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 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. chemotherapy, e.g. methotrexate
  3. lead poisoning
  4. normal variant: especially in a neonate – dense zone of provisional calcification
  5. aminopterin fetopathy
  6. bisphosphonate therapy
  7. chronic recurrent multifocal osteomyelitis
  8. congenital transplacental infection, e.g. toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis
  9. deprivation (psychosocial) dwarfism with trauma
  10. drug or hormone therapy in high dosage, e.g. steroids, parathyroid hormone, methotrexate, estrogen or heavy metal therapy to the mother during pregnancy
  11. dysosteosclerosis
  12. other heavy metal or chemical poisoning, e.g. bismuth, arsenic, phosphorus, fluoride, mercury, lithium, radium, Thorotrast
  13. hypoparathyroidism/pseudohypoparathyroidism
  14. hypothyroidism: cretinism (treated)
  15. meconium peritonitis (neonatal dense bands)
  16. metaphyseal chondrodysplasia(s)
  17. osteopetrosis
  18. oxalosis
  19. parathyroid hormone therapy
  20. Patterson syndrome
  21. radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32)
  22. sclerosteosis: especially knees
  23. scurvy: healing
  24. spondyloepimetaphyseal dysplasia(s)
  25. spondylometaphyseal dysplasia(s)
  26. vascular injury
  27. Williams syndrome: idiopathic hypercalcemia
  28. renal osteodystrophy (secondary hyperparathyroidism): healing
  29. trauma: non-accidental injury; stress fracture
  30. Stress lines
  31. Treated rickets
  32. Hypervitaminosis D
  33. 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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