Causes of Generalized increased bone density

Causes of Generalized increased bone density in an adult

Most common

  • 1. Metastases —prostate and breast most common. Heterogeneous; generally not diffuse.
  • 2. Sickle cell disease —medullary sclerosis and bone infarcts. Growth arrest of long bones. H-shaped vertebrae.
  • 3. Myelofibrosis —older patients. Diffuse medullary sclerosis, loss of corticomedullary differentiation. No heterogeneity.

Less common

  • 4. Renal osteodystrophy —axial > appendicular. Rugger jersey spine.
  • 5. Osteopetrosis —thickened cortices with reduced marrow space. Pathological transverse fractures.
  • 6. Paget’s disease —coarse trabeculae and bone expansion. Multiple bones rather than generalized.
  • 7. Systemic mastocytosis —lytic, sclerotic or mixed. Usually diffuse affecting spine and epiphyses of long bones.


  • 8. Fluorosis —diffuse osteosclerosis, particularly ribs and spine, with entheseal ossification.
  • 9. Pyknodysostosis —narrow medullary cavities with multiple long bone fractures.
  • 10. Hypoparathyroidism —diffuse sclerosis in 10%. Dense metaphyseal bands and skull vault thickening.
  • 11. Progressive diaphyseal dysplasia (Camurati-Engelmann disease) —young patients. Fusiform enlargement and sclerosis of long bones sparing the epiphyses.
  • 12. Myeloma —rare osteosclerosing form. Associated with POEMS syndrome.

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