Radiographic features of osteogenesis imperfecta

BACKGROUND Osteogenesis imperfecta (OI), commonly called "brittle bone disease", is a genetic disorder characterised by increased bone fragility and decreased bone density due to quantitative and/or qualitative abnormalities of type I collagen. Different types of OI exist, from mild to severe; they may lead to death, multiple bone fractures, skeletal deformity and short stature. METHODS Severe cases are usually diagnosed before birth and may incite the parents to choose therapeutic abortion, whereas milder cases are much more difficult to diagnose and may be sometimes confused with non-accidental injury (NAI) ("child abuse") in young children. Whatever the degree of severity, conventional radiography still remains the mainstay in diagnosing OI. RESULTS The prognosis of this disorder has changed in the last few years thanks to biphosphonate therapy. CONCLUSION The aim of this pictorial review is to illustrate the radiographic manifestations of OI, including in children receiving biphosphonates, and to outline specific patterns that help differentiate OI from NAI when necessary. KEY POINTS • The main radiographic features of OI are osteopenia, bone fractures and bone deformities. • Some radiographic features depend on the type of OI or may be encountered with biphosphonates.