{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:31:58Z","timestamp":1793323918742,"version":"4.5.0"},"reference-count":47,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Introduction<\/jats:title>\n Osteopoikilosis is a rare sclerosing bone dysplasia that may mimic osteoblastic metastases and complicate fracture assessment. Its influence on bone quality, fixation stability, and fracture healing remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To report a tibial plateau fracture in a patient with osteopoikilosis and systematically synthesize published evidence on fracture characteristics, management, and healing outcomes in osteopoikilosis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We integrated an index case with a systematic review and synthesis without meta-analysis. The index case involved a 66-year-old woman with a Schatzker type II tibial plateau fracture and incidental osteopoikilosis, evaluated using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and \u00b9\u2078F-NaF PET\/CT. A systematic literature search through January 2026 synthesized fracture characteristics and healing outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the index case, the fracture occurred within intervening bone, sparing sclerotic lesions. This localization revealed a bone quantity\u2013quality paradox: sclerotic lesions artifactually elevated BMD, whereas low TBS identified underlying systemic fragility. The systematic review (N=11) demonstrated fractures across the axial and appendicular skeletons, including both upper and lower extremities. Management ranged from conservative care to operative fixation with intramedullary nails, locking plates, and headless cannulated screws. Fracture union was consistently achieved, with no reported technical failures or delayed healing.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Osteopoikilosis may mask underlying systemic osteoporosis, as evidenced by fractures occurring in the \u201cspared\u201d bone despite high BMD. TBS serves as a critical diagnostic safeguard to unmask this fragility. Clinically, however, the condition does not compromise biological repair; standard fracture management principles yield excellent outcomes without the need for modified fixation strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.52965\/001c.165508","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:51:10Z","timestamp":1786369870000},"source":"Crossref","is-referenced-by-count":0,"title":["osteopoikilosis and fracture healing: the bone quantity\u2013quality paradox\u2014a case report and systematic review with synthesis without meta-analysis"],"prefix":"10.52965","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1886-9226","authenticated-orcid":false,"given":"Rathapoom","family":"Suwanaratana","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01qc5zk84","id-type":"ROR","asserted-by":"publisher"}],"name":"Chulabhorn Hospital","department":["Department of Orthopedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6965-9354","authenticated-orcid":false,"given":"Pichaya","family":"Thanindratarn","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01qc5zk84","id-type":"ROR","asserted-by":"publisher"}],"name":"Chulabhorn Hospital","department":["Department of Orthopedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1356-7888","authenticated-orcid":true,"given":"Nuttawut","family":"Chanalithichai","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01qc5zk84","id-type":"ROR","asserted-by":"publisher"}],"name":"Chulabhorn Hospital","department":["Department of Orthopedic Surgery"]},{"id":[{"id":"https:\/\/ror.org\/03b5p6e80","id-type":"ROR","asserted-by":"publisher"}],"name":"Chulabhorn Royal Academy","department":["Department of Orthopedics, Princess Srisavangavadhana Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"issue":"7","key":"ref1","doi-asserted-by":"publisher","first-page":"e9191","DOI":"10.1002\/ccr3.9191","article-title":"Osteopoikilosis-the incidental finding of a rare bone dysplasia: A case report","volume":"12","author":"T. P. Rosa-Juana","year":"2024","journal-title":"Clin Case Rep"},{"issue":"61","key":"ref2","doi-asserted-by":"publisher","DOI":"10.5152\/tftrd.2015.39019","article-title":"Osteopoikilosis-A Case Report","volume":"2015","author":"N. K\u00fc\u00e7\u00fck\u00e7ak\u0131r","year":"2016","journal-title":"Turk J Phys Med Rehab"},{"issue":"1","key":"ref3","article-title":"Osteopoikilosis: A Cause of Elevated Bone Mineral Density on Dual X-Ray Absorptiometry Measurement in a Young Woman: Case Report","volume":"16","author":"A. Kaparov","year":"2010","journal-title":"Turk J Osteoporos"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.bone.2015.05.016","article-title":"Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice","volume":"78","author":"N. C. Harvey","year":"2015","journal-title":"Bone"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.17816\/DD79504","article-title":"A Case Report of Osteopoikilosis in the ribs, pelvic region and spine","author":"I. Gangai","year":"2021","journal-title":"Digital Diagnostics"},{"issue":"23","key":"ref6","doi-asserted-by":"publisher","first-page":"e3868","DOI":"10.1097\/md.0000000000003868","article-title":"Benign incidental findings of osteopoikilosis on Tc-99m MDP bone SPECT\/CT: A case report and literature review","volume":"95","author":"S. Y. Tsai","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"M. Campbell","year":"2020","journal-title":"BMJ (Clinical research ed)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"D. Moher","year":"2009","journal-title":"BMJ (Clinical research ed)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"M. J. Page","year":"2021","journal-title":"BMJ (Clinical research ed)"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780198796619.001.0001","article-title":"Prognosis Research in Healthcare: Concepts, Methods, and Impact","author":"R. Riley","year":"2019"},{"issue":"2","key":"ref11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.13107\/jocr.2250-0685.095","article-title":"Traumatic Fracture in a patient of Osteopoikilosis with Review of Literature","volume":"3","author":"R. Bansal","year":"2013","journal-title":"J Orthop Case Rep"},{"key":"ref12","article-title":"The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis","author":"G. Wells","year":"2000"},{"issue":"3","key":"ref13","doi-asserted-by":"publisher","first-page":"201","DOI":"10.4274\/tod.galenos.2025.25986","article-title":"Osteopoikilosis as an Uncommon Cause of Extremity Pain: A Case Report","volume":"31","author":"E. Fidan","year":"2025","journal-title":"Turk J Osteoporos"},{"issue":"3","key":"ref14","first-page":"356","article-title":"[Osteopoikilosis and fracture]","volume":"193","author":"E. Jonasch","year":"1956","journal-title":"Bruns Beitr Klin Chir"},{"issue":"3","key":"ref15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/bf00349489","article-title":"Osteopoikilosis: a radiological and pathological study","volume":"11","author":"R. Lagier","year":"1984","journal-title":"Skeletal Radiol"},{"issue":"7-8","key":"ref16","first-page":"52","article-title":"[Problem of osteopoikilosis]","volume":"70","author":"A. S. Mochul'ski\u012d","year":"1992","journal-title":"Klin Med (Mosk)"},{"issue":"6","key":"ref17","first-page":"303","article-title":"[Osteopoikilosis--fracture healing]","volume":"15","author":"E. Sim","year":"1989","journal-title":"Unfallchirurgie"},{"issue":"7","key":"ref18","first-page":"725","article-title":"[Femoral neck fracture in osteopoikilosis]","volume":"88","author":"A. Zahar","year":"2002","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"issue":"4","key":"ref19","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jbspin.2004.10.006","article-title":"Fracture healing in a patient with osteopoikilosis","volume":"72","author":"O. Buyukbebeci","year":"2005","journal-title":"Joint Bone Spine"},{"issue":"6","key":"ref20","doi-asserted-by":"publisher","first-page":"e165","DOI":"10.1111\/j.1756-185X.2012.01763.x","article-title":"Cervical vertebral fracture in a patient with juvenile idiopathic arthritis and osteopoikilosis","volume":"15","author":"G. Gurcan","year":"2012","journal-title":"Int J Rheum Dis"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2024.09.036","article-title":"Distal radius fracture combined with osteopoikilosis in a young adult patient: A first case report","author":"B. Liu","year":"2024","journal-title":"Asian J Surg"},{"issue":"47","key":"ref22","doi-asserted-by":"publisher","first-page":"e8650","DOI":"10.1097\/md.0000000000008650","article-title":"Osteopoikilosis found incidentally in a 17-year-old adolescent with femoral shaft fracture: A case report","volume":"96","author":"C. Ye","year":"2017","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"ref23","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1302\/0301-620X.50B1.91","article-title":"The conservative treatment of Bennett's fracture-subluxation of the thumb metacarpal","volume":"50","author":"A. G. Pollen","year":"1968","journal-title":"The Journal of bone and joint surgery British volume"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.24911\/ejmcr.9-2224","article-title":"A Rare Variant of Osteopoikilosis: A Case Report","author":"F. Spiezia","year":"2025","journal-title":"European Journal of Medical Case Reports"},{"issue":"1","key":"ref25","doi-asserted-by":"publisher","first-page":"160","DOI":"10.13107\/jocr.2026.v16.i01.6636","article-title":"Incidental Osteopoikilosis in an Ankle Fracture Patient: Case Report and Literature Review","volume":"16","author":"J. Ogalde-Bravo","year":"2026","journal-title":"J Orthop Case Rep"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"7","DOI":"10.15406\/mojor.2017.07.00294","article-title":"Osteopoikilosis: an Incidental Finding in a Patient with Olecranon Fracture","author":"M. Ali","year":"2017","journal-title":"MOJ Orthopedics & Rheumatology"},{"issue":"2","key":"ref27","first-page":"59","article-title":"Osteopoikilosis: An incidental finding in a patient with olecranon fracture","volume":"22","author":"Y. J. Khattak","year":"2012","journal-title":"PJR"},{"issue":"8","key":"ref28","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1007\/s00296-010-1664-2","article-title":"A rare benign disorder mimicking metastasis on radiographic examination: a case report of osteopoikilosis","volume":"31","author":"A. E. Ozdemirel","year":"2011","journal-title":"Rheumatol Int"},{"issue":"3","key":"ref29","doi-asserted-by":"publisher","first-page":"98","DOI":"10.13107\/jocr.2021.v11.i03.2106","article-title":"Case Report of Osteopoikilosis: Sparse Cause of Bone Pain and Mimicker of Metastasis on Radiographs","volume":"11","author":"S. R. Panchal","year":"2021","journal-title":"J Orthop Case Rep"},{"issue":"C","key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3889\/oamjms.2022.10889","article-title":"Challenge in Diagnosing Osteopoikilosis: A Case Report","volume":"10","author":"Y. A. P. Putro","year":"2022","journal-title":"Open Access Macedonian Journal of Medical Sciences"},{"issue":"10","key":"ref31","doi-asserted-by":"publisher","first-page":"e24130","DOI":"10.1002\/ajhb.24130","article-title":"Bone density in postmenopausal women with scoliosis is associated with markers of degenerative joint disease","volume":"36","author":"E. Ganji","year":"2024","journal-title":"Am J Hum Biol"},{"issue":"1","key":"ref32","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s12020-021-02806-x","article-title":"DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis","volume":"74","author":"E. Shevroja","year":"2021","journal-title":"Endocrine"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"520651","DOI":"10.1155\/2014\/520651","article-title":"Traumatic fracture in a patient with osteopoikilosis","volume":"2014","author":"A. Du Mortier","year":"2014","journal-title":"Case Rep Orthop"},{"issue":"5","key":"ref34","doi-asserted-by":"publisher","first-page":"347","DOI":"10.5604\/01.3001.0012.7281","article-title":"Trabecular Bone Score (TBS) in Clinical Practice - Rewiev","volume":"20","author":"M. Warzecha","year":"2018","journal-title":"Ortop Traumatol Rehabil"},{"issue":"12","key":"ref35","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1097\/00003072-200412000-00032","article-title":"Abnormal bone scan in an adult with osteopoikilosis","volume":"29","author":"Y. S. An","year":"2004","journal-title":"Clin Nucl Med"},{"issue":"1","key":"ref36","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1097\/00003072-199401000-00002","article-title":"Tc-99m MDP uptake in osteopoikilosis","volume":"19","author":"J. A. Mungovan","year":"1994","journal-title":"Clin Nucl Med"},{"issue":"3","key":"ref37","doi-asserted-by":"publisher","first-page":"369","DOI":"10.3109\/17453678909149297","article-title":"Positive bone scan in a bone island. A histologically verified case in os capitatum","volume":"60","author":"S. Araki","year":"1989","journal-title":"Acta Orthop Scand"},{"issue":"02","key":"ref38","first-page":"113","article-title":"Increased localization of 99mTc-pyrophosphate in a bone island: case report","volume":"17","author":"E. A. Sickles","year":"1976","journal-title":"J Nucl Med"},{"issue":"12","key":"ref39","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22126504","article-title":"(18)F-Sodium Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications","volume":"22","author":"P. S. U. Park","year":"2021","journal-title":"Int J Mol Sci"},{"issue":"Suppl 1","key":"ref40","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaf149.529","article-title":"MON-787 Beyond DXA: Report of a patient with high bone turnover markers and rapid bone loss","volume":"9","author":"L. K. Ereifej","year":"2025","journal-title":"J Endocr Soc"},{"issue":"3","key":"ref41","doi-asserted-by":"publisher","first-page":"292","DOI":"10.4183\/aeb.2023.292","article-title":"PAGET'S DISEASE OF THE BONE FOUND INCIDENTALLY ON F-18 FDG PET\/CT: CLINICAL SIGNIFICANCE AND DIFFERENTIAL DIAGNOSTIC CRITERIA","volume":"19","author":"F. \u00dcst\u00fcn","year":"2023","journal-title":"Acta Endocrinol (Buchar)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"115313","DOI":"10.1016\/j.bone.2020.115313","article-title":"Modeling-based bone formation transforms trabeculae to cortical bone in the sclerotic areas in Buschke-Ollendorff syndrome. A case study of two females with LEMD3 variants","volume":"135","author":"M. Frost","year":"2020","journal-title":"Bone"},{"issue":"04","key":"ref43","doi-asserted-by":"publisher","first-page":"286","DOI":"10.36347\/sjmcr.2017.v05i04.018","article-title":"Osteopoikilosis: a case report and literature review","volume":"5","author":"Y. Huang","year":"2017","journal-title":"Sch J Med Case Rep"},{"issue":"1","key":"ref44","doi-asserted-by":"publisher","first-page":"84","DOI":"10.4103\/0975-7341.118750","article-title":"Osteopoikilosis: A case report with review of literature","volume":"6","author":"D. Krishna","year":"2013","journal-title":"Journal of Orthopaedics, Traumatology and Rehabilitation"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"81","DOI":"10.22551\/2015.06.0202.10037","article-title":"Osteopoikilosis- a case report","volume":"2","author":"A. Rusu","year":"2015","journal-title":"Archive of Clinical Cases"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"012","DOI":"10.29328\/journal.acr.1001068","article-title":"Osteopoikilosis: a rare case with interesting imaging","volume":"7","author":"M. Nejadhosseinian","year":"2023","journal-title":"Archives of Case Reports"},{"issue":"1","key":"ref47","doi-asserted-by":"publisher","first-page":"27","DOI":"10.24911\/PJNMed.175-1668153490","article-title":"Osteopoikilosis mimicking osteoblastic bone mets: A Case report","volume":"13","author":"M. Aslam","year":"2023","journal-title":"Pak J Nucl Med"}],"container-title":["Orthopedic Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/165508-osteopoikilosis-and-fracture-healing-the-bone-quantity-quality-paradox-a-case-report-and-systematic-review-with-synthesis-without-meta-analysis","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:46:19Z","timestamp":1793321179000},"score":1,"resource":{"primary":{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/165508-osteopoikilosis-and-fracture-healing-the-bone-quantity-quality-paradox-a-case-report-and-systematic-review-with-synthesis-without-meta-analysis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":47,"URL":"https:\/\/doi.org\/10.52965\/001c.165508","relation":{},"ISSN":["2035-8164"],"issn-type":[{"value":"2035-8164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}