Bone modeling disorders are conditions characterized by abnormalities in the development, growth, or shaping of bone, often due to genetic differences that affect growth plate regulation or bone formation. These disorders are distinct from metabolic bone diseases, which primarily involve impaired mineralization, and from bone remodeling disorders, which affect turnover in mature bone.
Bone modeling disorders include osteochondroses and genetic skeletal dysplasias (eg, osteochondrodysplasias), all of which are grouped together because they cause defects at the level of the growth plate or in bone development.
In children, bone modeling disorders typically present with short stature, disproportionate growth, and/or characteristic skeletal features rather than with low bone density or increased fracture risk. Bone and joint pain may also occur, often as a result of abnormal mechanical forces on the skeleton due to altered bone shape or alignment.
Osteochondroses (Growth Plate Disorders)
Osteochondroses are noninflammatory and noninfectious conditions that disrupt normal bone growth at ossification centers during periods of rapid skeletal development. These disorders primarily affect the epiphyses and are characterized by pain with important orthopedic implications.
Although the exact etiology of osteochondroses is unknown, some have a familial component, and other contributing factors include mechanical stress, repetitive trauma, and rapid growth. Osteochondroses differ in their anatomic distribution, course, and prognosis.
Common examples of disease (and the affected bones) include:
Köhler bone disease (navicular bone in the foot)
Legg-Calvé-Perthes disease (femoral head)
Osgood-Schlatter disease (tibial tubercle)
Scheuermann disease (vertebrae)
Sever disease (calcaneal apophysitis)
Rare examples include:
Freiberg disease (head of second metatarsal)
Panner disease (capitulum)
Blount disease (proximal tibia)
Osteochondroses are diagnosed primarily through clinical evaluation, with pain localized to the affected ossification center during growth (1). Imaging (especially radiographs) is used to exclude other conditions or confirm atypical cases (2). Radiographs may show epiphyseal osteonecrosis, growth plate closure, and abnormal secondary ossification centers. Less commonly, an MRI may be obtained; it is more sensitive for detecting early changes in disorders such as Legg-Calvé-Perthes disease (3).
Treatment is usually conservative with activity modification, physical therapy, and medications or other measures (eg, rest, ice) taken for symptomatic relief (1). Most cases are self-limiting and resolve with skeletal maturity, but close monitoring is needed. Surgery is rarely required and is reserved for refractory symptoms, mechanical dysfunction, or unstable lesions (leading to persistent joint locking, catching, pain, or swelling).
Prognosis is generally favorable but depends on site and severity.
References
1. Achar S, Yamanaka J. Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones. Am Fam Physician. 2019;99(10):610-618.
2. West EY, Jaramillo D. Imaging of osteochondrosis. Pediatr Radiol. 2019;49(12):1610-1616. doi:10.1007/s00247-019-04556-5
3. Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of Pediatric Growth Plate Disturbances. Radiographics. 2017;37(6):1791-1812. doi:10.1148/rg.2017170029
