Fig. 2.

(a, b, c): Patient 1. Radioclinical presentation of hands and feet. (a) Right hand shows extension and flexion deformity of the metacarpophalangeal and proximal interphalangeal joints respectively. Left hand shows a similar deformity but restricted to the little finger. (b) Radiographs show diffuse osteopenia, bilateral carpal osteolysis more pronounced on the right (hollow arrows) with minute pathologic fractures of metacarpals and feet (not shown). Note tapering of the proximal ends of some metacarpals. Note the transverse metaphyseal striations (arrows) which indicate previous bisphosphonate therapy. (c) Note the diffuse osteopenia of both feet and the osteolysis of the midtarsal joints especially of the right foot which also shows a hallux valgus deformity.