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