Differential diagnosis for dense metaphyseal bands

What is the differential diagnosis for dense metaphyseal bands, and how to know when they are abnormally dense?

  • Dense metaphyseal bands, also known as metaphyseal dysplasia, can be seen on imaging studies such as X-rays and may be associated with various conditions.
  • The presence of dense metaphyseal bands alone is not specific to a particular diagnosis, and further evaluation is needed to determine the underlying cause.
  • Dense metaphyseal bands may be a normal variant, so it is important to look at areas that do not have a lot of bone turnover to see whether they are affected as well.

Differential diagnosis for dense metaphyseal bands

  1. Growth acceleration lines following growth arrest due to systemic illness or stress in infancy or childhood, e.g. asthma, diabetes, cystic fibrosis, juvenile chronic arthritis, juvenile rheumatoid arthritis, malnutrition chronic anemia, e.g. sickle cell disease, thalassemia
  2. Metaphyseal chondrodysplasia: A group of genetic disorders characterized by abnormal development of the growth plate and metaphysis, leading to short stature and skeletal abnormalities. Dense metaphyseal bands are a common finding in several types of metaphyseal chondrodysplasia.
  3. Osteogenesis imperfecta: A genetic disorder characterized by brittle bones, frequent fractures, and skeletal abnormalities. Dense metaphyseal bands can be seen in some subtypes of osteogenesis imperfecta.
  4. Metaphyseal osteopathy (Pyle disease): A rare genetic disorder characterized by thickening of the metaphyses and long bones. Dense metaphyseal bands are a characteristic feature of Pyle disease.
  5. Metaphyseal dysplasia without hypotrichosis (Jansen type): A rare genetic disorder characterized by metaphyseal abnormalities, short stature, and other skeletal abnormalities. Dense metaphyseal bands can be seen on imaging studies.
  6. chemotherapy, e.g. methotrexate
  7. lead poisoning
  8. normal variant: especially in a neonate – dense zone of provisional calcification
  9. aminopterin fetopathy
  10. bisphosphonate therapy
  11. chronic recurrent multifocal osteomyelitis
  12. congenital transplacental infection, e.g. toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis
  13. deprivation (psychosocial) dwarfism with trauma
  14. drug or hormone therapy in high dosage, e.g. steroids, parathyroid hormone, methotrexate, estrogen or heavy metal therapy to the mother during pregnancy
  15. dysosteosclerosis
  16. other heavy metal or chemical poisoning, e.g. bismuth, arsenic, phosphorus, fluoride, mercury, lithium, radium, Thorotrast
  17. hypoparathyroidism/pseudohypoparathyroidism
  18. hypothyroidism: cretinism (treated)
  19. meconium peritonitis (neonatal dense bands)
  20. metaphyseal chondrodysplasia(s)
  21. osteopetrosis
  22. oxalosis
  23. parathyroid hormone therapy
  24. Patterson syndrome
  25. radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32)
  26. sclerosteosis: especially knees
  27. Scurvy: A condition caused by vitamin C deficiency, leading to impaired collagen synthesis and weakened connective tissues. Dense metaphyseal bands can be seen in severe cases of scurvy.
  28. spondyloepimetaphyseal dysplasia(s)
  29. spondylometaphyseal dysplasia(s)
  30. vascular injury
  31. Williams syndrome: idiopathic hypercalcemia
  32. renal osteodystrophy (secondary hyperparathyroidism): healing
  33. trauma: non-accidental injury; stress fracture
  34. Stress lines
  35. Treated rickets: A condition caused by vitamin D deficiency or impaired vitamin D metabolism, leading to softening and weakening of the bones. Rickets can manifest with metaphyseal changes, including dense metaphyseal bands.
  36. Hypervitaminosis D
  37. Treated leukemia

Differential diagnosis for dense metaphyseal bands

Specifically, the metaphyses of the fibula are good areas to check. A major concern is heavy metal poisoning (specifically lead intoxication).

Lead poisoning can be diagnosed by noting not only metaphyseal bands but also radiopaque lead chips floating in a child’s intestines seen on a frontal radiograph of the abdomen.


Radiopedia.org Dense metaphyseal bands (differential)


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