Skip to main content

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

The pathological changes of osteoporosis are due to resorption of the cortical and trabecular bone. The main radiographic findings include changes in the trabecular pattern, cortical thinning, and decreased bone density which are more prominent in the axial skeleton. Although the most common cause is primary osteoporosis, one has to be aware of the secondary causes as well. Conventional radiography helps in evaluating the secondary causes of osteoporosis, to confirm or rule out fractures and to diagnose concomitant or predisposing conditions. However, radiographs have certain limitations. Radiography only helps in qualitative assessment and cannot be considered as a tool for quantitative assessment. This chapter aims to review the radio-pathological changes and various causes of osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Albazaz R, Wong Y, Homer-Vanniasinkam S (2008) Complex regional pain syndrome: a review. Ann Vasc Surg 22(2):297–306

    Article  PubMed  Google Scholar 

  • Albright F (1947) Osteoporosis. Ann Intern Med 27(6):861–882

    Article  PubMed  CAS  Google Scholar 

  • Anil G, Guglielmi G, Peh WCG (2010) Radiology of osteoporosis. Radiol Clin North Am 48(3):497–518

    Article  PubMed  Google Scholar 

  • Ardran G (1951) Bone destruction not demonstrable by radiography. Br J Radiol 24(278):107–109

    Article  PubMed  CAS  Google Scholar 

  • Bailey D, Martin A, McKay H, Whiting S, Mirwald R (2000) Calcium accretion in girls and boys during puberty: a longitudinal analysis. J Bone Miner Res 15(11):2245–2250

    Article  PubMed  CAS  Google Scholar 

  • Bart (2008) Normal bone anatomy and physiology. Clin J Am Soc Nephrol 3(Suppl):131–139

    Google Scholar 

  • Benhamou C, Lespessailles E, Jacquet G et al (1994) Fractal organization of trabecular bone images on calcaneus radiographs. J Bone Miner Res 9(12):1909–1918

    Article  PubMed  CAS  Google Scholar 

  • Bordier PJ, Miravet L, Hioco D (1973) Young adult osteoporosis. Clin Endocrinol Metab 2:277–292

    Article  PubMed  CAS  Google Scholar 

  • Cheema J, Grissom L, Harcke H (2003) Radiographic characteristics of lower-extremity bowing in children. Radiographics 23(4):871–880

    Article  PubMed  Google Scholar 

  • Clinton J, Franta A, Polissar N et al (2009) Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am 91(3):503–511

    Article  PubMed  Google Scholar 

  • Cooney W, Dobyns J, Linscheid R (1980) Complications of Colles’ fractures. J Bone Joint Surg Am 62(4):613–619

    PubMed  Google Scholar 

  • Cranney A, Jamal S, Tsang J, Josse R, Leslie W (2007) Low bone mineral density and fracture burden in postmenopausal women. Can Med Assoc J 177(6):575–580

    Article  Google Scholar 

  • Delmas P, van de Langerijt L, Watts N et al (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20(4):557–563

    Article  PubMed  Google Scholar 

  • De Smet A, Neff J (1985) Pubic and sacral insufficiency fractures: clinical course and radiologic findings. Am J Roentgenol 145(3):601–606

    Article  Google Scholar 

  • Diard F, Hauger O, Moinard M, Brunot S, Marcet B (2007) Pseudo-cysts, lipomas, infarcts and simple cysts of the calcaneus: are there different or related lesions? JBR-BTR 90(5):315–324

    PubMed  CAS  Google Scholar 

  • Dijkstra P, Oudkerk M, Wiggers T (1997) Prediction of pathological subtrochanteric fractures due to metastatic lesions. Arch Orthop Trauma Surg 116(4):221–224

    Article  PubMed  CAS  Google Scholar 

  • D’ippolito G, Schiller PC, Ricordi C, Roos BA, Howard GA (1999) Age-related osteogenic potential of mesenchymal stromal stem cells from human vertebral bone marrow. J Bone Miner Res 14(7):1115–1122

    Article  PubMed  Google Scholar 

  • Doty S, DiCarlo E (1995) Pathophysiology of immobilization osteoporosis. Curr Opin Orthop 6(5):45–49

    Article  PubMed  CAS  Google Scholar 

  • Duncan H, Frame B, Frost H, Arnstein AR (1969) Regional migratory osteoporosis. South Med J 62:41–44

    Article  PubMed  CAS  Google Scholar 

  • Epstein DM, Dalinka MK, Kaplan FS, Aronchick JM, Marinelli DL, Kundel HL (1986) Observer variation in the detection of osteopenia. Skeletal Radiol 15:347–349

    Article  PubMed  CAS  Google Scholar 

  • Eriksen EF, Axelrod DW, Melsen F, Obrant K (1994) Bone histomorphometry. Raven Press, New York

    Google Scholar 

  • Finsen V, Anda S (1988) Accuracy of visually estimated bone mineralization in routine radiographs of the lower extremity. Skeletal Radiol 17:270–275

    Article  PubMed  CAS  Google Scholar 

  • Fitzpatrick LA (2002) Secondary causes of osteoporosis. Mayo Clin Proc 77:453–468

    PubMed  Google Scholar 

  • Gehlbach S, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood J (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11(7):577–582

    Article  PubMed  CAS  Google Scholar 

  • Genant H, Heck L, Lanzl L, Rossmann K, Horst J, Paloyan E (1973) Primary hyperparathyroidism. A comprehensive study of clinical, biochemical and radiographic manifestations. Radiology 109(3):513–524

    PubMed  CAS  Google Scholar 

  • Geraets W, Van der Stelt P, Netelenbos C, Elders P (1990) A new method for automatic recognition of the radiographic trabecular pattern. J Bone Miner Res 5(3):227–233

    Article  PubMed  CAS  Google Scholar 

  • Grampp S, Jergas M, Lang P et al (1996) Quantitative CT assessment of the lumbar spine and radius in patients with osteoporosis. Am J Roentgenol 167:133–140

    Article  CAS  Google Scholar 

  • Grampp S, Steiner E, Imhof H (1997) Radiological diagnosis of osteoporosis. Eur Radiol 7(Suppl 2):11–19

    Article  PubMed  Google Scholar 

  • Greenspan S, Myers E, Maitland L et al (1994) Trochanteric bone mineral density is associated with type of hip fracture in the elderly. J Bone Miner Res 9(12):1889–1894

    Article  PubMed  CAS  Google Scholar 

  • Guglielmi G, Muscarella S, Bazzocchi A (2011) Integrated imaging approach to osteoporosis: state-of-the-art review and update. Radiographics 31(5):1343–1364

    Article  PubMed  Google Scholar 

  • Harms HM, Kaptaina U, Kulpmann WR et al (1989) Pulse amplitude and frequency modulation of parathyroid hormone in plasma. J Clin Endocrinol Metab 69:843–851

    Article  PubMed  CAS  Google Scholar 

  • Hauschild O, Ghanem N, Oberst M et al (2009) Evaluation of Singh index for assessment of osteoporosis using digital radiography. Eur J Radiol 71(1):152–158

    Article  PubMed  CAS  Google Scholar 

  • Harris W, Heaney R (1969) Skeletal renewal and metabolic bone disease. New Engl J Med 280:193–202

    Article  PubMed  CAS  Google Scholar 

  • Hayes CW, Conway WF (1991) Hyperparathyroidism. Radiol Clin North Am 29:85–96

    PubMed  CAS  Google Scholar 

  • Heuck F, Schmidt E (1960) Die quantitative Bestimmung des Mineralgehaltes des Knochens aus dem Röntgenbild. Fortschr Röntgenstr 93:523–554

    Article  CAS  Google Scholar 

  • Hübsch P, Kocanda H, Youssefzadeh S et al (1992) Comparison of dual energy X-ray absorptiometry of the proximal femur with morphologic data. Acta Radiol 33:477–481

    PubMed  Google Scholar 

  • Ives R, Brickley M (2005) Metacarpal radiogrammetry: a useful indicator of bone loss throughout the skeleton? J Archaeol Sci 32:1552–1559

    Article  Google Scholar 

  • Jergas M (2008) Radiology of osteoporosis. In: Grampp S (ed) Radiology of osteoporosis. Springer, Berlin, pp 77–103

    Chapter  Google Scholar 

  • Jhamaria N, Lal K, Udawat M et al (1983) The trabecular pattern of the calcaneum as an index of osteoporosis. J Bone Joint Surg Br 65(2):195–198

    PubMed  CAS  Google Scholar 

  • Johnell O, Kanis J, Odén A et al (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15(3):175–179

    Article  PubMed  CAS  Google Scholar 

  • Jung H, Jee W, McCauley T, Ha K, Choi K (2003) Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 23(1):179–187

    Article  PubMed  Google Scholar 

  • Kalliakmanis AG, Pneumaticos S, Plessas S (2006) Transient hip osteoporosis. Orthopedics 29(3):263–264

    PubMed  Google Scholar 

  • Keen R (2007) Osteoporosis: strategies for prevention and management. Best practice and research. Clin Rheumatol 21(1):109–122

    Google Scholar 

  • Khosla S, Melton LJ 3rd, Riggs BL (2011) The unitary model for estrogen deficiency and the pathogenesis of osteoporosis: is a revision needed? J Bone Miner Res 26:441

    Article  PubMed  CAS  Google Scholar 

  • Kienböck R (1940) Osteomalazie, osteoporose, osteopsathyrose, porotische kyphose. Fortschr Röntgenstr 61:159

    Google Scholar 

  • Koot VCM, Kesselaer SM, Clevers GJ et al (1996) Evaluation of the Singh index for measuring osteoporosis. J Bone Joint Surg Br 78:831–834

    PubMed  CAS  Google Scholar 

  • Lee G, Weeks P (1995) The role of bone scintigraphy in diagnosing reflex sympathetic dystrophy. J Hand Surg 20(3):458–463

    Article  CAS  Google Scholar 

  • Lems W (2007) Clinical relevance of vertebral fractures. Ann Rheum Dis 66(1):2–4

    Article  PubMed  CAS  Google Scholar 

  • Link T, Majumdar S, Grampp S et al (1999) Imaging of trabecular bone structure in osteoporosis. Eur Radiol 9(9):1781–1788

    Article  PubMed  CAS  Google Scholar 

  • Lorenc R (2002) Idiopathic juvenile osteoporosis. Calcif Tissue Int 70(5):395–397

    Article  PubMed  CAS  Google Scholar 

  • Marhaug G (1993) Idiopathic juvenile osteoporosis. Scand J Rheumatol 22:45–47

    Article  PubMed  CAS  Google Scholar 

  • Mautalen C, Vega E, Einhorn T (1996) Are the etiologies of cervical and trochanteric hip fractures different? Bone 18(3 Suppl):133–137

    Article  Google Scholar 

  • Melchior R, Zabel B, Spranger J, Schumacher R (2005) Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis. Eur J Pediatr 164(1):22–27

    Article  PubMed  Google Scholar 

  • Meunier P, S-Bianchi G, Edouard C et al (1972) Bony manifestations of thyrotoxicosis. Orthop Clin North Am 3:745–774

    Google Scholar 

  • Nelson-Piercy C (1997) Hazards of heparin: allergy, heparin-induced thrombocytopenia and osteoporosis. Baillière’s Clin Obstetr Gynaecol 11(3):489–509

    Article  CAS  Google Scholar 

  • Nijweide P, Burger E, Feyen J (1986) Cells of bone: proliferation, differentiation, and hormonal regulation. Physiol Rev 66(4):855–886

    PubMed  CAS  Google Scholar 

  • O’Neill T, Cooper C, Finn J et al (2001) Incidence of distal forearm fracture in British men and women. Osteoporos Int 12(7):555–558

    Article  PubMed  Google Scholar 

  • Pacifici R, Rothstein M, Rifas L et al (1990) Increased monocyteinterleukin-1 activity and decreased vertebral bone density in patients with fasting idiopathic hypercalciuria. J Clin Endocrinol Metab 71:138–145

    Article  PubMed  CAS  Google Scholar 

  • Palvanen M, Kannus P, Parkkari J et al (2000) The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int 11(10):822–831

    Article  PubMed  CAS  Google Scholar 

  • Peh WCG, Khong PL, Yin YM et al (1996) Imaging of pelvic insufficiency fractures. Radiographics 16:335–348

    PubMed  CAS  Google Scholar 

  • Pfeil A, Haugeberg G, Hansch A et al (2011) Value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care Res 63:666–674

    Article  Google Scholar 

  • Rafii M, Mitnick H, Klug J, Firooznia H (1997) Insufficiency fracture of the femoral head: MR imaging in three patients. Am J Roentgenol 168(1):159–163

    Article  CAS  Google Scholar 

  • Reginato AJ, Falasca GF, Pappu R et al (1999) Musculoskeletal manifestations of osteomalacia: report of 26 cases and literature review. Semin Arthritis Rheum 28:287–304

    Article  PubMed  CAS  Google Scholar 

  • Resnick D (1981) The “rugger jersey” vertebral body. Arthritis Rheum 24:1191–1194

    Article  PubMed  CAS  Google Scholar 

  • Riggs BL, Melton LJ III (1983) Evidence for two distinct syndromes of involutional osteoporosis. Am J Med 75(6):899–901

    Article  PubMed  CAS  Google Scholar 

  • Riggs BL, MeltonLJ III (1986) Involutional osteoporosis. N Engl J Med 314:1676–1686

    Article  PubMed  CAS  Google Scholar 

  • Rocchietti March M, Tovaglia V, Meo A et al (2010) Transient osteoporosis of the hip. Hip Int 20(3):297–300

    PubMed  Google Scholar 

  • Salamat MR, Rostampour N, Zofaghari SJ et al (2010) Comparison of singh index accuracy and dualenergy X-ray absorptiometry bone mineral density measurement for evaluating osteoporosis Iran. J Radiat Res 8(2):123–128

    Google Scholar 

  • Schippers JC (1938) Over een geval van spontane algemene osteoporose bij een klein meisje. Maandschr Kindergeneeskunde 8:107

    Google Scholar 

  • Singh M, Nagrath A, Maini P (1970) Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg 52(3):457–467

    PubMed  CAS  Google Scholar 

  • Singh M, Riggs B, Beabout J, Jowsey J (1972) Femoral trabecular-pattern index for evaluation of spinal osteoporosis. Ann Intern Med 77(1):63–67

    Article  PubMed  CAS  Google Scholar 

  • Singh M, Riggs B, Beabout J, Jowsey J (1973) Femoral trabecular pattern index for evaluation of spinal osteoporosis. A detailed methodologic description. Mayo Clin Proc 48(3):184–189

    Google Scholar 

  • Sissons H (1956) The osteoporosis of Cushing’s syndrome. J Bone Joint Surg Br 38(1):418–433

    PubMed  Google Scholar 

  • Smith R (1995) Idiopathic juvenile osteoporosis: experience of twenty-one patients. Br J Rheumatol 34(1):68–77

    Article  PubMed  CAS  Google Scholar 

  • Stoch S, Saag K, Greenwald M et al (2009) Once-weekly oral alendronate 70 mg in patients with glucocorticoid-induced bone loss: a 12-month randomized, placebo-controlled clinical trial. J Rheumatol 36(8):1705–1714

    Google Scholar 

  • Swischuk L, Hayden C (1979) Rickets: a roentgenographic scheme for diagnosis. Pediatr Radiol 8(4):203–208

    Article  PubMed  CAS  Google Scholar 

  • Takata S, Yasui N (2001) Disuse osteoporosis. J Med Invest 48(3–4):147–156

    PubMed  CAS  Google Scholar 

  • Toh SH, Claunch BC, Brown PH (1985) Effect of hyperthyroidism and its treatment on bone mineral content. Arch Intern Med 145:883–886

    Article  PubMed  CAS  Google Scholar 

  • Toms A, Marshall T, Becker E et al (2005) Regional migratory osteoporosis: a review illustrated by five cases. Clin Radiol 60(4):425–438

    Article  PubMed  CAS  Google Scholar 

  • Vernon-Roberts B, Pirie C (1973) Healing trabecular microfractures in the bodies of lumbar vertebrae. Ann Rheum Dis 32(5):406–412

    Article  PubMed  CAS  Google Scholar 

  • von Meyer H (1867) Die architektur der spongiosa (The architecture of the spongiosa) Reichert und Dubois-Reymonds Archiv 34:615–628 (in German)

    Google Scholar 

  • Vu MQ, Weintraub N, Rubenstein LZ (2006) Falls in the nursing home: are they preventable? J Am Med Dir Assoc 7:S53

    Article  PubMed  Google Scholar 

  • Wagner S, Stäbler A, Sittek H et al (2005) Diagnosis of osteoporosis: visual assessment on conventional versus digital radiographs. Osteoporos Int 16(12):1815–1822

    Article  PubMed  Google Scholar 

  • Williamson MR, Boyd CM, Williamson SL (1990) Osteoporosis: diagnosis by plain chest film versus dual photon bone densitometry. Skeletal Radiol 19:7–30

    Article  Google Scholar 

  • Wolbarst AB (1993) Dependence of attenuation on atomic number and photon energy. In: Physics of Radiology. Appleton and Lange, Norwalk, pp 113–121

    Google Scholar 

  • Yamasaki S, Masuhara K, Miki H et al (2003) Three cases of regional migratory osteoporosis. Arch Orthop Trauma Surg 123(8):439–441

    Article  PubMed  Google Scholar 

  • Yamamoto T, Schneider R, Bullough P (2000) Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol 24(3):464–468

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wilfred C. G. Peh .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Srinivasan, S., Peh, W.C.G. (2013). Radiography in Osteoporosis. In: Guglielmi, G. (eds) Osteoporosis and Bone Densitometry Measurements. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_728

Download citation

  • DOI: https://doi.org/10.1007/174_2012_728

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27883-9

  • Online ISBN: 978-3-642-27884-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics