The Forgotten Art of Plain Radiography in the Evaluation of Metabolic Bone Disease

Abstract

Although the metabolic bone diseases are fairly commonly encountered in routine practice in India, unfortunately, the clinical presentation is quite non-specific and often remains unrecognized for years, leading to increased morbidity. In this era of advanced imaging technologies, magnetic resonance imaging (MRI) is increasingly being requested by clinicians as an initial investigation for the non-specific presentation of metabolic bone conditions, including back pain, generalized weakness, and arthralgias, and is usually largely non-contributory. Thus, the importance of plain radiographs is neglected. Although basic radiographs are frequently available at the time of MRI, it is often ignored by both the radiologists and clinicians who can lead to misdiagnosis or missed diagnosis. A variety of radiographic findings is encountered in metabolic bone diseases, though often subtle, is unceasingly diagnostic, and recognition of these findings leads to early diagnosis and treatment, resulting in improved patient outcomes. Therefore, the objective of our paper is to present a systematic approach to the interpretation of plain radiographs of the pelvis, spine, and chest that can facilitate identifying subtle imaging findings supported by complementary other region plain radiographs and laboratory data for the evaluation of metabolic bone diseases.