Zebra stripe sign

Case contribution: Dr Radhiana Hassan


  • A 13 years old girl
  • Underlying ostegenesis imperfecta on biphosphonate treatment
  • Multiple admission due to injury after trivial trauma
  • Mainly involving the limbs
Plain radiograph of right ankle in AP and lateral views
Plain radiograph of left tibia and fibula in AP and lateral views
Plain radiograph of right knee in AP and lateral views

X-Ray findings:

  • There are alternating lucent and sclerotic lines at metaphyseal region of femur and tibia (white arrows) giving rise to zebra stripe sign
  • Bowing of the long bones are also seen
  • Osteoporosis evidence by coarse trabeculation and cortical thinning
  • Multiple and multiages fracture (images not shown)

Diagnosis: Osteogenesis imperfecta

Discussion: Zebra stripe sign

  • Alternating radiolucent and radiodense metaphyseal lines can occur in a few conditions such as growth arrest, rickets on prolong treatment, osteopetrosis, chemotherapu, biphosphonate therapy, chronic anemia and treated leukaemia
  • Zebra stripe sign occurs in children with osteogenesis imperfecta treated with cyclical biphosphonate therapy
  • This is due to bone formation white treatment is given resulting in dense stripes across the metaphysis and can be visualized radiographically.


Author: radhianahassan