Osteitis condensans ilii

Last revised by Rohit Sharma on 5 Apr 2024

Osteitis condensans ilii, also known as osteopathia condensans ilii or hyperostosis triangularis ilii in Germany, is characterized by benign sclerosis of the ilium adjacent to the sacroiliac (SI) joint, typically bilateral and triangular in shape.

Osteitis condensans ilii has an incidence of 0.9-2.5%, and is much more common in women than men; primarily in pregnancy and the puerperium .

It is usually asymptomatic but uncommonly may cause axial lower back pain typically not centered over the SI joints, with a frequency of about 1-2.5% 4.

The underlying etiology is unknown but believed to be mechanical stress and imbalance across the SI joints causing a chronic stress response. Supporting this hypothesis, it is most often seen in women who have given birth; however, men and nulliparous women can be affected 2-4

Osteitis condensans ilii is often diagnosed incidentally. The iliac side of the SI joint demonstrates sclerosis which is typically bilateral, symmetrical, and triangular in shape 3,4. The sclerosis is sharply defined and dense, mainly in the anterior mid third of the joint. Lack of sacral involvement or joint space narrowing is considered diagnostic and may obviate the need for further imaging 3 (symmetric small focal sclerosis of the apposing sacrum is allowable though). Unilateral osteitis condensans ilii has been reported.

It carries a benign prognosis and may even resolve spontaneously.

It is thought to have been first described by Sicard, Gally, and Haguenau in 1926 10.

The main differential diagnoses are:

In osteitis condensans ilii, the sacroiliac joint is normal, with no irregularity, erosions, or loss of joint space.

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