Intramedullary osteosclerosis

Last revised by Henry Knipe on 11 Mar 2021

Intramedullary osteosclerosis is a sclerosing dysplasia associated with increased bone formation within the medullary cavity. It is a diagnosis of exclusion. 

There is a female predilection, with the condition usually discovered in adulthood. No hereditary risk has been demonstrated.

The disorder is usually detected by plain radiography performed following protracted leg pain that may worsen with mechanical loading 1,3.

On histology of the medullary cavity, there is a combination of irregular woven bone characterized by crowded bony trabeculae and interspersed lamellar bone.

The long bones (usually the mid-diaphysis) of the lower extremities are typically affected, with unilateral or bilateral involvement of one or more long bones. The tibia is most commonly affected, but the process may also involve the femur or fibula 1,2. There are no specific radiographic features 3.

  • osteosclerosis limited to the medullary cavity
  • +/- adjacent to the soft tissue swelling
  • no cortical thickening nor periosteal reaction
  • homogeneous and continuous sclerosis extending into the medullary canal from endosteal bone +/- obliteration of the canal
  • minimal, if any, periosteal cortical thickening
  • +/- soft tissue edema/enhancement

The distribution, as described above, is best demonstrated on bone scan and helps differentiate from other sclerosing dysplasias. Intense uptake is usually demonstrated in the affected regions.

No treatment is usually required, with supportive management for symptoms as indicated.

Overall, intramedullary osteosclerosis is a rare condition and is a diagnosis of exclusion once other causes of osteosclerosis have been ruled out.

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