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Ortho X-Ray

Decreased Bone Density

February 15th, 2021

Generalised Osteopaenia

Look for a reduction in bone density, either generally or surrounding a joint.
Generalised osteopaenia suggests an imbalance in bone deposition and resorption, placing bone at risk of pathological fractures.
  • Causes of Generalised Osteopaenia

  • Post-menopausal
  • Senile (age-related)
  • Genetic - osteogenesis imperfecta
  • Metabolic - hyperparathyroidism, hypogonadism, hyperthyroidism, Cushing's disease, Addison's disease, vitamin D deficiency, ESRF, paraneoplastic syndrome, T1DM, acromegaly
  • Malnutrition - eating disorder, poor intake
  • Malabsorption - coeliac disease, IBD, pancreatic insufficiency
  • Hepatic - chronic hepatitis, alcoholic liver disease, biliary cirrhosis
  • Marrow failure - leukaemia / lymphoma, multiple myeloma, thalassaemia, sickle cell anaemia, haemochromatosis, amyloidosis, sarcoidosis
  • Transplant - marrow, heart, lung, liver, kidney
  • Medications - corticosteroids, chemotherapy drugs, anticonvulsants, PPIs, SSRIs, lithium, aluminium
On a plain x-ray it is not possible to distinguish between osteopaenia and osteoporosis.

Periarticular Osteopaenia

  • Look For

  • Loss of bone density surrounding joints.
  • Causes of Periarticular Osteopaenia

  • Rheumatoid arthritis
  • Chronic joint disuse
  • Early Paget's disease

Lytic Lesions

  • Look For

  • Focal areas of bony hypodensity.
  • Significance

  • Classically a sign of multiple myeloma.
  • Causes of Lytic Lesions

  • Fibrous dysplasia
  • Osteoblastoma
  • Giant cell tumor
  • Metastasis / multiple myeloma
  • Aneurysmal bone cyst
  • Chondroblastoma
  • Hyperparathyroidism (brown tumour) / haemangioma
  • Infection (osteomyelitis)
  • Nonossifying fibroma
  • Eosinophilic Granuloma
  • Solitary Bone Cyst
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