technetium-tc-99m-medronate and Malabsorption-Syndromes

Topics: Adult; Bone Density; Calcitriol; Fatty Acids; Female; Humans; Malabsorption Syndromes; Muscle Weakness; Technetium Tc 99m Medronate; Vitamin D Deficiency; Wheelchairs

We report an interesting case of osteomalacia in which flare response was seen during therapy. The first 99mTc-methylene diphosphonate bone scan showed increased bilateral and symmetric uptake in the ribs, clavicles and iliac bones. Thoracic CT showed symmetric radiolucent seams (Looser's zones) in both ribs, which were pathognomonic of osteomalacia. After initiation of therapy with vitamin D, the patient's subjective symptoms gradually were relieved. On a second bone scan 4 mo. after initiation of therapy, the hot spots in the ribs remained unchanged. Uptake in the bilateral clavicles had become more intense, and new hot spots were recognized in the right lower ribs and left tibia. A third bone scan after 10 mo. demonstrated an obvious decrease in the number and intensity of the hot spots. Increased uptakes in the second scan were thought to be a flare response caused by therapy.

Topics: Aged; Bone and Bones; Follow-Up Studies; Gastrectomy; Humans; Malabsorption Syndromes; Male; Osteomalacia; Pain; Radionuclide Imaging; Radiopharmaceuticals; Stomach Neoplasms; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed; Vitamin D

We report on 4 patients with secondary hyperparathyroidism of intestinal origin presenting a characteristical pattern of distribution, namely focal accumulations of 99mTc-methylene diphosphonate on locations typical of Looser's zones. In accordance with other authors we demonstrate the higher sensitivity of skeletal scintigraphy as compared to radiography which is well known from other disorders of bone. We also refer to the problems of differential diagnosis arising when multiple foci are visible on bone scan.

Topics: Aged; Bone and Bones; Diphosphonates; Female; Humans; Hyperparathyroidism, Secondary; Malabsorption Syndromes; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate