Presentation
Wrist pain since minor injury when knocked wrist a few weeks ago.
Patient Data
Transverse sclerotic lines across the distal radial and ulnar metaphyses, secondary to cyclical bisphosphonate therapy.
Healing fracture of the distal ulnar diaphysis with callus formation.
Case Discussion
Patient with known osteogenesis imperfecta type IV (confirmed genetic mutation), on cyclical bisphosphonate infusions, demonstrating transverse metaphyseal sclerotic lines 'zebra stripe' lines, typically with regular spacing.
These appear radiologically similar to growth arrest lines (or Harris lines) but are a distinct histological process. Bisphosphonate zebra lines are due to increased mineralization of the metaphysis during normal endochondral ossification and can appear regular due to cyclical bisphosphonate therapy. Growth arrest lines instead relate to slowing or halting of the ossification front during endochondral ossification secondary to stress (including infection and malnutrition), and increased mineralization on recovery 1.
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