Metabolic Bone Diseases: An Updated View – Part Two

 

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Volume 2 of this double issue begins with a discussion of the imaging aspects of fragility fractures of the axial and appendicular skeleton. In current clinical practice, the differential diagnosis of vertebral fractures still remains a common challenge for radiologists who need deep knowledge of the imaging features and full awareness of the capabilities of each technique.

Nonspinal fragility fractures are also described as insufficiency fractures and represent spontaneous fractures or traumatic fractures from minimal energy trauma that would not normally result in fracture in healthy people. Common locations and differential diagnosis aspects are discussed extensively.

Subsequent articles address the spectrum of bone abnormalities and musculoskeletal complications observed in patients with chronic kidney disease. In the last few decades, we have seen major revisions of the old concept of renal osteodystrophy, leading to the broader definition of chronic kidney disease-mineral and bone disorder (CKD-MBD). Nasuto and colleagues provide a detailed update of all the imaging aspects associated with the different patterns of bone alterations, with a special emphasis on dialysis-related complications and advanced techniques for bone fragility assessment in CKD-MBD.

There is increasing awareness that skeletal fragility can be associated with malabsorption due to celiac disease or inflammatory bowel disease. This review provides an updated and comprehensive discussion of the bone turnover, formation, and mineralization dysfunctions occurring in these diseases.

The wide adoption of antiresorptive drugs in the treatment of osteoporosis was recently associated with atypical femoral fractures. These entities can arise as unexpected complications of prolonged bisphosphonate use, and they can easily be missed in clinical radiologic routine because of their subtle signs and atypical localization.

Besides drug treatments for osteoporosis, vertebroplasty and kyphoplasty represent minimally invasive treatment procedures that have become an almost indispensable tool to treat pain and deformities consequent to osteoporotic vertebral fractures.

The final contribution of this volume arises from the increasing use of techniques based on X-ray to detect and monitor osteoporosis, and it surveys the data in the literature regarding the magnitude of radiation exposure.

We thank all the authors for their excellent contributions and hope readers find the topics interesting and useful for their clinical practice.