Fig. 2.

Initial and posttreatment radiographs of the lumbar spine and both hands and feet. Diffuse osteoporosis through the lumbar spine is noted (A). There is complete loss or scale-like residue of the distal phalanges in all fingers, and clubbing of the terminal tufts is seen (B). Subluxation of the metatarsophlangeal joint of the left second toe, osteolytic thinning of the left fifth metatarsal, and shortening of the proximal phalanges are seen (B). Follow-up radiographs 2 months after administration of the third dose of zoledronic acid shows nor osteoporosis or vertebral fracture, and dense end-plates represent the biphosphonate effect (C). Note progressive worsening of osteolysis affecting the middle phalanges of the fingers as well as the phalanges of the feet and peri-articular bone loss (arrowheads)(D).