DOI: https://doi.org/10.36347/sjmcr.2026.v14i02.028

Pages: 292-295

The spine is the most frequent site of bone metastases, particularly those originating from breast and lung cancers. Vertebral osteoporosis, on the other hand, is a common benign condition, usually asymptomatic from a neurological standpoint, but which can sometimes be complicated by vertebral compression fractures causing pain, radiculopathy, or, more rarely, neurological deficits. Distinguishing between osteoporotic and metastatic fractures is a major diagnostic challenge, relying primarily on imaging. Osteoporosis is characterized by diffuse and homogeneous bone demineralization. Vertebral compression fractures are often multiple, predominantly in the thoracolumbar region, with biconcave or wedge-shaped forms. On imaging, the cortical bone remains recognizable and reconstructible, without bone obliteration. On MRI, old osteoporotic vertebral compression fractures show a normal or hyperintense signal on T1-weighted images, while recent forms show a localized, well-defined T1 hypointensity with homogeneous contrast enhancement. The presence of an intrasomatic void is a strong sign suggestive of a benign etiology. Conversely, vertebral metastases cause osteolytic or mixed lesions, often irregular, with cortical effacement, involvement of the posterior wall, and extension to the pedicles, sometimes creating the appearance of a "blind vertebra." The compression fractures are disorganized and frequently accompanied by soft tissue extension or epidural invasion. On MRI, tumor replacement of the bone marrow appears as a diffuse, poorly defined T1 hypointensity with heterogeneous enhancement after gadolinium injection. In conclusion, cross-sectional imaging, particularly CT and MRI, plays a fundamental role in the differential diagnosis between metastases and vertebral osteoporosis, conditioning therapeutic management.