Long bone metaphyseal cupping is most likely due to the local oligemia from thrombosis in the terminal epiphyseal arteries to the epiphyseal plate, induced by prolonged regional immobilization 7.
The differential diagnosis of long bone metaphyseal cupping includes:
Common
- normal variant
- renal osteodystrophy
- rickets
- sickle cell anemia
Less common
- pediatric fracture
- prolonged immobilization
- scurvy
- hypophosphatasia
- achondroplasia
- metaphyseal dysplasias
- poliomyelitis (prolonged immobilization)
- hypervitaminosis A
- post infection
- radiation-induced