[Painful and swollen ankles: no arthritis].

A 53 year old male patient suffering from painful and swollen ankles showed a large enhancement on skeletal scintigraphy. The DXA bone density values for the neck of the femur and the lumbar vertebrae indicated severe osteoporosis. The conventional diagnostic x-ray revealed stress fractures of both distal tibiae (Looser's transformation zones). The patient had been treated with glucocorticoids for many years because of a liver transplantation. A further risk factor was impaired renal function with a hypovitaminosis D3 and secondary hyperparathyroidism.