Introduction

Compared to the increasing prevalence of osteoporosis, osteosclerosis is rare and often associated with serious underlying conditions. It refers to an abnormal increase in bone density resulting from disordered bone remodeling, usually involving both cortical and cancellous bone [1]. This can either result from an imbalance of mediators promoting osteoblastic activity, inhibiting osteoclastic activity or direct infiltration into bone tissue [2]. Some studies have used elevated Z-scores as a surrogate marker of high bone density; however, osteosclerosis remains a radiologic diagnosis rather than defined by dual-energy x-ray absorptiometry (DXA) [3]. Importantly, increased bone density does not equate to preserved bone strength, and affected individuals may remain at risk of fragility fractures [1, 4].

Osteosclerosis is frequently secondary to one of several diseases, some of which carry a poor prognosis. These include hematological malignancies, metastatic malignancies, renal osteodystrophy, and infiltrative disorders, such as systemic mastocytosis (SM). Recognition of this radiological finding should therefore prompt a thorough investigation to identify reversible or treatable causes. By reporting this case of diffuse osteosclerosis in a young female individual, we aim to contribute to the limited literature on osteosclerosis and highlight the current challenges managing SM-related bone disorders.