Imaging Findings

Based on the provided X-ray, CT, and MRI images, it can be observed that multiple areas of bone in the proximal and diaphyseal regions of the left femur, the pelvis (ilium, ischium, pubis, etc.), and the skull display varying degrees of “ground-glass” density changes and bone expansion. The margins are relatively well-defined. In some areas, the trabecular structure is blurred or shows fibrous changes. The proximal left femur shows a certain degree of deformity (in a “Shepherd’s crook” configuration), with cortical thinning but an overall smooth outer contour. No obvious large-scale abnormal soft tissue invasion is observed. Some previous fracture sites show surgical traces, but there is currently no clear sign of a new significant fracture line. In MRI, the lesions generally appear low or intermediate signal intensity on T1-weighted images, and intermediate to slightly high signal on T2-weighted images, with heterogeneous enhancement after contrast administration. Bone scan indicates multiple skeletal lesions, corresponding to radiographic fibrous changes in various locations.

Potential Diagnoses

1. Multiple Fibro-Osseous Lesions (Polyostotic Fibrous Dysplasia)
   Reasoning: The typical “ground-glass” density changes, the lesion’s expansive bone changes, and the patient’s history of lesions and pathological fractures since adolescence are consistent with the pathogenesis and imaging features of this disease.
2. Paget’s Disease (However, the patient’s age is somewhat younger than typical, and although the lesions share some features with the initial or mixed phase of Paget’s disease, the overall imaging findings—such as lack of marked thickening of bone or cortical thickening—do not strongly support Paget’s disease. Additionally, there is no clinical evidence of markedly elevated alkaline phosphatase, making this less likely.)
3. Rare Osteoblastoma or Other Fibrous-Osseous Tumors (These often have less distinct margins, more aggressive symptoms, and are often solitary. Considering the imaging and distribution in this case, this possibility is low.)

Final Diagnosis

Taking into account that the patient is a 35-year-old female who has had a history of bone fractures and confirmed fibrous lesions in the left femur since childhood (around 8−9 years old), and now demonstrates similar lesions in multiple skeletal sites, together with the characteristic imaging features (“ground-glass” pattern, expansive lesions, thinning of the cortex yet maintaining a generally smooth external contour), the most likely diagnosis is Polyostotic Fibrous Dysplasia. Further confirmation could involve clinical pathology or genetic testing, but currently there is no clear evidence of malignant transformation.

Treatment Plan and Rehabilitation Program

1. Treatment Strategy

• Pharmacotherapy: For patients with significant pain, notable bone destruction, or multiple affected sites impacting daily function, bisphosphonate therapy (e.g., zoledronic acid, alendronate) may be considered to increase bone density and relieve pain.
• Surgical Intervention: For recurrent pathological fractures or severe deformities that significantly affect ambulation, orthopedic corrective surgery (e.g., internal fixation, lesion curettage, or bone grafting) can be considered. An assessment of the lesion distribution and healing potential is necessary beforehand.
• Other Treatments: Currently, there is no clear sign of malignant transformation, so no specific radiotherapy or chemotherapy is needed. Regular follow-up (imaging + clinical symptoms evaluation) is crucial to detect potential complications.

2. Rehabilitation and Exercise Prescription (FITT-VP Principle)

• Frequency: Initially, low-impact training or aquatic exercises are suggested 2−3 times per week, observing relief of bone pain and weight-bearing capacity; this can gradually be increased to 3−5 times per week.
• Intensity: Focus on moderate to low intensity (e.g., brisk walking, light lower-limb resistance exercises), ensuring no significant pain or excessive fatigue. The principle is to maintain no increase in pain 24 hours post-exercise.
• Time: Each session should last about 20−30 minutes. At the start, the training can be divided into multiple segments (5−10 minutes each) with rest intervals. As tolerance and condition improve, duration can be extended to 45 minutes.
• Type: Activities that put minimal stress on the joints—such as swimming, stationary cycling, or resistance band exercises for the lower limbs—are recommended, combined with core muscle training to strengthen overall skeletal support.
• Progression: After 2−4 consecutive weeks of adapting to the current exercise volume with good pain control, exercise duration or slight resistance may be increased. Moreover, repeat imaging and bone density evaluation every 3−6 months is advisable.
• Individualization: Patients with significant deformities or post-fixation surgery should follow an individualized rehabilitation plan under the guidance of orthopedic or rehabilitation specialists. Using braces or crutches may be considered. Activities that involve excessive loading, such as deep squats, should be avoided.

Because excessive movement or agitation may increase the risk of pathological fractures, protective measures should be enhanced during any weight-bearing or resistance training. For patients with significant bone pain or biomechanical abnormalities in the joints, physical therapy strategies (cold/heat therapy, ultrasound therapy, etc.) may be used first to relieve discomfort before starting an exercise rehabilitation program.

Disclaimer: This report is a reference analysis for healthcare professionals and does not replace offline consultation or professional medical advice. Please seek immediate medical attention if you have any concerns or if symptoms worsen.