strontium-radioisotopes and Fractures--Bone

This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates.. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival.. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010.. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope.. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis.. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 (. This update adds new evidence on efficacy of radioisotopes versus placebo,

Topics: Bone Neoplasms; Fractures, Bone; Humans; Hypercalcemia; Pain; Pain Measurement; Phosphorus Radioisotopes; Radioisotopes; Randomized Controlled Trials as Topic; Ruthenium Radioisotopes; Samarium; Spinal Cord Compression; Strontium Radioisotopes

This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates.. To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival.. We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010.. Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope.. We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis.. This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 ((89)Sr) with Samarium-153 ((153)Sm), Rhenium-186 ((186)Re) and Phosphorus-32 ((32)P). We observed no significant differences between treatments. Similarly, we observed no differences when we compared different doses of (153)Sm (0.5 versus 1.0 mCi).. This update adds new evidence on efficacy of radioisotopes versus placebo, (89)Sr compared with other radioisotopes, and dose-comparisons of (153)Sm and (188)Re. There is some evidence indicating that radioisotopes may provide complete reduction in pain over one to six months with no increase in analgesic use, but severe adverse effects (leucocytopenia and thrombocytopenia) are frequent.

Topics: Bone Neoplasms; Fractures, Bone; Humans; Hypercalcemia; Pain; Pain Measurement; Phosphorus Radioisotopes; Radioisotopes; Randomized Controlled Trials as Topic; Ruthenium Radioisotopes; Samarium; Spinal Cord Compression; Strontium Radioisotopes

Topics: Animals; Calcium Radioisotopes; Diphosphates; Dogs; Extremities; Fractures, Bone; Hormones; Humans; Lymphoscintigraphy; Minerals; Osteomyelitis; Strontium Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Wound Healing; Xenon Radioisotopes

Topics: Autoradiography; Fractures, Bone; Humans; Kinetics; Polyphosphates; Pseudarthrosis; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Technetium Compounds; Time Factors; Tin Polyphosphates; Wound Healing

The radionuclide investigation of skeletal trauma in the past was confined generally to scintimetry and an occasional bone scan. The development of improved radiopharmaceuticals, including 99mTc-labeled compounds with their enhanced sensitivity, and the refinement of imaging devices offering superior resolution and speed have allowed a more detailed assessment of conditions resulting from trauma. Practical approaches to the diagnosis of subtle bone injury resulting in stress fracture, the differentiation between delayed healing and nonunion, and early recognition of avascular necrosis and osteomyelitis are now available. The changing pattern of radionuclide uptake in bone following damage by radiation and other abnormalities as a consequence of trauma also can be easily studied.

Topics: Adolescent; Adult; Athletic Injuries; Calcium Radioisotopes; Child; Diphosphates; Female; Femur Head Necrosis; Fluorine; Fractures, Bone; Fractures, Spontaneous; Fractures, Ununited; Humans; Male; Middle Aged; Myositis Ossificans; Osteomyelitis; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Strontium Radioisotopes; Technetium

A 26-year-old female umbrella cockatoo (

Topics: Animals; Beak; Bird Diseases; Cockatoos; Female; Fractures, Bone; Granuloma; Strontium Radioisotopes

An initial assessment of treatment of chronic osteomyelitis in 16 adults with Strontium 85 is presented. A dose 3.5-5 times greater than standard scintigraphic one was administered. In 3 cases the dose has been repeated because of the persistence of infection. The radionuclide was well tolerated. In 14 cases ceasing of osteomyelitis have been achieved. Laboratory tests showed no abnormalities.

Topics: Adult; Aged; Fractures, Bone; Humans; Male; Middle Aged; Osteomyelitis; Radiotherapy Dosage; Strontium Radioisotopes

Injuries to the epiphysel plates without involvement of the epiphyses or metaphyses, such as crush fractures or pure epiphysiolysis may be difficult to diagnose radiologically. Thirteen bone scans after damage to the growth plate have been performed on eight children. These indicate that these scans are able to diagnose lesions of the epiphyseal plates at an early stage and with certainty. The scintigrams also provide information concerning the healing process of the plate; they indicate when healing has been completed and when the extremity can be used for weight-bearing again. Radiation exposure of the children during scintigraphy with 99mTc-polyphosphate is within acceptable limits.

Topics: Adolescent; Child; Epiphyses; Epiphyses, Slipped; Female; Fibula; Follow-Up Studies; Fractures, Bone; Humans; Male; Polyphosphates; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Tibia

Topics: Adolescent; Adult; Aged; Bony Callus; Female; Fractures, Bone; Humans; Leg Injuries; Middle Aged; Radionuclide Imaging; Strontium Radioisotopes; Time Factors

Topics: Adolescent; Adult; Arthritis, Infectious; Bone Diseases; Bone Neoplasms; Bone Transplantation; Epiphyses, Slipped; Femoral Fractures; Femur Head; Follow-Up Studies; Fractures, Bone; Hip Joint; Humans; Joint Diseases; Osteochondritis; Osteomyelitis; Pseudarthrosis; Radionuclide Imaging; Strontium Radioisotopes; Transplantation, Homologous

Topics: Animals; Bone and Bones; Diphosphonates; Dogs; Fractures, Bone; Krypton; Microspheres; Models, Biological; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Strontium Radioisotopes; Technetium

Topics: Arm Injuries; Evaluation Studies as Topic; Fractures, Bone; Humans; Leg Injuries; Radiography; Strontium Radioisotopes

Activity levels of 99TC-labeled compounds, 18F, and 85Sr were obtained at 1, 3, and 5 hr. postinjection in normal and healing fractured bone and in soft-tissue rat specimens. Serial diagnostic bone images and blood and urine kinetics were obtained in patients with each of the TC-labeled compounds. Computer-processed images were used to evaluate in vivo kinetics. 99mTC pyrophosphate provides the best overall characteristics for bone imaging. Improved quality and bioassay procedures are required, however, before any one agent can be designated the radiopharmaceutical of choice for diagnostic bone imaging.

Topics: Animals; Diphosphates; Disease Models, Animal; Fluorine; Fractures, Bone; Humans; Isotope Labeling; Kinetics; Phosphates; Radioisotopes; Radionuclide Imaging; Rats; Strontium Radioisotopes; Technetium; Tibial Fractures; Wound Healing

85Sr uptake and ash-weights of the fracture callus of the tibia and of a heterotopic tibia graft in the same animal were measured in mice and followed up to 30 days after grafting and fracture. Growth and uptake of 85Sr was higher in the callus compared to the graft and reached a maximum at about 17 days post fracture. After this period 85Sr uptake of the callus decreased rapidly, whereas in the graft an initial increase of 85Sr uptake was followed by a slow decline after 17 days. Ash-weights of the grafts increased slightly up to day 11 und remained constant thereafter. A low 85Sr uptake of the uninjured tibia between days 2 and 4 post fracture compared to the data of the following period was assumed to be due to a transitory enhanced excretion of 85Sr along with Ca during this early period. Between 9 and 30 days the 85Sr uptake of the uninjured tibia remained unchanged. An influence of fracture repair or graft healing on the mineral uptake of the whole skeleton therefore cannot be confirmed by our data.

Topics: Animals; Bone and Bones; Bone Transplantation; Bony Callus; Fractures, Bone; Mice; Minerals; Strontium Radioisotopes; Time Factors; Transplantation, Homologous; Wound Healing

Topics: Adult; Fractures, Bone; Humans; Leg Injuries; Male; Radionuclide Imaging; Strontium Radioisotopes

Sixty-seven hip joints with intracapsular fracture and the 67 opposite, normal hip joints were studied with 85Sr scintimetry from two weeks to six years after fracture. Consistently, fractures that developed osteonecrosis showed extremely high counts at the fracture site and the femoral head; fractures that failed to unite also showed extremely high counts at the fracture site and somewhat lower counts in the femoral head; fractures that were healing normally showed counts at the fracture site that were higher than those of the normal, uninjured hip but lower than those at fracture sites where osteonecrosis or nonunion was present. Prediction of complications by 85Sr scintimetry is not reliable within the first few months on injury; thereafter, however, the procedure has definite diagnostic value, particularly for osteonecrosis.

Topics: Adult; Aged; Bone Diseases; Fractures, Bone; Hip Injuries; Hip Joint; Humans; Middle Aged; Necrosis; Postoperative Complications; Radionuclide Imaging; Strontium Radioisotopes; Time Factors; Wound Healing

Topics: Adolescent; Adult; Aged; Fractures, Bone; Humans; Leg Injuries; Middle Aged; Prognosis; Radionuclide Imaging; Strontium Radioisotopes; Wound Healing

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child, Preschool; Exostoses; Female; Fibroma; Fractures, Bone; Humans; Male; Maxillary Sinus; Middle Aged; Osteoma, Osteoid; Paranasal Sinus Neoplasms; Radiography; Radionuclide Imaging; Strontium Radioisotopes

Topics: Bone and Bones; Diphosphates; Female; Follow-Up Studies; Foot; Fractures, Bone; Hand; Humans; Iron; Male; Middle Aged; Radiation Dosage; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Skin Temperature; Strontium Radioisotopes; Technetium

Topics: Fractures, Bone; Humans; Scintillation Counting; Strontium Radioisotopes

Topics: Adolescent; Adult; Aged; Biopsy; Bone and Bones; Bone Diseases; Bone Neoplasms; Calcium; Female; Fluorides; Fractures, Bone; Hodgkin Disease; Humans; Hydroxyapatites; Ion Exchange; Male; Middle Aged; Paraganglioma, Extra-Adrenal; Radiation Dosage; Radiography; Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes; Technetium

Topics: Adult; Follow-Up Studies; Fractures, Bone; Humans; Methods; Middle Aged; Osteoporosis; Radiography; Strontium Radioisotopes; Talus; Time Factors; Wound Healing

Topics: Fractures, Bone; Humans; Radionuclide Imaging; Strontium Radioisotopes

Topics: Adolescent; Adult; Bone and Bones; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Chondroma; Female; Fractures, Bone; Hodgkin Disease; Humans; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Sarcoma, Ewing; Spinal Neoplasms; Strontium Radioisotopes; Time Factors

Topics: Adolescent; Adult; Chronic Disease; Diagnosis, Differential; Fascia; Fasciotomy; Female; Fractures, Bone; Humans; Ischemia; Leg; Leg Injuries; Male; Muscular Diseases; Necrosis; Pain; Physical Exertion; Sports Medicine; Strontium Radioisotopes

Topics: Animals; Bone Diseases; Bone Neoplasms; Bony Callus; Diagnosis, Differential; Female; Fractures, Bone; Half-Life; Humans; Injections, Intravenous; Male; Neoplasm Metastasis; Rabbits; Spinal Neoplasms; Strontium Radioisotopes

Topics: Age Factors; Bone and Bones; Bone Diseases; Bone Neoplasms; Calcification, Physiologic; Fluorine; Fractures, Bone; Humans; Infections; Necrosis; Neoplasm Metastasis; Osteitis; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Sclerosis; Strontium Radioisotopes; Technetium; Time Factors; Whole-Body Counting

Topics: Adolescent; Adult; Aged; Ankle Injuries; Female; Femoral Fractures; Femur Head Necrosis; Follow-Up Studies; Forearm Injuries; Fractures, Bone; Humans; Knee Injuries; Leg Injuries; Male; Middle Aged; Osteitis; Pseudarthrosis; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Thrombophlebitis; Wound Healing

Topics: Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Female; Fractures, Bone; Humans; Hydroxyproline; Male; Middle Aged; Radiography; Radionuclide Imaging; Strontium Radioisotopes

Topics: Bone and Bones; Fractures, Bone; Humans; Strontium; Strontium Radioisotopes