Osteoporosis and Unexpected Osteosclerosis
Right hip DXA at baseline
Right hip DXA at 5 years later
CT shows decubitus ulcer extending to bone with ischial sclerosis
Later X-ray shows dense ischial sclerosis after treatment for osteomyelitis
Case Description:
This woman in her mid-60’s was wheelchair bound due to multiple sclerosis. Her initial DXA showed osteoporosis, with lowest T-score -5.4 for the right total hip (lumbar spine T-score was -2.7). She was started on treatment and her repeat DXA showed new sclerosis involving the right ischium. There is a broad differential for osteosclerosis. In this case, review revealed a right gluteal decubitus ulcer extending to bone with clinical, CT and x-ray evidence of osteomyelitis.
The extremely low hip BMD is partially attributable to immobilization. Total hip BMD increased on follow up by 0.047 g/cm2 (=0.379-0.332) which exceeds the 95% LSC (0.030 g.cm2).
Credit:
William D. Leslie, MD FRCPC MSc CCD, University of Manitoba