The causes of generalised increase in bone density in adult patients, also known as generalised or diffuse osteosclerosis, can be divided according to broad categories:
- haematological disorders
-
myelosclerosis
- marrow cavity is narrowed by endosteal new bone
- patchy lucencies due to the persistence of fibrous tissue (generalised osteopenia in the early stages due to myelofibrosis)
- hepatosplenomegaly
- sickle cell disease 2
- osteosclerosing multiple myeloma
-
myelosclerosis
- metabolic
- poisoning
-
fluorosis
- with periosteal reaction, prominent muscle attachments and calcification of ligaments and interosseous membranes
- changes are most marked in the innominate bones and lumbar spine
-
fluorosis
- neoplastic (more commonly multifocal than generalised)
- malignancy
- osteoblastic metastases: most commonly prostate and breasts
- lymphoma: infiltrative
- leukaemia: infiltrative
-
mastocytosis
- sclerosis of marrow-containing skeleton with patchy areas of radiolucency
- urticaria pigmentosa
- can have symptoms and signs of carcinoid syndrome
- idiopathic (more commonly multifocal than generalised)
- Paget disease: coarsened trabeculae, bony expansion and thickened cortex
- congenital: sclerosing bone dysplasias
- other
A mnemonic for the causes of dense bones is 3 M's PROOF.
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