title: Imaging features of therapeutic drug-induced musculoskeletal abnormalities.
abstract: Increasing use of a wide variety of therapeutic drugs with known musculoskeletal side-effect profiles necessitates a rigorous understanding and approach when evaluating imaging features suggestive of drug-induced musculoskeletal abnormalities. The etiology of such abnormalities is diverse, and the clinical and imaging manifestations may be nonspecific. The recognition of adverse effects depends, first, on the physician's vigilant review of clinical information for relevant drug history and indicative signs, and second, on the radiologist's ability to detect musculoskeletal changes consistent with known potential effects of specific drugs. Musculoskeletal abnormalities induced by therapeutic drugs may be broadly categorized as embryopathic, juvenile, or postmaturation. Embryopathic skeletal abnormalities result from the teratogenic effects of drugs administered to pregnant women (eg, thalidomide, anticonvulsants). Other therapeutic agents characteristically lead to abnormalities during postnatal skeletal maturation (eg, high-dose vitamins or prostaglandin) either because they are used exclusively in children or because they have idiosyncratic effects on immature musculoskeletal structures. Many drugs (eg, statins) may have musculoskeletal side effects that, although independent of the stage of skeletal maturation, are most often seen in adults or elderly people because they are commonly prescribed for people in these age groups. Drug-induced musculoskeletal abnormalities may be further characterized according to the predominant skeletal manifestations as osteomalacic, proliferative, or osteoporotic and according to the involvement of soft tissues as musculotendinous or chondral.
authors.affiliation: Department of Radiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Derriford Rd, Crownhill, Plymouth, Devon PL6 8DH, England. harbirsidhu@doctors.org.uk
authors.forename: Harbir S
authors.initials: HS
authors.lastname: Sidhu
authors.forename: Nanda
authors.initials: N
authors.lastname: Venkatanarasimha
authors.forename: Gauraang
authors.initials: G
authors.lastname: Bhatnagar
authors.forename: Varut
authors.initials: V
authors.lastname: Vardhanabhuti
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Fox
authors.forename: Sri Priya
authors.initials: SP
authors.lastname: Suresh
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000175:diagnosis; D013723:Teratogens
chemical_list: D013723:Teratogens