Renal osteodystrophy

Changed by Daniel J Bell, 28 Mar 2023
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Disclosures - updated 19 Aug 2022: Nothing to disclose

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Renal osteodystrophy, also known as uraemic osteopathy, is a constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure, due to concurrent and superimposed:

Radiographic features

Plain radiograph

Imaging findings are many and varied:

Bone scintigraphy

The bony skeleton has high affinity towards 99mTc- diphosphonate especially in the calvaria, and mandible. Beading of the costochondral junction (also known as "tie"tie sternum") is also seen. The bone findings are usually due to secondary hyperparathyroidism but an osteomalacia component may contribute to some of its scintigraphy features. Meanwhile, kidneys and urinary bladder appear faint or not visualised 6.

Differential diagnosis

General imaging differential considerations include:

  • -<p><strong>Renal osteodystrophy</strong>, also known as <strong>uraemic osteopathy</strong>, is a constellation of musculoskeletal abnormalities that occur in patients with <a href="/articles/chronic-kidney-disease" title="Chronic renal failure">chronic renal failure</a>, due to concurrent and superimposed:</p><ul>
  • -<li><p><a href="/articles/osteomalacia">osteomalacia </a>(adults) / <a href="/articles/rickets">rickets</a> (children)</p></li>
  • -<li>
  • -<p>secondary <a href="/articles/hyperparathyroidism">hyperparathyroidism</a>: abnormal calcium and phosphate metabolism</p>
  • -<ul>
  • -<li><p>bone resorption</p></li>
  • -<li><p><a href="/articles/generalised-increased-bone-density-in-adults">osteosclerosis</a></p></li>
  • -<li><p>soft tissue and vascular calcifications</p></li>
  • -<li><p><a href="/articles/brown-tumours">brown tumours</a></p></li>
  • -</ul>
  • -</li>
  • -<li><p>aluminium intoxication, e.g. if the patient is on dialysis</p></li>
  • -</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Imaging findings are many and varied:</p><ul>
  • -<li><p><a href="/articles/generalised-osteopenia-1">osteopenia</a>: (often seen early) thinning of cortices and trabeculae</p></li>
  • -<li><p><a href="/articles/salt-and-pepper-skull">salt and pepper skull</a></p></li>
  • -<li><p>demineralisation: usually subperiosteal, however, it may also involve joint margins, endosteal, subchondral, subligamentous areas, cortical bone, or trabeculae <sup>5</sup> </p></li>
  • -<li><p><a href="/articles/subperiosteal-bone-resorption">subperiosteal resorption</a>: characteristic subperiosteal resorption may be seen on radial aspects of the middle phalanges of the index and long fingers</p></li>
  • -<li>
  • -<p>bone sclerosis ​ ​</p>
  • -<ul>
  • -<li><p><a href="/articles/generalised-increased-bone-density-in-adults" title="Diffuse bony sclerosis">diffuse bony sclerosis</a></p></li>
  • -<li><p><a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a>: sclerosis of the vertebral body endplates</p></li>
  • -<li><p><a href="/articles/reverse-rugger-jersey-spine" title="reverse rugger jersey spine">reverse rugger jersey spine</a><sup>7</sup></p></li>
  • -</ul>
  • -</li>
  • -<li><p><a href="/articles/periarticular-soft-tissue-calcification">soft tissue calcification</a></p></li>
  • -<li><p><a href="/articles/amyloid-arthropathy">amyloid deposition</a>: erosion in and around joint</p></li>
  • -<li><p><a href="/articles/insufficiency-fracture">insufficiency fractures</a></p></li>
  • -<li><p><a href="/articles/looser-zones-1">Looser zone</a></p></li>
  • -<li><p><a href="/articles/brown-tumour">brown tumours</a></p></li>
  • -</ul><h5>Bone scintigraphy</h5><p>The bony skeleton has high affinity towards 99mTc- diphosphonate especially in the calvaria, and mandible. Beading of the costochondral junction (also known as "tie sternum") is also seen. The bone findings are usually due to secondary hyperparathyroidism but osteomalacia component may contribute to some of its scintigraphy features. Meanwhile, kidneys and urinary bladder appear faint or not visualised <sup>6</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
  • -<li><p><a href="/articles/osteomalacia">osteomalacia</a></p></li>
  • -<li><p><a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a></p></li>
  • -<li><p><a href="/articles/seronegative-spondyloarthritis-1">seronegative spondyloarthropathies</a></p></li>
  • -<li><p>neoplasms: <a href="/articles/multiple-myeloma-1">multiple myeloma</a>, <a href="/articles/distal-appendicular-bone-metastases">metastases</a>; <a href="/articles/brown-tumour">brown tumours</a> can mimic primary malignant tumour of bone; amyloid deposition may mimic <a href="/articles/tenosynovial-giant-cell-tumour-2" title="Tenosynovial giant cell tumour">tenosynovial giant cell tumour</a> or <a href="/articles/synovial-chondromatosis">synovial chondromatosis</a></p></li>
  • -<li><p><a href="/articles/osteomyelitis">osteomyelitis</a></p></li>
  • -<li><p>occult marrow abnormalities</p></li>
  • +<p><strong>Renal osteodystrophy</strong>, also known as <strong>uraemic osteopathy</strong>, is a constellation of musculoskeletal abnormalities that occur in patients with <a href="/articles/chronic-kidney-disease" title="Chronic renal failure">chronic renal failure</a>, due to concurrent and superimposed:</p><ul>
  • +<li><p><a href="/articles/osteomalacia">osteomalacia </a>(adults) / <a href="/articles/rickets">rickets</a> (children)</p></li>
  • +<li>
  • +<p>secondary <a href="/articles/hyperparathyroidism">hyperparathyroidism</a>: abnormal calcium and phosphate metabolism</p>
  • +<ul>
  • +<li><p>bone resorption</p></li>
  • +<li><p><a href="/articles/generalised-increased-bone-density-in-adults">osteosclerosis</a></p></li>
  • +<li><p>soft tissue and vascular calcifications</p></li>
  • +<li><p><a href="/articles/brown-tumours">brown tumours</a></p></li>
  • +</ul>
  • +</li>
  • +<li><p>aluminium intoxication, e.g. if the patient is on dialysis</p></li>
  • +</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Imaging findings are many and varied:</p><ul>
  • +<li><p><a href="/articles/generalised-osteopenia-1">osteopenia</a>: (often seen early) thinning of cortices and trabeculae</p></li>
  • +<li><p><a href="/articles/salt-and-pepper-skull">salt and pepper skull</a></p></li>
  • +<li><p>demineralisation: usually subperiosteal, however, it may also involve joint margins, endosteal, subchondral, subligamentous areas, cortical bone, or trabeculae <sup>5</sup> </p></li>
  • +<li><p><a href="/articles/subperiosteal-bone-resorption">subperiosteal resorption</a>: characteristic subperiosteal resorption may be seen on radial aspects of the middle phalanges of the index and long fingers</p></li>
  • +<li>
  • +<p>bone sclerosis ​ ​</p>
  • +<ul>
  • +<li><p><a href="/articles/generalised-increased-bone-density-in-adults" title="Diffuse bony sclerosis">diffuse bony sclerosis</a></p></li>
  • +<li><p><a href="/articles/rugger-jersey-spine-hyperparathyroidism-1">rugger jersey spine</a>: sclerosis of the vertebral body endplates</p></li>
  • +<li><p><a href="/articles/reverse-rugger-jersey-spine" title="reverse rugger jersey spine">reverse rugger jersey spine</a> <sup>7</sup></p></li>
  • +</ul>
  • +</li>
  • +<li><p><a href="/articles/periarticular-soft-tissue-calcification">soft tissue calcification</a></p></li>
  • +<li><p><a href="/articles/amyloid-arthropathy">amyloid deposition</a>: erosion in and around joint</p></li>
  • +<li><p><a href="/articles/insufficiency-fracture">insufficiency fractures</a></p></li>
  • +<li><p><a href="/articles/looser-zones-1">Looser zone</a></p></li>
  • +<li><p><a href="/articles/brown-tumour">brown tumours</a></p></li>
  • +</ul><h5>Bone scintigraphy</h5><p>The bony skeleton has high affinity towards 99mTc- diphosphonate especially in the calvaria, and mandible. Beading of the costochondral junction (also known as "<a href="/articles/tie-sternum" title="tie sternum">tie sternum</a>") is also seen. The bone findings are usually due to secondary hyperparathyroidism but an osteomalacia component may contribute to some of its scintigraphy features. Meanwhile, kidneys and urinary bladder appear faint or not visualised <sup>6</sup>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
  • +<li><p><a href="/articles/osteomalacia">osteomalacia</a></p></li>
  • +<li><p><a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a></p></li>
  • +<li><p><a href="/articles/seronegative-spondyloarthritis-1">seronegative spondyloarthropathies</a></p></li>
  • +<li><p><a href="/articles/neoplasms" title="bone neoplasms">neoplasms</a>: <a href="/articles/multiple-myeloma-1">multiple myeloma</a>, <a href="/articles/distal-appendicular-bone-metastases">metastases</a>; <a href="/articles/brown-tumour">brown tumours</a> can mimic primary malignant tumour of bone; amyloid deposition may mimic <a href="/articles/tenosynovial-giant-cell-tumour-2" title="Tenosynovial giant cell tumour">tenosynovial giant cell tumour</a> or <a href="/articles/synovial-chondromatosis">synovial chondromatosis</a></p></li>
  • +<li><p><a href="/articles/osteomyelitis">osteomyelitis</a></p></li>
  • +<li><p>occult marrow abnormalities</p></li>

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