Renal Osteodystrophy¶

Definition¶

Renal osteodystrophy encompasses the skeletal manifestations of chronic kidney disease, including secondary hyperparathyroidism, osteomalacia, osteosclerosis, and amyloid deposition. In the spine, the most characteristic finding is the "rugger jersey" spine.

Imaging Findings¶

Radiography/CT¶

"Rugger jersey" spine — Alternating bands of sclerosis and lucency within the vertebral bodies on lateral radiograph, resembling the horizontal stripes of a rugby jersey. The sclerotic bands are at the endplates (subchondral sclerosis) with a lucent central zone.
Diffuse osteosclerosis — Generalized increased bone density
Brown tumors — Lytic lesions from secondary hyperparathyroidism (rare in the spine)
Soft tissue calcifications — Vascular and periarticular calcifications

MRI¶

The sclerotic endplate bands appear as low T1 and T2 signal
The lucent central zone has relatively normal marrow signal

Clinical Pearl

The "rugger jersey" spine — horizontal bands of dense endplate sclerosis alternating with lucent central vertebral body zones — is virtually pathognomonic of renal osteodystrophy. It results from secondary hyperparathyroidism causing subchondral bone resorption followed by reactive sclerosis. When you see this pattern, check the patient's renal function.

Key Points¶

"Rugger jersey" spine is the characteristic finding — alternating sclerotic and lucent bands
Results from secondary hyperparathyroidism in chronic kidney disease
Diffuse osteosclerosis and soft tissue calcifications are additional findings
Brown tumors are rare in the spine but can occur

References¶

Murphey MD, Sartoris DJ, Quale JL, Pathria MN, Martin NL. Musculoskeletal manifestations of chronic renal insufficiency. RadioGraphics. 1993;13(2):357-379. https://pubmed.ncbi.nlm.nih.gov/8460225/
Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging Findings of Metabolic Bone Disease. RadioGraphics. 2016;36(6):1871-1887. https://pubmed.ncbi.nlm.nih.gov/27726750/
Jevtic V. Imaging of renal osteodystrophy. Eur J Radiol. 2003;46(2):85-95. https://pubmed.ncbi.nlm.nih.gov/12714225/
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1):1-59. https://pmc.ncbi.nlm.nih.gov/articles/PMC6340919/
Kiss E, Keusch G, Zanetti M, et al. Dialysis-related amyloidosis revisited. AJR Am J Roentgenol. 2005;185(6):1460-1467. https://pubmed.ncbi.nlm.nih.gov/16303998/
Patel P, Hashmi MF. Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD). In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2024 Apr 3. https://www.ncbi.nlm.nih.gov/books/NBK560742/
Rugger jersey spine (hyperparathyroidism). Radiopaedia.org. https://radiopaedia.org/articles/rugger-jersey-spine-hyperparathyroidism-1