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In this era of advanced high-tech imaging, the utility of plain radiographs in conditions of the bone is increasingly being overseen by both clinicians and radiologists. Plain radiography is the first-line, essential screening or diagnostic tool for diverse bone diseases, where magnetic resonance imaging (MRI) may be non-contributory. Plain radiographs often play a pivotal role in diagnosing metabolic bone disorders. This paper from a single tertiary care centre discusses ten real-life patients with metabolic bone conditions and other bone diseases with near-normal MRI of the spine, in whom plain radiographs revealed subtle findings and aided in making diagnoses. Each of these cases had a non-specific clinical presentation. They all showed inconclusive features on MRI, but subtle important radiographic findings led to a specific diagnosis. Plain radiography is key in diagnosing bone diseases. Many of these metabolic conditions clinically mimic rheumatologic conditions owing to non-specific arthralgia and back pain. Familiarity with subtle radiographic findings of these conditions may lead to early diagnosis and treatment, resulting in improved patient outcomes.

Utility of Plain Radiographs in Metabolic Bone Disease – A Case-Based Pictorial Review from a Tertiary Centre