Rugger-jersey spine

Rugger-jersey spine describes the prominent subendplate densities at multiple contiguous levels to produce an alternating sclerotic-lucent-sclerotic appearance. This simulates the transverse bands of a rugby jersey.

This term and pattern is distinctive for hyperparathyroidism.


The effect of parathyroid hormone is to normalise calcium levels by:

  • stimulating vitamin D metabolism, increasing resorption of calcium in the intestines which antagonizes the effects of phosphate on 1,2(OH)2D synthesis
  • increasing resorption of calcium and excretion of phosphate by the kidneys
  • increased osteoclastic activity

In response to bone resorption and subsequent loss of bone mass, osteoblasts form an increased amount of osteoid that does not contain hydroxyapatite, but does appear opaque on radiographs. The sclerotic bands on the superior and inferior endplates of the vertebral bodies represent accumulations of excess osteoid and appear opaque because of their increased volume when compared to normal bone.

Differential diagnosis

Note: some authors use the term rugger jersey for osteopetrosis, although most would assume the term refers to hyperparathyroidism.

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