Scintigraphic Evidence of Osteomalacia: Usefulness and Typical Signs

A 34-year-old woman has experienced muscle weakness and morning back stiffness for the past 10 years. She was diagnosed and treated as ankylosing spondylitis previously, but the symptoms still persisted. Thereafter she visited our hospital, and osteomalacia was suspected after serial work-up, including biochemical test, radiographs and MR images. In addition, a dual-energy X-ray absorptiometry study was performed for the evaluation of bone mineral density and osteopenia was impressed. Whole body bone scintigraphy was acquired for further evaluation, and the results showed all the typical signs of osteomalacia, i.e. widening of the mandible, rachitic rosary sign, tie sign of the sternum, pseudofracture signs, and prominent epiphyses of the knees. The presented case suggested that bone scintigraphy can help distinguish osteomalacia from ankylosing spondylitis.