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Osteitis condensans ilii

Osteitis condensans ilii is a benign condition of unknown etiology found more often in women then in men. It is essentially a radiologic diagnosis. It is characterized by asymptomatic bilateral involvement along the inferior iliac side of the sacroiliac joint, which on X-Ray may be confused with sacroileitis of spondyarthropaties. However, the clinical picture and CT help to clarify any doubt in the differential diagnosis. Unlike sacroiliitis, however, the articular margins are intact and the joint space is preserved. The radiographic changes of osteitis condensans ilii can vary and may even resolve with time.

Frontal view
Frontal view

Ax CT
Ax CT

51 yo female with low back pain

Osteitis condensans ilii is a benign condition found more often in women then in men. It is essentially a radiologic diagnosis. It is characterized by asymptomatic bilateral involvement along the inferior iliac side of the sacroiliac joint, which on X-Ray may be confused with sacroileitis of spondyarthropaties. However, the clinical picture and CT help to clarify any doubt in the differential diagnosis. Unlike sacroiliitis, however, the articular margins are intact and the joint space is preserved. The radiographic changes of osteitis condensans ilii can vary and may even resolve with time.
The etiology of osteitis condensans ilii is unknown. The most popular hypothesis is that it results from stress across the sacroiliac joint and increased vascularity secondary to pregnancy. Clinical findings, if present, are usually mild. The condition is usually discovered during imaging of patients presenting with low back or buttock pain. Morning stiffness, limited motion, and polyarthralgia may also occur though inflammatory articular findings are generally absent. Differential diagnostic considerations in cases of osteitis condensans ilii include seronegative spondyloarthropathies, renal osteodystrophy and primary hyperparathyroidism, lymphoma, Paget's disease, and skeletal metastasis.

Suggested reading:

Numaguchi Y . Osteitis condensans ilii, including its resolution. Radiology. 1971;98:1-8.

Olivieri I , Ferri S , Barozzi L . Osteitis condensans ilii. B r JRheumatol. 1996;35:295-7.

Resnik D, eds. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: Saunders, 2002.
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