Differential diagnosis for dense metaphyseal bands

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

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. 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. Other etiologic factors include stress lines, treated rickets, scurvy, hypervitaminosis D, and treated leukemia.

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