In our article, "The 'Bone Within a Bone,' " we never stated that subcortical osteoporosis of the round bones of the carpus and tarsus is unique to the reflex dystrophy syndrome (Sudeck's atrophy). We agree with Dr Kilcoyne that such subcortical osteoporosis is often seen in immobilization osteoporosis (disuse osteoporosis) as well. In fact, differentiation on radiological grounds alone is often impossible.1The case illustrated in Fig 7 of our article represents the foot and ankle of a 13-year-old boy who had the classic clinical manifestation of the acute reflex dystrophy syndrome in addition to the described roentgenographic findings.
Frager D, Subbarao K. Sudek's Atrophy v Disuse Osteoporosis-Reply. JAMA. 1983;250(7):899. doi:10.1001/jama.1983.03340070016012
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