Zebra lines after bisphosphonate therapy

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5445 (Published 17 September 2014) Cite this as: BMJ 2014;349:g5445
  1. Nicholas Chua, core trainee year 3, medicine,
  2. Rachel Jenner, consultant in emergency medicine
  1. 1Emergency Department, Manchester Royal Infirmary Children’s Hospital, Manchester M13 9WL, UK
  1. Correspondence to: N Chua nczchua{at}googlemail.com

A 12 year old boy with osteogenesis imperfecta who had been given cycled intravenous pamidronate developed wrist pain after falling onto an outstretched hand. Radiography showed metaphyseal bands (zebra lines)—sclerotic lines perpendicular to the growth axis, which follow the contour of the physis and are seen in the growing skeleton. They first appear two months after treatment with intravenous bisphosphonates. They correlate with the number of treatment cycles and reflect inhibition of osteoclastic activity with increased bone mineralisation. They are not reported to cause pain, and this patient’s wrist pain was caused by soft tissue injury.


Cite this as: BMJ 2014;349:g5445


  • Parental consent obtained.

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