osteopoikilosis , spotted bone disease or osteopathia condensans is a rare asymptomatic bone dysplasia of unknown etiology.1 it is characterized by an abnormality in bone maturation process and often found incidentally on radiologic examination .
albers - schonberg was the first to describe this uncommon sclerosing bone dysplasia in 1915.2 incidence in both sexes is identical and it can occur at any age .
overall incidence of opk has been claimed to be one in every 50,000 subjects.3 radiologic signs of opk are homogeneous , small , well - defined symmetric round and ovoid radio opacities lesions .
the commonly involved sites are metaphyses and epiphyses of long bones , scapulae , pelvis , carpi and tarsi.4 pain is not a prominent feature of opk , but in some patients , pain could be a presenting symptom of the disorder .
a 46 year old female patient was referred to our pain clinic , complaining of pelvic pain starting 8 years ago .
her pain was constant , but worsened when climbing stairs and walking for long distances .
the quality of pain was vague and its severity was rated as 56 on the visual analogue scale .
she did not report any history of past or recent trauma or systemic disease and was not taking any medications .
inspection of pelvis showed bilateral symmetry of muscle bulk and there were no scares or bruising .
palpatory examination revealed slight tenderness over the great trochanters and symphysis pubis , however no trigger points were located . on physical exam ,
neurologic examination revealed no abnormality and provocative tests such as thomas test , patrick s test , femoral stretch test and straight leg raising were normal .
all findings for complete blood count , erythrocyte sedimentation rate , c  reactive protein , rheumatoid factor , serum electrolytes , alkaline phosphatase , calcium , phosphate and thyroid function tests were normal .
pelvic x - ray showed multiple oval shaped radiodensities of various degrees on the upper heads of femur , acetabulum and symphysis pubis ( figs . 1 , 2 )
: osteopoikilotic lesions has also found in the foot x ray of the patient . in order to rule out metastases ,
abdomino pelvic ultrasonography was also normal . in light of these characteristic lesions and findings without cancer red flags , a diagnosis of osteopoikilosis was made .
she was found to be pain free and asymptomatic in a follow up visit after the first month .
two months later , she returned to our clinic along with her 11-year - old son and sixteen year old daughter .
plain radiographs revealed the same characteristic ovoid sclerotic lesions of opk in distal end of tibia , fibula ( fig 3 , 4 ) and foot .
further work up showed no other abnormalities except for an exostosis in medial aspect of tibia in her son s x ray .
this current report presents a 46 year old female patient and her son and daughter diagnosed with opk .
an epidemiologic study on 53 patients affected with opk indicated that the frequent sites for opk , were phalanges ( 100% ) , carpal bones ( 97.4% ) , metacarpals ( 92.5% ) , foot phalanges ( 87.2% ) , metatarsals ( 84.4% ) , tarsal bones ( 84.6% ) , pelvis ( 74.4% ) , femur ( 74.4% ) , radius ( 66.7% ) , ulna ( 66.7% ) , sacrum ( 58.9% ) , humerus ( 28.2% ) , tibia ( 20.5% ) , and fibula ( 2.8%).5 in our cases , we found multiple oval shaped radiodensities of various degrees on the upper heads of femur , acetabulum and symphysis pubis .
characteristic radiologic signs of opk consist of numerous 210 mm ovals or round shaped densities , symmetrically distributed within epiphyses and metaphyses of long bones .
these lesions appear as dense radiopaque spots.6 in the current study , pelvic x - ray showed multiple oval shaped radiodensities of various degrees on the upper heads of femur , acetabulum and symphysis pubis .
pain is not a dominant feature of opk but in 15%20% of patients , slight joint pain and effusion have been reported.4 the main complaint in our patients , which caused them to seek medical help , was persistent pain in affected areas .
it is presumed that joint pain is an incidental finding in the course of opk .
increased localized bone metabolism at the location of the lesion , irritation of joint capsule attachment by sclerotic areas and increased intraosseous pressure due to venous stasis at the areas of lesion could produce joint pain.7 in nearly 25% of patients , opk is associated with buschke 
ollendrof syndrom.8 however , we could not find any dermatologic conditions as those in buschke 
therefore , the major differential diagnosis should be considered for osteoblastic metastases , mastocytosis and tuberoussclerosis.9 asymmetry , variation in size , axial skeleton involvement , osseous destruction and periostal reaction differentiates osteoblastic metastases from opk .
in addition , scintigraphy can help distinguish opk from osteoblastic bone metastases but abnormal bone scan does not exclude opk.10 in our case , there were no hot spots indicating increased uptake of radiotracer in bone scan . because of the familial nature of the disorder , when the patient came back with two offspring ( her son and daughter ) , they were also evaluated and
although the risk of malignant transformation with opk is very rare , some complications such as osteosarcoma,11 giant cell tumors12 and chondrosarcoma13 have been reported in the literature .
therefore , we regularly followed up with the patient and other affected members of her family . in conclusion , opk is an asymptomatic natural variation with benign nature but in patients with characteristic radiologic findings , the patients may be presented with pain .
thus , well - timed follow - up visits of the patients are recommended to survey other conditions which may require treatment .
 osteopoikilosis is a rare asymptomatic sclerosing bony dysplasia of benign origin . 
 it is usually found incidentally on radiological examinations . 
 familial occurrence indicates a genetic milieu with autosomal dominant pattern . here , we present a case report of a young woman suffering from pelvic pain due to osteopoikilosis ( opk ) . 
 the same disorder was later found in her son and daughter . 