The differential diagnosis of dense metaphyseal bands is wide.
Differential diagnosis
Common
chronic anaemia, e.g. sickle cell disease, thalassaemia
chemotherapy, e.g. methotrexate
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
leukaemia: treated
normal variant: especially in a neonate - dense zone of provisional calcification
renal osteodystrophy (secondary hyperparathyroidism): healing
rickets: healing
trauma: non-accidental injury; stress fracture
Uncommon
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, oestrogen or heavy metal therapy to the mother during pregnancy
other heavy metal or chemical poisoning, e.g. bismuth, arsenic, phosphorus, fluoride, mercury, lithium, radium, Thorotrast
hypothyroidism: cretinism (treated)
meconium peritonitis (neonatal dense bands)
parathyroid hormone therapy
radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32)
sclerosteosis: especially knees
scurvy: healing
vascular injury
Williams syndrome: idiopathic hypercalcaemia
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