and comparison is made with multiple myeloma.

Bone marrow changes related to disuse

“…A lot of studies have described the bone changing process beginning with the immobilization period [1; 3; 8; 14; 18; 22–24]. Most of these studies used blood and urine tests to assess the loss of calcium as well as radiological exams such as two dimensional dual-energy x-ray absorptiometry (DXA) and quantitative CT (QCT) techniques to evaluate the loss of bone.…”

“…Disuse osteopenia results from reduced weight-bearing on lower limbs, leading to loss of bone mass, compromised bone architecture, and increased fracture rates [1–5]. The exact pathophysiological process of disuse is unknown.…”

Benign osseous and articular abnormalities of the pelvis: a review of CT imaging findings

“…9) [33 ,34]. These findings can potentially be confused with more malign etiologies that also result in a permeative osseous pattern, and careful correlation with the patient's level of activity should be performed [35].…”

The double cortical line: A sign of osteopenia

“…Such signs are the result of structural changes secondary to osteopenia, for example, cortical thinning, prominent trabeculation and deformity. The double cortical line is another structural change which aids radiographic diagnosis of osteopenia (Jones 1969, Joyce and Keats 1986, Yagan and others 1987. In primary hyperparathyroidism of humans, intracortical bone resorption resulting in 'tunneling' or double cortical line may be the only radiographic abnormality in mild disease (Jensen 1988). lntracortical bone resorption resulting in a double cortical line or lamellation of the cortex must be differentiated from the lamellar periosteal bone reaction which follows intermittent elevation of the periosteum (Stowater 1986).…”

“…Radiographic signs of osteopenia in small animals include decreased opacity of bones, thin cortices, coarse trabeculation, prominent metaphyses or vertebral end-plates, and deformity (including compression or folding fractures) (Riser 1964, Morgan 1981, Campbell and Griffiths 1984. Studies of the radiographic appearance of disuse osteopenia in humans have revealed additional signs including intracortical resorption or 'lamellation' which produces a double cortical line in the diaphysis (Jones 1969, Joyce andKeats 1986). The double cortical line has also been observed in the acetabular subchondral plate in paraplegic humans (Yagan and others 1987).…”