Metabolic Bone Diseases, Osteoporosis, and Endocrine Bone Disorders — WACS Viva & Clinical Scenarios (Musculoskeletal and Trauma Imaging)

Exam-style metabolic bone diseases, osteoporosis, and endocrine bone disorders viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 68-year-old postmenopausal woman presents with acute severe mid-back pain after lifting a light object. Thoracolumbar radiographs show diffuse osteopenia and multiple vertebral compression deformities. Detail the qualitative radiographic features, Dual-energy X-ray Absorptiometry (DEXA) diagnostic criteria, and imaging pitfalls encountered when evaluating postmenopausal osteoporosis.
• SCENARIO 2: A 3-year-old child presents with delayed walking, widening of the wrists, and lower limb bowing. Explain the pathophysiological basis and plain radiographic signs of rickets across active and healing phases, and contrast these findings with adult osteomalacia.
• SCENARIO 3: A 45-year-old male with end-stage renal disease on maintenance haemodialysis undergoes a skeletal survey. Describe the comprehensive radiological spectrum of hyperparathyroidism and renal osteodystrophy, including subperiosteal bone resorption patterns, brown tumors, and soft tissue calcification.
• SCENARIO 4: A 62-year-old male presents with deep aching pelvic pain, enlarging hat size, and hearing loss. Plain radiographs of the pelvis and skull reveal mixed lytic and sclerotic changes with cortical thickening and trabecular coarsening. Discuss the imaging features across the stages of Paget disease of bone (osteitis deformans), along with its key radiological complications.
• SCENARIO 5: A 35-year-old patient on long-term systemic corticosteroid therapy for an autoimmune condition develops hip and spine pain. Discuss the radiographic and cross-sectional imaging features of steroid-induced musculoskeletal complications, and outline the distinguishing features of other systemic metabolic and endocrine bone disorders including acromegaly, Gaucher disease, and skeletal fluorosis.