December 2007 Vol 8 After Meeting.indd


Osteopoikilosis - Spotted bone

S S Suresh

SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 
DECEMBER 2007 VOL 7, NO. 3, P. 265-266
SULTAN QABOOS UNIVERSITY©
SUBMITTED - 31ST MAY 2007
ACCEPTED - 2ND SEPTEMBER 2007

I N T E R E S T I N G  M E D I C A L  I M A G E

العظم املنقط - ظام العِ لُ تَبَكُّ

سوريش اس. اس. د.

Department of Orthopaedics, Ibri Regional Hospital, P. O. Box 46, Ibri 516, Sultanate of Oman

To whom correspondence should be addressed. Email: dr.s.s.suresh@gmail.com

symptomatology. Her skeletal survey was normal.  A 
diagnosis of osteopoikilosis was made.

Osteopoikilosis, or spotted bone, is a rare autosom-
al dominant bone disorder of unknown pathology seen 
incidentally on X-rays.1,2 It was initially described by 
Albers-Schonberg and Ledoux-Lebard and associates 
in the year 1915.3  It is usually detected as an incidental 
finding in X-rays taken for other conditions.  There are
multiple small (2-10 mm) well circumscribed round or 
oval areas of increased bone density widely distributed 
in periarticular areas.4 The distribution is symmetrical.
It develops in childhood and persists throughout life.
There is predilection for the epiphysis and metaphy-
sis of the long tubular bones, carpus, tarsus, pelvis and 
scapula.4 Lesions of the spine, skull, ribs and scapula are 
rare. It should be differentiated from osteoblastic bone
metastasis, osteopathia striata, melorheostosis and tu-
berous sclerosis.  The oval lesions of osteopoikilosis are
often oriented with their long axis parallel to the shafts 
of tubular bones.2 

It is usually asymptomatic, but in 15-20% of patients 
there may be slight articular pain and joint effusions.3   
In approximately 25 % of cases whitish fibrocollagen-
ous infiltrations (Buschke-Ollendorf Syndrome) are
found.3 Histopathological study reveals a picture simi-
lar to bone islands, with focal condensations of com-
pact lamellar bone with the spongiosa. Bone scans 
are normal.The recognition of this condition by plain
radiograph makes other expensive investigations 
unnecessary.5

A 21 YEAR OLD GIRL PRESENTED AT THE  orthopaedic clinic of Ibri Regional Hospital, Oman, with history of vague pain of the left 
wrist.  The X-rays of the wrist showed multiple small
osteosclerotic lesions. Her blood investigations were 
normal ruling out systemic disease. Her ESR (erythro-
cyte sedimentation rate) was normal. She had no other 

Figure 1: X-ray image of patients left hand



S  S  S U R E S H

266

C O N C L U S I O N

Osteopoikilosis should be included in the differential
diagnosis of sclerotic bone lesions and, if diagnosed, 
has not much clinical significance.

R E F E R E N C E S

1. Handa R, Gulati MS. Osteopoikilosis. J Indian Rheuma-
tol Assoc 2003; 11:59.

2. Benli IT, Skalin S, Boysan E etal. Epidemiological, clinical 

and radiological aspects of osteopoikilosis. J Bone Joint 
Surg 1992; 74:504-506.

3. Tunc E, Savas S. Osteopoikilosis: Report of a familial 
case. Tr J Med Science 1999; 29:701-704.

4. Knot R, Sikarwar JS, Gupta RP, Shrama GL. Osteopoikil-
osis: A case report. Ind J Radiol Imag 2005; 15:453-454.

5. Tander B, Cengiz K, Diren B, Canturk F. A case of oste-
opoikilosis mimicking metastasis on MRI study. Turk J 
Phy Med Rehab 2006; 52:85-87.