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The incidence of detecting focal chronic recurrent multifocal osteomyelitis (CRMO) lesions on dual-energy x-ray absorptiometry (DXA), and the effect of these lesions on DXA bone mineral density (BMD), bone mineral content (BMC), and their associated Z-scores were retrospectively reviewed. Materials and Methods. The study included 22 patients (14 females, 8 males; median age of 13 years) with CRMO and in whom a total body less head (TBLH) and lumbar spine DXA scan had been obtained. Whole-body bone scintigraphy and MRI were used as the reference standards. Sites involved with CRMO were subsequently detected and DXA measurements were re-measured after removing the sclerotic lesions from the analysis. Results. In total, sclerotic CRMO lesions were detected in 15 of the 22 patients (68%) by DXA, although the number of lesions detected (on a per-lesion analysis) was much less (i.e. 29 of 129 lesions; 19.4%) when compared to MRI and/or bone scintigraphy. Larger lesions had a greater impact on the derived BMD/BMC measurements, and changed the diagnosis in one patient from having normal to abnormal DXA results based on the final Z-score. Discussion. CRMO lesions detected on DXA examinations should be regarded as a potential source of error. Careful inspection and re-quantification of the BMD, BMC and associated Z-score after applying an appropriate correction should be considered in patients with large CRMO lesions identified on DXA examinations.

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry