technetium-tc-99m-medronate and Osteomalacia

A 39-year-old man with bone pain underwent Tc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A Tc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.

Topics: Adult; Bone and Bones; Bone Neoplasms; Humans; Male; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Topics: Adenine; Alkynes; Anti-HIV Agents; Benzoxazines; Cyclopropanes; Deoxycytidine; Drug Therapy, Combination; Emtricitabine; Fanconi Syndrome; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Hypophosphatemia; Middle Aged; Muscle Weakness; Musculoskeletal Diseases; Organophosphonates; Osteomalacia; Pain; Radionuclide Imaging; Radiopharmaceuticals; Substance Abuse, Intravenous; Technetium Tc 99m Medronate; Tenofovir

Osteomalacia can be a late but unrecognized complication following jejunoileal bypass. We describe a 53-year-old man who underwent jejunoileal bypass for morbid obesity twenty years earlier who suffered from progressive diffuse bony pain refractory to nonsteroidal anti-inflammatory drugs. He was initially diagnosed with a malignancy with bone metastasis. However, pertinent laboratory data were notable for hypocalcemia (7.5 mg/dL, albumin 4.1 mg/dL) with low urinary calcium excretion (14 mg/day), hypophosphatemia (2.0 mg/dL) with low urinary phosphate excretion (53 mg/day), hypomagnesemia (1.5 mg/dL) with low urine magnesium excretion (23 mg/day), low 1, 25 (OH)2 vitamin D3, and elevated serum alkaline phosphatase and intact parathyroid hormone (iPTH). These laboratory findings pointed to a defect in calcium, phosphate, and magnesium handling in the gastrointestinal tract. Bone biopsy of the iliac crest clearly demonstrated typical changes of osteomalacia with excessive osteoid accumulation and reduced mineralization. His clinical symptoms were refractory to oral 1, 25 (OH)2 vitamin D3 and calcium supplementation but significantly improved with the addition of intermittent intravenous active 1, 25 (OH)2 vitamin D3, calcium, phosphate, and magnesium supplementation. Osteomalacia is an easily misdiagnosed late complication of jejunoileal bypass. Early recognition can avoid circuitous diagnosis and inappropriate management.

Topics: Biopsy; Chest Pain; Diagnosis, Differential; Hip; Humans; Ilium; Jejunoileal Bypass; Male; Middle Aged; Osteomalacia; Pain, Postoperative; Postoperative Care; Radionuclide Imaging; Shoulder Pain; Technetium Tc 99m Medronate

We describe a distinctly unusual MR appearance of the cancellous bone never before described in a patient with biopsy-proven fibrogenesis imperfecta ossium.

Topics: Bone Density; Bone Matrix; Collagen Diseases; Epiphyses; Fractures, Bone; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomalacia; Radiography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

This prospective study was conducted to demonstrate the role of bone mineral density (BMD) and bone scan in the management of adult Saudi female patients with established diagnosis of osteomalacia.. Bone scan using Tc99m methylene diphosphonate (MDP) and BMD of the lumbar spine and femoral neck using dual x-ray absorptiometry (DXA) were performed at the time of diagnosis 6 months and one year after therapy in 96 Saudi female patients attending the metabolic bone disease clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 1997 through to June 1999, aged between 20 and 73-years (mean 42 years). Alkaline phosphatase, calcium and inorganic phosphorus were measured for all patients before and after treatment. 25 Hydroxy Vitamin D was only measured with the first BMD measurements.. The bone profile showed typical biochemical abnormalities of osteomalacia. The bone scan showed feature of "superscan" in all patients and "pseudofractures" in 43 patients. Bone mineral density measurements were compared with that of normal Saudi subjects matched for age and sex. The BMD was significantly low at diagnosis and showed significant improvement after therapy. The improvement of bone density in response to therapy was more evident in lumbar spine than in femoral neck bone.. Our results showed that BMD in adult Saudi female patients with osteomalacia was markedly affected probably due to specific constitutional and environmental factors (inadequate exercise, lack of sun exposure and lack of intake of milk and dairy products). In addition, lumbar BMD and serum calcium appeared to be better markers to monitor therapy. Bone scan helped in demonstrating disease activity, the presence of pseudofractures.

Topics: Absorptiometry, Photon; Adult; Aged; Bone and Bones; Bone Density; Female; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteomalacia; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Saudi Arabia; Technetium Tc 99m Medronate

A 27-year-old female patient was admitted to our hospital with a history of leg pain and mass. She had a benign osteoblastoma in right tibia. Resection of the tumor without treatment by vitamin D antagonist resulted in rapid cure of the osteomalacia. Bone scintigraphy with Tc-99m MDP revealed multiple hot uptakes in initial scan, and follow up scan showed a clear resolution of the lesions.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteoblastoma; Osteomalacia; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Calcium Citrate; Cholecalciferol; Emigration and Immigration; Female; Germany; Humans; Osteomalacia; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Vitamin D; Vitamin D Deficiency

The aim of this study was to assess the role of 99Tcm(V)-dimercaptosuccinic acid (99Tcm(V)-DMSA) scintigraphy in the evaluation of patients with metabolic bone disease. The study group comprised eight women aged 17-72 years, six with osteomalacia and two with primary hyperparathyroidism. Six patients were imaged scintigraphically before their treatments were started, whereas the other two underwent treatment during the time of examination. All six patients who had not previously been treated had prominent skeletal 99Tcm(V)-DMSA uptake, revealing a bone-scan-like pattern. In the two patients receiving medical therapy, their 99Tcm(V)-DMSA scans revealed a normal physiological distribution. Many of the fracture and pseudofracture sites detected on bone scans were also discerned with 99Tcm(V)-DMSA scintigraphy. Our results suggest that 99Tcm(V)-DMSA scintigraphy might have the potential as a screening method in patients with metabolic bone disease.

Topics: Adolescent; Adult; Aged; Bone and Bones; Female; Humans; Hyperparathyroidism; Middle Aged; Osteomalacia; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Tissue Distribution

Hypophosphatemic osteomalacia, a familial or rarely acquired disorder, is characterized biochemically by hypophosphatemia, decreased renal tubular reabsorption of phosphate, decreased intestinal absorption of calcium, and normal serum calcium. This report concerns a rare case of hypophosphatemic osteomalacia of unknown cause that was shown on Tc-99m MDP bone scanning.

Topics: Adult; Bone and Bones; Humans; Hypophosphatemia, Familial; Male; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

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

In order to demonstrate the role of bone mineral density (BMD) measurement and bone scans in the management of patients with osteomalacia, radioisotope bone scintigraphy using technetium-99m methylene diphosphonate (MDP) and BMD measurements of the lumbar spine and femur by means of dual X-ray absorptiometry (DXA) were performed at the time of diagnosis and 6 months after therapy in 26 Saudi patients (17 females and nine males). Their mean age was 13.5 years (range, 5-16). BMD measurements were compared with those of normal Saudi subjects matched for age and sex. Bone scan showed an increase in tracer uptake throughout the skeleton ("superscan") in all children and demonstrated multiple stress fractures in eight. The mean BMD for the lumbar spine was 0.53 g/cm2 (Z-score, -3.1) and for the femoral neck 0.55 g/cm2 (Z-score, -2.8). Repeated bone scan and BMD after 6 months of therapy with oral vitamin D, calcium and proper sun exposure demonstrated a significant increase (P<0.001) in BMD and healing of pseudofractures. In conclusion, as a non-invasive method with minimal radiation exposure, measurements of BMD in children with osteomalacia are to be recommended in the initial assessment of the severity of osteopenia and in the follow-up to monitor the response to therapy. Bone scintigraphy is valuable in demonstrating the site and severity of stress fractures.

Topics: Absorptiometry, Photon; Adolescent; Bone and Bones; Bone Density; Child; Child, Preschool; Female; Femur; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Osteomalacia; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

A patient with osteomalacia secondary to vitamin D deficiency after gastrectomy for gastric cancer is presented. Initial bone scintigrams showed both asymmetric and symmetric focal areas of intense uptake due to pseudofractures reminiscent of bone metastases. Radiographs only confirmed the presence of pseudofractures at some, but not all, of the abnormal sites demonstrated by bone scintigraphy. At first, metastatic bone disease was suspected. However, the appearance of repeated bone scintigram was normalized after treatment with vitamin D. A diagnosis of osteomalacia was established. The present case serves to illustrate that symmetric focal lesions are important features of pseudofractures secondary to osteomalacia, and comparison with radiographs and repeated bone scintigraphy are necessary in distinguishing between bone metastases and pseudofractures.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Fractures, Bone; Gastrectomy; Humans; Male; Middle Aged; Osteomalacia; Postoperative Complications; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Medronate; Vitamin D Deficiency

Distal renal tubular acidosis (RTA) is known to cause metabolic bone abnormalities. For the first time to our knowledge, a case of distal RTA is reported in association with a superscan on bone scintigraphy. Reported cases of metabolic bone diseases producing a superscan appearance were reviewed, and underlying mechanisms are discussed. We speculate that impaired hydrogen ion secretion in this patient with distal RTA subclinically increased bone turnover, contributing to the superscan appearance on bone scintigraphy.

Topics: Acidosis, Renal Tubular; Adult; Female; Humans; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Humans; Hyperparathyroidism, Secondary; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

A bone scan and red blood cell scan in the rare epidermal naevus syndrome, associated with multiple haemangiomas of the bone and hypophosphataemic osteomalacia in a 20-year-old man are reported. The typical pattern of osteomalacia on the bone scan was associated with lesions of increased bone metabolism in the peripheral bones. The haemangiomas did not pool labelled red blood cells. Thus, the bone scan seems to be suitable for diagnosing the complete extent of haemangiomas in bone, but they could not be specifically proven by red blood cell pooling.

Topics: Adult; Bone and Bones; Bone Neoplasms; Erythrocytes; Hemangioma; Humans; Male; Neoplasms, Multiple Primary; Nevus, Pigmented; Osteomalacia; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate

During osteomalacia in patients with terminal renal failure, the coefficient of diphosphonate elimination from the blood bed (K1) was less than 0.1 min-1, which was determined by the rise of the concentration of uremic toxins, inhibiting interaction of the radiopharmaceutical with the bone, in the patients' tissues. Dynamic scintigraphy permits one to study the pharmacokinetics of diphosphonate in every patient and thus can be used for differential diagnosis between osteomalacia and other forms of renal osteodystrophy.

Topics: Chronic Kidney Disease-Mineral and Bone Disorder; Diagnosis, Differential; Humans; Kidney Failure, Chronic; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

The value of radionuclide bone scanning in the diagnosis of renal osteodystrophy is still debated. In order to re-examine this issue, 25 uremic patients treated by intermittent hemodialysis underwent 99m-Technetium Methylene Diphosphonate (99mTc-MDP) bone scan. They were subdivided into three groups according to quantitative bone histology. Group 1 (N = 8) had pure dialysis osteomalacia, group 2 (N = 7) mixed lesions, and group 3 (N = 10) pure osteitis fibrosa. The scintigraphic studies were interpreted by means of a five point semi-quantitative scale. Using this quantification, all but one group 1 patients had decreased bone tracer uptake, and all patients of group 3 had an increased uptake (chi square test of Yates, P less than 0.001). Among patients of group 2, bone uptake was decreased in the three patients with clearly reduced mineralization front and moderate osteitis fibrosa, but it was increased in all patients with severe osteitis fibrosa and subnormal mineralization front. A quantitative analysis of regional tracer uptake into bone was performed in two patients: one of group 2 and one of group 3. The results obtained clearly corroborated the semi-quantitative findings. Thus, in hemodialysis patients with symptomatic bone disease, the 99mTc-MDP bone scan provides useful information for the differential diagnosis between dialysis-related osteomalacia and secondary hyperparathyroidism. In patients with mixed lesions, the importance of bone tracer uptake appears to depend on the extent of the mineralization front and on the intensity of osteitis fibrosa.

Topics: Adult; Aged; Biopsy; Bone and Bones; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Humans; Male; Middle Aged; Osteitis Fibrosa Cystica; Osteomalacia; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate; Uremia

The 24-h whole-body retention of diphosphonates (WBR), a useful measure of bone metabolism in young subjects, was measured in 27 elderly subjects (19 from home and eight in-patients). WBR rose with increasing age (r = 0.55, P less than 0.01) and was negatively correlated with renal function (r = -0.60, P less than 0.01). In five subjects given vitamin D, WBR did not fall. The measurement of WBR in the elderly has to be assessed in the light of an accurate assessment of renal function and so is rarely clinically useful.

Topics: Aged; Aging; Bone and Bones; Diphosphonates; Female; Glomerular Filtration Rate; Humans; Male; Osteomalacia; Technetium Tc 99m Medronate; Vitamin D

A simple method of quantifying skeletal uptake of 99Tcm-methylene diphosphonate, using a rectilinear scanner and a simultaneously image standard, is described. The pattern of quantified uptake in ten regions of the skeleton, the sacro-iliac joints and kidneys in 57 controls and 54 patients with various metabolic bone disease is presented. This method distinguishes patients with primary hyperparathyroidism and osteomalacia from controls with a sensitivity adequate for clinical purposes. In primary hyperparathyroidism the increased skull uptake of tracer correlated well with levels of serum alkaline phosphatase, plasma parathyroid hormone, urinary hydroxyproline excretion and the degree of intracortical resorption in the metacarpal bones. The skull uptake in oestoporosis was normal or moderately elevated and correlated well with bone mass density measurements of the radius. Patients with osteomalacia also showed the greatest increase in tracer uptake in the skull. Patients with thyrotoxicosis differed from most other patients by showing moderately increased uptake in shafts of long bones. We propose our method of quantitative bone uptake as a useful noninvasive test to detect metabolic bone disease and to monitor responses to therapy of bone disease.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Diphosphonates; Female; Humans; Hyperparathyroidism; Hyperthyroidism; Male; Middle Aged; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Bone and Bones; Child; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Female; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Osteomalacia; Radionuclide Imaging; Renal Dialysis; Technetium; Technetium Tc 99m Medronate

A case of osteomalacia with multiple asymmetrically distributed pseudofractures (Looser's zones) simulating metastases is presented. Radiographic correlation is essential to increase specificity and avoid misinterpretation.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Femoral Fractures; Fractures, Spontaneous; Humans; Male; Osteomalacia; Radionuclide Imaging; Rib Fractures; Scapula; Technetium Tc 99m Medronate

A method is described for the quantitation of total skeletal activity during bone scans. The method requires a single plasma sample only, taken at the time of imaging. The ratio of % injected dose of 51Cr EDTA to that of 99Tcm MDP is calculated from this sample following combined injection of the two radiopharmaceuticals. The 51Cr EDTA level corrects for the glomerular filtration of 99Tcm MDP. Using this method, which only requires a gamma counter, significant differences from normal controls have been shown in patients with osteomalacia, renal osteodystrophy, Paget's disease and hypercalcaemia. The method provides routine quantitative data to add to the imaging information in the bone scan.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Chromium Radioisotopes; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Edetic Acid; Humans; Hypercalcemia; Metabolic Clearance Rate; Middle Aged; Osteitis Deformans; Osteomalacia; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Radio-isotope bone scanning was used to detect osteomalacia in 17 elderly subjects who had equivocal biochemical evidence of this condition. The scan was positive in 10 of the 17 subjects. Bone biopsy confirmed osteomalacia in all 10, but also identified a further two cases. Isotope bone scanning is a practical and relatively non-invasive method of detecting osteomalacia in elderly subjects.

Topics: Aged; Alkaline Phosphatase; Biopsy, Needle; Bone and Bones; Calcium; Diphosphonates; Female; Humans; Male; Osteomalacia; Phosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The bone scan may be of value in the assessment of patients with metabolic bone disease. However the superiority of the bone scan when compared to radiology in conditions such as renal osteodystrophy, osteomalacia, primary hyperparathyroidism, and osteoporosis requires substantiation with the newer radiopharmaceuticals which have a higher affinity for bone. Two methods of quantitating skeletal uptake of tracer have been assessed to try to remove the subjective aspect of bone scan evaluation. Measurements of bone to soft tissue ratios have proved clinically disappointing, but 24 hour whole body retention of diphosphonate appears to provide a sensitive index of increased bone turnover.

Topics: Bone and Bones; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Etidronic Acid; Humans; Hyperthyroidism; Organotechnetium Compounds; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The kinetics of 99mTc-methylene diphosphonate (MDP) and 47Ca were studied in three patients with osteoporosis, three patients with hyperparathyroidism, and two patients with osteomalacia. The activities of 99mTc-MDP were recorded in the lumbar spine, paravertebral soft tissues, and in venous blood samples for 1 h after injection. The results were submitted to deconvolution analysis to determine regional bone accumulation rates. 47Ca kinetics were analysed by a linear two-compartment model quantitating short-term mineral exchange, exchangeable bone calcium, and calcium accretion. The 99mTc-MDP accumulation rates were small in osteoporosis, greater in hyperparathyroidism, and greatest in osteomalacia. No correlations were obtained between 99mTc-MDP bone accumulation rates and the results of 47Ca kinetics. However, there was a significant relationship between the level of serum alkaline phosphatase and bone accumulation rates (R = 0.71, P less than 0.025). As a result deconvolution analysis of regional 99mTc-MDP kinetics in dynamic bone scans might be useful to quantitate osseous tracer accumulation in metabolic bone disease. The lack of correlation between the results of 99mTc-MDP kinetics and 47Ca kinetics might suggest a preferential binding of 99mTc-MDP to the organic matrix of the bone, as has been suggested by other authors on the basis of experimental and clinical investigations.

Topics: Adult; Aged; Calcium; Connective Tissue; Diphosphonates; Female; Humans; Hyperparathyroidism; Kinetics; Lumbar Vertebrae; Male; Middle Aged; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Kinetics; Liver Cirrhosis; Middle Aged; Osteitis Deformans; Osteomalacia; Osteoporosis; Technetium; Technetium Tc 99m Medronate