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Metacarpal cortical striations were evaluated in 350 patients using fine-detail radiography with optical magnification. Compared to the control population, mean striation-indices were elevated in growing children, primary and secondary hyperparathyroidism, osteomalacia and reflex sympathetic dystrophy syndrome. This technique may provide a useful quantitative assessment of bone metabolism, allowing differentiation of normal from hypermetabolic states. Serial assessment of cortical striation may be useful in monitoring response to therapy.