technetium-tc-99m-medronate and Osteoporosis

Topics: Humans; Osteoporosis; Technetium Tc 99m Medronate

The authors report atypical findings of discordant bone scans and radiography seen in a patient with transient osteoporosis of the hip (TOH). Presented in the case of a 60-year-old man who had spontaneous onset of left hip pain which worsened for 2 months with weight-bearing on the affected side. Initial and follow-up radiographs of the let hip were normal. Bone scan demonstrated intense uptake of Tc-99m MDP in the affected femoral head and neck, corresponding to characteristics of abnormal signal intensity of TOH or transient bone marrow edema syndrome on MRI. This discordant pattern of bone scan and radiographs has rarely been reported in the literature. Its possible mechanism of causation and clinical implication in TOH, together with a review of the literature, are discussed in this report.

Topics: Bone Marrow; Edema; Femur Head; Femur Neck; Hip Joint; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteoporosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

We report ten cases of insufficiency fracture of the sacrum, a recently individualized pathological entity. These fractures occur in elderly women with pronounced osteopenia of the pelvis. The clinical symptoms are low back pain and sometimes mechanical radiculalgia. Histories of previous injury are rare. In 50 per cent of the cases X-ray films of the pelvis show fractures of the anterior pelvic arch (iliopubic and ischiopubic rami). Computerized tomography or radionuclide bone scanning provide an almost certain diagnosis of sacral insufficiency fracture. This diagnosis is confirmed by a favorable clinical outcome after 2 months.

Topics: Aged; Aged, 80 and over; Female; Fractures, Bone; Humans; Middle Aged; Osteoporosis; Radionuclide Imaging; Retrospective Studies; Sacrum; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Radionuclide imaging with Tc-99m diphosphonates is not an effective method for detecting or ruling out most osteoporotic diseases including senile osteoporosis or accelerated postmenopausal osteoporosis, and the slow loss of bone tissue generally remains undetected by this modality. Nonetheless, it frequently surpasses or supplements radiographic findings in evaluating the focal complications of metabolic bone disease, including fractures, microfractures, stress fractures, vertebral compressions, Milkman-Looser zones, aseptic necrosis, and acute infarction. In contrast to its secondary role in osteoporosis, bone imaging is of prime importance in investigating hypercalcemia, because the major cause of this abnormality is skeletal metastatic malignancy. In defective bone mineralization due to hyperparathyroidism or osteomalacia, a general increase in diphosphonate skeletal uptake is detected more frequently than radiographic abnormalities. However, normal skeletal images do not rule out metabolic bone disease. Biochemical testing is more reliable in detecting primary hyperparathyroidism. On the other hand, in renal osteodystrophy, biochemical abnormalities are variable and bone imaging is helpful in assessing the severity of skeletal involvement, but not its etiology. Many methods of quantitating the kinetics of Tc-99m diphosphonates have been explored, such as plasma clearance, bone-to-soft-tissue ratios, 24-hour total body retention and 24-hour urinary excretion. None of these have been widely accepted. The value of bone imaging is established in other systemic diseases, most notably in Paget's disease, hypertrophic pulmonary osteoarthropathy, sickle cell disease, fibrous dysplasia, and sympathetic dystrophy.

Topics: Bone Diseases; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hypercalcemia; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

The aim of this study was to investigate the effectiveness of a technetium-99m-methylene diphosphonate (Tc-MDP) bone scan and the bone mineral density (BMD) test in monitoring the efficacy of osteoporosis (OP) treatment.. A total of 50 women with OP were prospectively enrolled in this study from January 2011 to October 2016 in our hospital. All the patients underwent a Tc-MDP whole-body bone scan and the BMD test before and after alendronate sodium treatment at 3, 6, 12 and 18 months, respectively. Bone metabolism rate on the Tc-MDP bone scan was analysed and expressed as the region-of-interest (ROI) ratio of target bones (L1-L4 vertebrae and femoral neck) to the control right tibia shaft, which was subsequently compared with the bone mass on BMD test at each time point of the treatment.. The mean ROI ratio of the L1 vertebra on the Tc-MDP bone scans decreased significantly starting at 3 months and continued to decrease at 6, 12 and 18 months, respectively (P<0.001). The mean ROI ratio decreased significantly starting at 6 months at the L2 (P<0.001) and L3 (P<0.001) and starting at 12 months at the L4 (P<0.001) and the right femoral head (P<0.001), respectively. In contrast, the BMD levels of the L1, L2, L3 and L4 vertebrae and the femoral neck increased significantly after 12, 12, 18, 18 and 18 months alendronate treatment respectively.. Tc-MDP bone scan can detect the alendronate therapeutic efficacy for OP much earlier than the BMD test.

Topics: Aged; Alendronate; Bone Density; Female; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Technetium Tc 99m Medronate; Time Factors; Treatment Outcome; Whole Body Imaging

We evaluated the role of bone scintigraphy in 60 osteoporotic patients with back pain. Thirty-four had scintigraphic evidence of vertebral fracture and were found to have a significantly lower bone density compared to those without fractures (p = 0.01). In only 14 patients was vertebral fracture considered to be the sole cause of pain with 38 having alternative abnormalities, the most common of which was facet joint disease (n = 30). Results of bone scintigraphy influenced a direct change in management in 18 patients and were able to exclude vertebral fracture as a cause of symptoms in 30. In symptomatic osteoporotic patients the bone scan may be helpful in elucidating the etiology of back pain and can impact on patient management.

Topics: Back Pain; Bone Density; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Clinical Trials as Topic; Diphosphonates; Humans; Osteoporosis; Radionuclide Imaging; Sodium Fluoride; Technetium; Technetium Tc 99m Medronate

The duration of antiresorptive therapy is an important risk factor for medication-related osteonecrosis of the jaw. We performed a pilot study using quantitative analysis by bone scintigraphy to test the hypothesis that mandibular metabolism is affected by long-term bisphosphonate (BP) therapy. Our primary objectives were to assess changes in bone metabolism of the mandible in response to long-term BP therapy and compare the bone metabolism changes of the mandible with other bone sites. We compared the metabolic difference at the site in the mandible unaffected by disease, the humerus and the femur between 14 osteoporosis patients who were being treated with BP (BP group) and 14 patients who were not being treated with BP (control group) using a quantitative analysis and bone scintigraphy. Study endpoints were the mean and maximum bone uptake values (BUVs) quantified using bone scintigraphy images of the mandible, humerus and femur. Quantified images of the site in the mandible unaffected by disease had significantly higher mean and maximum BUVs compared to the controls (mean, 0.74 vs. 0.49, p = 0.019; max., 1.29 vs. 0.85, p = 0.009, respectively). The mean and maximum BUV of femur ROIs in the BP group were significantly lower than those in control patients (mean BUV, 0.23 vs. 0.30, p = 0.039; max. BUV, 0.43 vs. 0.53, p = 0.024, respectively). This is the first report of mandible changes in response to long-term BP treatment, using bone scintigraphy. The results using bone scintigraphy demonstrated that the bone metabolism of the intact mandible is affected by a long-term administration of BP.

Topics: Aged; Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Case-Control Studies; Diphosphonates; Female; Femur; Humans; Humerus; Mandible; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Visual changes on radionuclide bone scans have been reported with teriparatide treatment. To assess this, serial studies were evaluated and quantified in ten postmenopausal women with osteoporosis treated with teriparatide (20 μg/day subcutaneous) who had (99m)Tc-methylene diphosphonate (MDP) bone scans (baseline, 3 and 18 months, then after 6 months off therapy).. Women were injected with 600 MBq (99m)Tc-MDP, and diagnostic bone scan images were assessed at 3.5 h. Additional whole-body scans (10 min, 1, 2, 3 and 4 h) were analysed for (99m)Tc-MDP skeletal plasma clearance (K(bone)). Regional K(bone) differences were obtained for the whole skeleton and six regions (calvarium, mandible, spine, pelvis, upper and lower extremities). Bone turnover markers (BTM) were also measured.. Most subjects showed visual changes on 3- and 18-month bone scan images that disappeared after 6 months off therapy. Enhanced uptake was seen predominantly in the calvarium and lower extremities. Whole skeleton K(bone) displayed a median increase of 22% (3 months, p = 0.004) and 34% (18 months, p = 0.002) decreasing to 0.7% (6 months off therapy). Calvarium K(bone) changes were three times larger than other sites. After 6 months off therapy, all K(bone) and BTM values returned towards baseline.. The increased (99m)Tc-MDP skeletal uptake with teriparatide indicated increased bone formation which was supported by BTM increases. After 6 months off therapy, metabolic activity diminished towards baseline. The modulation of (99m)Tc-MDP skeletal uptake during treatment was the result of teriparatide's metabolic activity. These findings may aid the radiological evaluation of similar teriparatide patients having radionuclide bone scans.

Topics: Aged; Bone and Bones; Bone Density; Bone Remodeling; Female; Humans; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Radionuclide Imaging; Technetium Tc 99m Medronate; Teriparatide; Time Factors; Whole Body Imaging

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.

Topics: Bone Density; Diaphyses; Diphosphonates; Female; Femoral Fractures; Fracture Fixation, Internal; Fracture Healing; Fractures, Spontaneous; Fractures, Stress; Humans; Middle Aged; Osteoporosis; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome; Whole Body Imaging

Technetium-99 conjugated with methylene diphosphonate ((99)Tc-MDP) is a novel bisphosphonate derivative without radioactivity and has been successfully used to treat arthritis in China for years. Since bisphosphonate therapy has the potential to induce bisphosphonate-related osteonecrosis of the jaw (BRONJ), we examined whether (99)Tc-MDP represents a new class of bisphosphonate for antiresorptive therapy to ameliorate estrogen deficiency-induced bone resorption with less risk of causing BRONJ. We showed that (99)Tc-MDP-treated, ovariectomized (OVX) mice had significantly improved bone mineral density and trabecular bone volume in comparison to the untreated OVX group by inhibiting osteoclasts and enhancing osteogenic differentiation of bone marrow mesenchymal stem cells. To determine the potential of inducing BRONJ, (99)Tc-MDP/dexamethasone (Dex) or zoledronate/Dex was administered into C57BL/6J mice via the tail vein, followed by extraction of maxillary first molars. Interestingly, (99)Tc-MDP treatment showed less risk to induce osteonecrosis in the maxillary bones compared to zoledronate treatment group, partially because (99)Tc-MDP neither suppressed adaptive regulatory T cells nor activated the inflammatory T-helper-producing interleukin-17 cells. Taken together, our findings demonstrate that (99)Tc-MDP therapy may be a promising approach in the treatment of osteoporosis with less risk of causing BRONJ.

Topics: Animals; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Density Conservation Agents; Female; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Osteoporosis; Ovariectomy; Phenotype; Radiopharmaceuticals; Technetium Tc 99m Medronate

Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves affected new bone formation, bone microarchitecture, and the mechanical properties of bone in a healthy rat model, in order to evaluate whether extracorporeal shock wave therapy might be a potential treatment for osteoporosis.. Thirteen rats received 1000 electrohydraulically generated unfocused extracorporeal shock waves to the right tibia. The contralateral, left tibia was not treated and served as a control. At two, seven, twenty-one, and forty-nine days after administration of the shock waves, in vivo single-photon-emission computed tomography (SPECT) scanning was performed to measure new bone formation on the basis of uptake of technetium-labeled methylene diphosphonate ((99m)Tc-MDP) (n = 6). Prior to and forty-nine days after the extracorporeal shock wave therapy, micro-computed tomography (micro-CT) scans were made to examine the architectural bone changes. In addition, mechanical testing, microcrack, and histological analyses were performed.. Extracorporeal shock waves induced a strong increase in (99m)Tc-MDP uptake in the treated tibia compared with the uptake in the untreated, control tibia. Micro-CT analysis showed that extracorporeal shock waves stimulated increases in both trabecular and cortical volume, which resulted in higher bone stiffness compared with that of the control tibiae. Histological analysis showed intramedullary soft-tissue damage and de novo bone with active osteoblasts and osteoid in the bone marrow of the legs treated with extracorporeal shock waves. Microcrack analysis showed no differences between the treated and control legs.. This study shows that a single treatment with extracorporeal shock waves induces anabolic effects in both cancellous and cortical bone, leading to improved biomechanical properties. Furthermore, treatment with extracorporeal shock waves results in transient damage to the bone marrow, which might be related to the anabolic effects. After further examination and optimization, unfocused extracorporeal shock waves might enable local treatment of skeletal sites susceptible to fracture.

Topics: Animals; Biomechanical Phenomena; High-Energy Shock Waves; Hindlimb; Imaging, Three-Dimensional; Male; Osteogenesis; Osteoporosis; Radiopharmaceuticals; Rats; Rats, Wistar; Statistics, Nonparametric; Technetium Tc 99m Medronate; Tibia; Tomography, Emission-Computed, Single-Photon; X-Ray Microtomography

We studied the therapeutic effects of one-year alendronate treatment in three cases (two males and one female) of osteoporosis with parietal thinning of skull. Plain radiography and three dimensional computed tomography revealed asymmetric external thinning of the posteromedial part of the bilateral parietal bones. Technetium-99m methylenediphosphate bone scintigraphy did not show any changes in these three cases. Pretreatment levels of urinary type I collagen cross-linked N-telopeptides (NTX) in all three cases were high compared to the normal range. Pretreatment levels of serum bone-specific alkaline phosphatase (BAP) in the two male patients were high in contrast to the normal values in the female patient. Pretreatment mean bone mineral density (BMD) values of the 2nd to 4th lumbar vertebrae (L2-4BMD), head BMD, femoral neck BMD, and whole body BMD of all three patients were low compared with the respective normal ranges. One-year alendronate treatment decreased both urinary NTX and serum BAP in all three cases to normal values. Treatment also increased the whole body BMD in all three cases, the L2-4BMD of the female patient, the femoral neck BMD of the female patient and one male patient, and the head BMD of the female patient when compared to pretreatment levels.

Topics: Aged; Alendronate; Bone Density; Bone Density Conservation Agents; Female; Humans; Male; Osteoporosis; Parietal Bone; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors

To evaluate the advantage of Gukangling Decoction (GKLD), a compound traditional Chinese herbal medicine, combined with technetium [(99)Tc] methylene diphosphonate injection ((99)Tc-MDP) in treating osteoporosis in rabbits.. A rabbit model of osteoporosis was established by intramuscular injection of dexamethasone (DX). Fifty-six rabbits were divided into 8 groups: Group A, B, C, D, E, F, G and H. Rabbits in groups A and B were intramuscularly injected normal saline as normal control, groups C and D were untreated groups, rabbits in group E were treated by (99)-MDP, rabbits in group F were treated by aminodiphosphate, rabbits in group G were treated by GKLD, and rabbits in group H were treated by (99)-MDP and GKLD. Rabbits in groups A and C were executed to demonstrate the establishment of the rabbit model of osteoporosis at the 8th week of experiment. Rabbits in the other six groups were executed after 16-week experiment (8-week treatment), and then bone structure and cell shape were observed by electron microscope, X-ray, CT and emission computed tomography (ECT). Bone density, biomechanical parameters, the levels of bone specific alkaline phosphatase (BALP) and bone Gla protein (BGP) were measured too.. After 8-week of intramuscular injection of DX, the bone trabecula in group A were regular and showed normal configuration, while the bone trabecula in group C were sparse, ruptured and showed damaged form. The bone density and biomechanical parameters in group A were higher than those in group C, indicating that the rabbit model of osteoporosis was established successfully. At the 9th week of experiment, the results of cell pathology in group D showed that the bone trabeculas were sparse, ruptured, defected or had hollow section, but the bone trabeculas in group B were regular and dense. The bone trabeculas in groups H and E were restored, and were thicker than those in group D. The bone quality in groups H and E was better than group D significantly, the bone quality in group F was better than group G, and the bone quality in group G was better than group D slightly.. GKLD combined with (99)-MDP had superiority in treating osteoporosis of rabbits as compared with the respective single therapy.

Topics: Animals; Dexamethasone; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Male; Osteoporosis; Phytotherapy; Rabbits; Technetium Tc 99m Medronate

We have undertaken a retrospective review of 1017 Tc-methylene diphosphonate (Tc-MDP) skeletal scintigrams performed in patients over 70 years of age in order to identify those with insufficiency fractures.. Patients with the diagnosis of insufficiency fracture then underwent clinical follow-up of 2 years for mortality, which was compared to the national aged-matched population.. One hundred and ninety-four patients were found to have scintigraphic evidence of fractures categorized as insufficiency fractures. Typical H-shaped sacral fractures were present in only 17 (4%) patients. Multiple sites of fracture were observed in 114 patients; the commonest being in the vertebrae. Radiological corroboration was available in 161 patients (83%) and bone scintigraphic findings were concordant with at least one of plain radiograph, computed tomography or magnetic resonance imaging in 107 (55%) patients. Of the 48 patients with insufficiency fracture who had undergone measurement for bone mineral density (BMD), 38 were found to have osteoporosis/osteopenia. Eighty-six patients died during the follow-up period, which was markedly higher than expected in the age-matched population. There was no definite relationship between the mortality in insufficiency fracture and BMD or the number of fractures.. Our findings demonstrate that insufficiency fractures are common in the elderly and generally occur at multiple sites. The typical H-shaped fractures are rare and their absence should not lead to any mistaken diagnosis. The patients with insufficiency fractures appear to have poor survival but this does not appear to have any significant relationship with either BMD or the number of fractures. Finally, insufficiency fracture is an important diagnosis to make because survival may be improved if specific management is used.

Topics: Aged; Aged, 80 and over; Bone Density; Female; Foot; Fractures, Bone; Humans; Low Back Pain; Magnetic Resonance Imaging; Male; Multiple Trauma; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sacrococcygeal Region; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adolescent; Adult; beta-Thalassemia; Epiphyses; Humans; Hypogonadism; Iron Overload; Liver; Male; Osteoporosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Aged; Bone and Bones; Bone Density; Humans; Lumbar Vertebrae; Male; Osteitis Deformans; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 34-year-old male was seen with severe right hip pain, rapidly worsening in 1 to 2 weeks, with no history of trauma. There was no fever and laboratory studies were normal. Bone scan showed markedly increased uptake in the femoral head. Magnetic resonance imaging showed bone marrow edema. The patient became asymptomatic with conservative therapy, confirmed by returning toward normal on bone scintigraphy 5 months later. He was readmitted 4 months later because the patient developed similar symptoms on the opposite side. A bone scan showed demineralization of the left femoral head. He recovered on conservative therapy and there was a normal bone scan one year after the initial admission.

Topics: Adult; Arthralgia; Disease Progression; Hip Joint; Humans; Male; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors

Topics: Adult; Anorexia Nervosa; Bulimia; Female; Foot Injuries; Fractures, Stress; Humans; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Rib Fractures; Technetium Tc 99m Medronate; Whole-Body Counting

This study investigated the feasibility of ordered subsets expectation maximisation (OS-EM) reconstruction of pinhole single-photon emission tomography (SPET) acquired with a tilted detector head and a 180 degrees orbit. Phantom and patient data were recorded using a standard single-head camera. Reconstructions were performed using a dedicated OS-EM algorithm. Reconstructed images of line, uniformity and Picker's thyroid phantoms showed that the geometry, physical size and uniformity of the radioactive objects were preserved. For the range of radius corresponding to the patient studies, the measured full-widths at half-maximum lay between 4.90+/-0.25 mm and 6.05+/-0.25 mm. Finally, the gain in resolution associated with the use of the pinhole collimator instead of a parallel-hole collimator was highlighted in a parathyroid exploration and in a shoulder bone study.

Topics: Aged; Algorithms; Female; Humans; Hyperparathyroidism; Image Processing, Computer-Assisted; Middle Aged; Osteoporosis; Phantoms, Imaging; Radiopharmaceuticals; Shoulder Pain; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

In two women aged 85 and 62 years respectively, with pain in the lower back and the hip region, insufficiency fractures of the sacrum were diagnosed. They were treated by bed rest and pain medication with good clinical outcome. Especially in older, postmenopausal women who have been treated for a malignancy (possibly with irradiation of the pelvis), the possibility of sacral insufficiency fractures should be kept in mind. Many unnecessary and sometimes invasive investigations to exclude tumour or metastases can be avoided by adequate diagnostic imaging: first conventional X-ray investigation followed by skeletal scintigraphy. A typical H-shaped pattern of sacral uptake is diagnostic of insufficiency fractures. As this pattern is seen in only approximately 20% of the patients, additional CT will often be necessary. CT can demonstrate the fracture lines and exclude bone destruction or a soft tissue mass. In case CT is not conclusive MRI is indicated.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Bed Rest; Diagnosis, Differential; Female; Fractures, Spontaneous; Humans; Low Back Pain; Magnetic Resonance Imaging; Middle Aged; Neoplasms; Osteoporosis; Sacrum; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Treatment Outcome

Constitutional delayed puberty (DP) and idiopathic hypogonadotropic hypogonadism (IHH) lead to osteoporosis in adult men. We were interested in whether response to treatment of these conditions by testosterone could be predicted by in vivo quantitative bone SPECT (QBS) measurement of bone turnover and whether testosterone administration affects bone mineral density (BMD) in these subjects.. In vivo QBS and BMD measurements were performed in the lumbar spine (LS) and femoral neck (FN) of 29 young men with DP and 16 young men with IHH. In vivo QBS and BMD values in these patients were compared to the values obtained from 27 age-matched normal controls. The effect of testosterone treatment was determined by measuring changes in QBS and BMD, before and after treatment of 22 patients with DP and of all 16 patients with IHH. Seven patients with DP were not treated.. In vivo QBS values in patients with DP were significantly higher than those in controls (8.44% +/- 2.55%ID/ml compared to 5.63% +/- 1.12%ID/ml x 10(-3), p < 0.001, for the LS; and 7.86% +/- 3.01%ID/ml compared to 4.29% +/- 1.25%ID/ml, p < 0.001, for the FN). One year after testosterone treatment, QBS values in DP were significantly reduced. Pretreatment BMD values in patients with DP were significantly lower than those in normal subjects (0.77 +/- 0.11 g/cm2 compared to 1.03 +/- 0.14 g/cm2, p < 0.0001, for the LS; and 0.89 +/- 0.11 g/cm2 compared to 1.08 +/- 0.18 g/cm2, p < 0.006, for the FN). One year after treatment, BMD values increased significantly (0.91 +/- 0.14 g/cm2, p < 0.0001, for the LS; and 0.97 +/- 0.11 g/cm2, p < 0.0001, for the FN). The seven untreated young men with DP still had significantly lower-than-normal BMD values (0.82 +/- 0.08 g/cm2, p < 0.008, for the LS; and 0.89 +/- 0.05 g/cm2, p < 0.04, for the FN). In patients with IHH, QBS values were not significantly different from those found in normal controls. The values for BMD were significantly lower for both the LS (p < 0.0001) and the FN (p < 0.001). After treatment, BMD values in patients with IHH were still significantly lower than those of normals (p < 0.009 for the LS; and p < 0.006 for the FN).. Young men with maturation abnormalities show low bone density. Patients with DP and high bone turnover, as revealed by high QBS values, respond to testosterone treatment. Patients with IHH have normal bone turnover and do not respond to testosterone.

Topics: Adolescent; Adult; Bone and Bones; Bone Density; Case-Control Studies; Humans; Hypogonadism; Male; Osteoporosis; Puberty, Delayed; Radiopharmaceuticals; Technetium Tc 99m Medronate; Testosterone; Tomography, Emission-Computed, Single-Photon

A 61-year-old female patient presenting with mixed connective tissue disease (Sharp syndrome), underwent a long-term high dose glucocorticoid treatment because of multiple organ manifestations. Under steroid therapy she developed severe osteoporosis resulting in multiple fractures. A dynamic [18F]fluoride PET study in this patient revealed reduced fluoride influx in non-fractured vertebrae. This finding corresponds to pathogenetic concepts which propose an inhibition of bone formation as major cause of glucocorticoid-induced osteoporosis. In the light of the presented case it seems to be promising to evaluate the diagnostic benefit of [18F]fluoride PET in osteoporosis.

Topics: Esophagus; Female; Fluorides; Fluorine Radioisotopes; Fractures, Bone; Glucocorticoids; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Mixed Connective Tissue Disease; Osteoporosis; Radiopharmaceuticals; Respiratory Function Tests; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

To understand age-related changes of whole-body and regional skeletal metabolism, it is important to investigate the mechanisms of age-related bone loss and to develop suitable treatments for it. Bone biopsies show metabolism of the particular site examined while biochemical markers for bone metabolism reflect total skeletal metabolism. Bone scintigraphy is a convenient and simple way to analyze whole-body and regional skeletal metabolism. We attempted to study and understand age-related changes in bone metabolism by quantifying the bone scan and correlating it with biochemical bone metabolic markers.. The whole-body skeletal uptake (WBSU) and tracer distribution pattern were studied in men and women by bone scintigraphy using 99mTc-hydroxy-methane-diphosphonate (HMDP). Bone scans were performed using a standard protocol and quantified by setting regions of interest (ROIs) on selected regions. WBSU and the skeletal distribution pattern were compared with simultaneously obtained serum biochemical markers.. WBSU showed an increase with age in both sexes, but in women, uptake in the head and legs increased more relatively than in the thoracic region, while in men no such tendency was observed. Increase of WBSU and relative increase of uptakes in the head demonstrated a weak correlation with the serum levels of alkaline phosphatase and type 1 collagen metabolites.. These results show an age-related increase of skeletal turnover and sex-dependent regional skeletal metabolism. The age-related changes seen in bone scintigrams might be a sign of progressive bone loss, reflecting changes in local bone metabolism.

Topics: Age Factors; Aging; Alkaline Phosphatase; Bone and Bones; Collagen; Collagen Type I; Female; Humans; Male; Middle Aged; Osteoporosis; Peptide Fragments; Peptides; Procollagen; Radionuclide Imaging; Sex Factors; Technetium Tc 99m Medronate

This study is based on the assumption that is bone turnover, shown by the uptake of 99mTc-MDP, indicates a high rate of bone loss in patients with osteoporosis, it could potentially predict bone loss in patients at risk before significant bone loss has occurred.. Quantitative bone SPECT (QBS) using 99mTc-MDP, expressed as the %ID/cc x 10(-3), was performed in 71 women who had osteoporosis in the lumbar vertebrae, the femoral neck or both, and in 54 age-matched normal female controls. Of the women with osteoporosis, 42 had postmenopausal osteoporosis and 29 had primary hyperparathyroidism (HPT) and osteoporosis.. QBS increased with age in the cortical bone and decreased in the trabecular bone of the normal women. Quantitative bone SPECT in the femoral neck was 3.18 +/- 1.20 and was 2.73 +/- 1.06 in the femoral shaft in 20 women with postmenopausal osteoporosis of the femoral neck. In 19 women with HPT and osteoporosis of the femoral neck, the QBS value in the femoral neck was 3.57 +/- 0.92 and in the femoral shaft 3.38 +/- 1.12. These values were also significantly higher for the femoral neck and for the femoral shaft than those of normals. Although QBS values were higher in the lumbar region in 39 women with postmenopausal osteoporosis (4.59 +/- 1.45) and in 27 women with HPT (4.30 +/- 1.52), as compared with the normal group (4.28 +/- 1.61), the difference was not statistically significant.. This study shows that bone turnover is significantly higher in the cortical bone of women with osteoporosis than in normal women.

Topics: Bone and Bones; Bone Density; Female; Femur Neck; Humans; Hyperparathyroidism; Lumbar Vertebrae; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Eleven patients who underwent nuclear medicine bone scanning were reviewed to determine the incidence of bone scan abnormalities associated with hepatoblastoma. Of these, six patients had abnormal bone scan findings--four with focal involvement. Correlating plain radiographs and/or follow-up nuclear bone scans were available for three of these four. All plain films indicated the presence of osteoporosis. Follow-up scans showed improvement or resolution of abnormalities. None of the patients had documented metastatic bone disease. While there has been no prior reported association, the authors attribute the abnormal bone scan findings to a paraneoplastic syndrome of osteoporosis associated with this primary tumor. They conclude that bone scanning is not routinely indicated in the initial diagnostic staging of hepatoblastoma.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Hepatoblastoma; Humans; Infant; Liver Neoplasms; Male; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Calcaneus; Female; Fractures, Spontaneous; Humans; Middle Aged; Osteoporosis; Radionuclide Imaging; Sodium Fluoride; Technetium Tc 99m Medronate

Pulmonary deposition of technetium 99m methylene diphosphonate was found on a bone scan of a patient with undiagnosed primary AL amyloidosis. Unusual clinical manifestations during the course of the disease led to a post-mortem diagnosis. The mechanisms for pulmonary and other ectopic soft tissue bone scan tracer depositions, as well as their significance in the diagnosis of amyloidosis, are discussed.

Topics: Aged; Amyloidosis; Bone and Bones; Humans; Lung; Lung Diseases; Male; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

A young patient with severe generalized osteopenia and multiple compressed vertebral fractures caused by systemic mastocytosis is presented. Extensive clinical, laboratory, and pathologic examination showed the involvement of the skeleton alone. Follow-up bone scintigraphy with Tc-99m MDP during a period of 6 years demonstrated migratory multiple axial lesions. These results suggest that Tc-99m MDP imaging is an accurate detection of the activity of the disease.

Topics: Adult; Fractures, Spontaneous; Humans; Male; Mastocytosis; Osteoporosis; Radionuclide Imaging; Spinal Fractures; Technetium Tc 99m Medronate

The reproducibility and diagnostic value of local bone to soft tissue uptake ratio of 99mTc(Sn)-MDP as a bone tracer was examined in a prospective study in 35 patients who were under investigation and/or treatment for postmenopausal osteoporosis. The ratio of tracer uptake in the second lumbar vertebra (L2) and both femoral shafts was calculated from the number of counts in suitable regions of interest. Results obtained with settings and calculations in the routine practice were compared to the results obtained by revision of all raw data in one run by one person. The results were compared to the serum alkaline phosphatase activity (AP) and to local bone mineral mass as determined by dual photon absorptiometry (DPA). In 15 patients serial measurements during fluoride therapy were also compared to serum osteocalcin values and to bone histomorphometric data. The precision error of the calculation of uptake ratios from raw counts (including selection of region of interest) was 13.9% for the femoral shaft and 14.7% for L2. The mean difference between left and right femoral shaft in individuals was not significant and its variance was small P greater than 0.1). There was a weak but significant linear correlation between local uptake ratio in the spine and AP in the total material (r = 0.328 P less than 0.01). However, changes in local uptake ratio during therapy with fluoride in 15 patients were too small to be of any value and did not correlate with changes in alkaline phosphatase or osteocalcin or trabecular surface covered with osteoblasts.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Connective Tissue; Female; Humans; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Sodium Fluoride; Tablets, Enteric-Coated; Technetium Tc 99m Medronate

In addition to its established oncological indications the sensitivity of bone scintigraphy is of steadily increasing significance in traumatology. Inactivity-induced osteoporosis plays a major role during the immobilization period in the plaster cast. In the region of the joints remodelling intensity may reach such a high level that the non-injured bone shows a higher rate of accumulation than the fracture. This process already begins between the third and fourth week of immobilization. The highest uptake is found after fracture of the scaphoid bone at the end of twelve weeks of immobilization. Control scintigraphies at intervals of several days are indicated to differentiate between various clinical conditions (pseudoarthrosis, activated osteoarthrosis, algodystrophy in case of doubtful x-ray results).

Topics: Carpal Bones; Fracture Fixation; Fractures, Bone; Humans; Osteoporosis; Radionuclide Imaging; Radius Fractures; Technetium Tc 99m Medronate

A continuous bone remodelling takes place throughout life at different turnover speed according to age, physiological and pathological conditions. The evaluation of bone turnover may be of value for a prognostic and therapeutical assessment. Calcium bone exchange may be considered a suitable marker of bone turnover; for this reason 47Ca or 45Ca kinetics may be used; these methods have been employed in the past. Labelled diphosphonates, and in particular 99Technetium-methylene-diphosphonate (99TcmDP) are simpler and safer, because these substances are strongly and almost completely stored in bone and not absorbed by the soft tissue; for this reason they are used at the present time. The evaluation of blood levels and 24 hrs urinary elimination of 99TcmDP is used to measure whole bone diphosphonate retention (WBR). This parameter is positively correlated with other markers of bone turnover such as alkaline phosphatase (AP), osteocalcin (OC), urinary hydroxyproline (HOP). A bicompartmental analysis schedule of 99TcmDP distribution has been proposed some years ago and therefore applied by our group, based on the mathematical evaluation of serum concentration at different times and urinary elimination of the label given intravenously. This method provides the possibility to calculate not only WBR but also total body retention (TBR) and a constant (Kbh) which reflects the influx speed of the tracer in the bone. Kbh probably represents a more sensitive index of bone turnover than WBR. It presents a better correlation with AP and OC values and also shows some (statistically less significant correlations with some indices of bone remodelling obtained by histomorphometry on bone biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone and Bones; Calcium-Binding Proteins; Humans; Hydroxyproline; Middle Aged; Osteitis Deformans; Osteocalcin; Osteoporosis; Technetium Tc 99m Medronate

The following report summarizes the authors' initial experience with detecting and aging vertebral fractures in elderly patients with osteoporosis, emphasizing the use of an inversion recovery sequence with a short time to inversion (STIR) and comparing these results to that achieved using RBI.

Topics: Aged; Aged, 80 and over; Female; Fractures, Spontaneous; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Vertebrae

We studied 20 women who were at risk for osteoporosis (postmenopausal, or on dialysis, or on steroids), who presented with severe back pain. Patients underwent a dual photon (153Gd) densitometry study of the L2-L4 vertebrae, as well as an emission bone scan (99mTc-MDP). The dual photon method revealed abnormal results (20% or more below the mean expected value) in 13/20 patients (65%), and below the "fracture threshold" in 15/20 (75%). The emission bone scan delineated abnormal foci of uptake in 15/19 (79%). We conclude that women at risk for osteoporosis, who present with severe back pain, are likely to have a positive bone scan due to compression fracture or other derangements related to bone demineralization.

Topics: Adult; Aged; Aging; Back Pain; Bone and Bones; Female; Gadolinium; Humans; Middle Aged; Osteoporosis; Radioisotopes; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate

Solitary abnormalities located within the spine from 75 bone images with Tc-99m MDP were reviewed. For the sake of convenience, patients were grouped in three classes of age: 15-50, 51-65, and 66-90 years. In 67 cases, the diagnosis was apparent from clinical studies, x-ray examinations, or biopsies. In eight cases, no diagnosis could be made. The maximum percentage of lesion sites were within the lumbar spine (45 cases). Metastatic lesions were the most common solitary abnormalities within the spine (29.3%). Osteoporosis was second (24%) with the maximum percentage in age group 66-99 years (83%) with a greater female predominance (67%).

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

Regional migratory osteoporosis (RMO) is a well-defined clinical entity, consisting of migratory osteoporosis involving the lower extremities with associated radiographic changes. Idiopathic osteoporosis (IO) is considered to be a separate and distinct entity, occurring in young adults and consisting of axial osteoporosis and back pain. We describe a patient who had hybrid characteristics, both clinically and radiographically, and include iliac-crest biopsy histologic correlation. We believe that this pattern of osteoporosis in many ways resembles RMO, but with severe axial involvement; hence the term disseminated migratory osteoporosis.

Topics: Adult; Ankle; Foot; Hip; Humans; Ilium; Knee; Male; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

The bisphosphonate whole body retention test (WBR) has been used to estimate bone mineralization rate (bone turnover). Bisphosphonates given i.v. are taken up by bone or excreted in urine. The aim of the present investigation was to test the efficacy of WBR in estimating bone mineralization rate (m) and to evaluate the influence of renal function (Clcr) and bone mass (forearm bone mineral content; BMC) on WBR. The 24-h retention of 3.7 MBq 99mTc-HMBP (1-hydroxymethylene-1,1-bisphosphonate) (Osteoscan) given i.v. was measured by a medium sensitive whole body counter in thirty-one patients with hyperparathyroidism (n = 14), hyperthyroidism (n = 8) or hypothyroidism (n = 9) (group 1) and in seventy-six females with postmenopausal spinal crush fracture osteoporosis (group 2). In the same individuals m was calculated from a 7-day 47Ca-kinetic study using the expanding calcium pool model. Multiple regression analysis of WBR vs. m and Clcr in group 1 disclosed that WBR correlated positively to m [rp = 0.49, P less than 0.01 (rp = partial correlation coefficient)] and inversely to Clcr (rp = -0.44, P less than 0.02). Inclusion of BMC in the analysis did not reveal any significant partial correlation between WBR and BMC (rp = -0.33, 0.05 less than P less than 0.10). In group 2 WBR correlated inversely to Clcr (rp = -0.48, P less than 0.001) but showed no significant relation to m (rp = 0.10, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Female; Humans; Kidney; Male; Middle Aged; Minerals; Osteoporosis; Regression Analysis; Technetium Tc 99m Medronate

Serum calcium, albumin, phosphorus, and alkaline phosphatase, urinary creatinine and retention of 99mTc-methylene bisphosphonate (99mTc-MDP) were measured in 61 subjects with osteoporosis and the values compared with those obtained in normal subjects. 99mTc-MDP retention was inversely related with urinary creatinine output in normal subjects. In osteoporotic subjects urinary creatinine output was lower and 99mTc-MDP retention higher even when urinary creatinine output was taken into account. Other measurements were similar. In 21 subjects these measurements together with urinary hydroxyproline were performed before and after treatment with calcium and vitamin D. 99mTc-MDP and alkaline phosphatase fell; urinary hydroxyproline was unchanged. A single 24 h urine measurement after 99mTc-MDP injection is a valuable method of predicting whether calcium and vitamin D therapy will be useful in a particular case of osteoporosis.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone and Bones; Calcium; Creatinine; Female; Humans; Hydroxyproline; Middle Aged; Osteoporosis; Phosphorus; Radionuclide Imaging; Serum Albumin; Technetium Tc 99m Medronate; Vitamin D

A 48-year-old man with a ten-year history of corticosteroid-dependent asthma and a previous fracture of the right humerus after minimal trauma was referred for a dual photon absorptiometry (DPA) study to assess the degree of osteoporosis. The DPA study revealed a large discrepancy in bone mineral density (BMD) between the right and left hips. A Tc-99m MDP bone scan and an anteroposterior frog-leg radiograph demonstrated changes typical of Paget's disease in the sacrum, pelvis, and femurs. This case is an example of how underlying bone disease may artificially elevate bone mineral density, and demonstrates the value of performing BMD tests on both hips and the necessity for correlative bone scans and radiographs in selected cases.

Topics: Bone and Bones; Femur; Humans; Lumbar Vertebrae; Male; Middle Aged; Minerals; Osteitis Deformans; Osteoporosis; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

We have reviewed 11 patients with idiopathic transient osteoporosis of the hip; the six who were women all developed the condition during pregnancy. Both simultaneous and sequential bilateral involvement were seen, but biochemical studies were consistently normal and one synovial biopsy showed only non-specific inflammation. Radioisotope bone scans and CT scans were useful to aid diagnosis. Treatment by limiting weight-bearing relieved symptoms, and spontaneous resolution was paralleled by radiographic remineralisation, usually within a few months. One patient developed a stress fracture of the hip and other areas of transient osteoporosis. A hip involved by the condition should be protected from overloading until bone density has recovered.

Topics: Adult; Crutches; Female; Hip Joint; Humans; Male; Middle Aged; Osteoporosis; Pregnancy; Pregnancy Complications; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Walkers; Wheelchairs

A simple technique for determining the whole body retention of 99mTc labeled methylene diphosphonate (MDP) at 4-h and 24-h was applied to 28 adult patients (22 prostate cancer, 6 osteoporosis). Following administration of 20 mCi (740 MBq) 99mTc-MDP, a qualitative scintigram was performed and whole body retention was recorded at 4 and 24 h. The prostate cancer patients all had positive bone scintigrams, and of this group, 7 were in relapse and 15 in remission on chemotherapy. The osteoporotic groups whole body retention values were determined prior to the initiation of drug therapy. Mean percent whole body retention values were significantly greater at 4 and 24 h for the cancer patients in relapse relative to both the prostate cancer patients in remission and the osteoporotics: 4-h%/24-h%; equals 74.3/60.2, 57.5/33.5, and 48.0/30.3, respectively. The whole body retention values of the latter two groups, however, were only significantly different at 4-h. An additional index of skeletal pathology was developed by combining the 4-h/24-h values to calculate the biological half time (t1/2b) for this time period using a single exponential model. Again the cancer patients in relapse exhibited a significantly longer half time relative to those in remission and the osteoporotics (70.4 vs 25.7 h and 29.2 h, respectively). The combination of 4 and 24-h whole body retention values with the associated t1/2b has potential for following and classifying patients during the course of their skeletal disease. These values have been shown to be especially valuable with cancer patients with metastatic disease.

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Male; Osteoporosis; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

The association of reflex sympathetic dystrophy in one or more extremities with vertebral crush fracture syndrome is reported in six cases. In two of them the reflex sympathetic dystrophy preceded the vertebral crush fractures. The 99mTc-methylene diphosphonate scintigraphy results of the skeletons of 42 consecutive patients suffering from vertebral collapse and of 30 matched controls without osteoporosis have been evaluated by three independent observers for abnormal uptakes in the extremities. An abnormal radioactive bone tracer uptake in the extremities has been observed in 15 osteoporotics (36%) and 8 controls (29%). In most cases, osteoporotics and controls, the abnormal uptake was of the zonal type in a localized area, probably reflecting bone remodeling due to localized degenerative changes. An abnormal uptake of the segmental type involving multiple joints and even multiple extremities, as seen in reflex sympathetic dystrophy, was observed in 7 patients of the osteoporotic group (17%) and in none of the control group (P less than 0.05). The patients with an abnormal segmental uptake were younger and had a significantly higher mean 24 h calcium:creatinine ratio as well as a higher urinary hydroxyproline excretion. These observations and results suggest that in some cases of idiopathic osteoporosis there might be a relation between reflex sympathetic dystrophy and vertebral crush fracture syndrome, the vertebral crush fracture syndrome being the axial type of reflex sympathetic dystrophy.

Topics: Adult; Aged; Bone Development; Female; Fractures, Bone; Humans; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Spinal Injuries; Technetium Tc 99m Medronate

Before operation, 99mTc-MDP scintimetry was performed in 103 patients with femoral neck fractures. There was a significant correlation (r = 0.63, p less than .01) between osteoporosis and fracture displacement, but no correlation (r = 0.07, p greater than .01) between femoral neck trabecular bone patterns and femoral head viability and no correlation (r = 0.11, p less than .01) between fracture displacement and femoral head viability.

Topics: Female; Femoral Neck Fractures; Femur Neck; Humans; Joint Dislocations; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Hip Joint; Humans; Male; Osteoporosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

The effect of a pulse dose of Vitamin D3 on uptake of [99mTc]MDP by fractured and osteoporotic bone, respectively, was compared with D3's effect on uptake by normal bone in rats. At 4, 7, and 14 days, respectively, after femoral fracture, basal uptake was significantly (p less than 0.005) increased at the fracture site by 336.8, 276.1, and 183.5%, respectively, over the contralateral control site. D3-treated rats had lower uptakes than untreated controls at all three fracture sites and at 12 of 15 normal bone sites but analysis of variance showed the uptake differences were not significant. Cortisone-induced osteoporosis caused a significant (p less than 0.05) decrease in basal uptake. The decrease occurred in all nine bone areas studied. D3 caused a significant (p less than 0.05) increase (mean 16.2%) in uptake by these osteoporotic bones, but a significant (0.1 greater than p greater than 0.05) decrease (mean 13.0%) in uptake by the same bones in normal controls. Thus, D3 had an effect on uptake by the bone lesion, osteoporosis, that differed from D3's effect on uptake by fracture or normal bone.

Topics: Animals; Bone and Bones; Cholecalciferol; Cortisone; Diphosphonates; Female; Femoral Fractures; Femur; Male; Osteoporosis; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Time Factors

Two patients with T-cell malignancy having radiographic manifestations of generalized and localized bone demineralization are reported. One, a 53-year-old man, had marked osteoporosis and severe hypercalcemia, but no clinical evidence of leukemia throughout his illness. At autopsy there was no definite evidence of bone involvement. Histologic proof was obtained from abdominal skin which revealed "adult T-cell leukemia/lymphoma (ATLL)." The second case, a 33-year-old man, complained of arthralgia in his hands and feet; radiographs showed severe localized demineralization and pathologic fractures. Specimens of his peripheral blood, cervical lymph nodes, and bone marrow revealed ATLL cells.

Topics: Adult; Bone and Bones; Deltaretrovirus; Humans; Leukemia; Male; Middle Aged; Minerals; Osteoporosis; Radiography; Radionuclide Imaging; Retroviridae Infections; Technetium Tc 99m Medronate

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

Biological fixation of the Christiansen endoprosthesis takes place gradually as a result of osteogenetic activity in the endosteal wall of the femur, which is subjected to mechanical stimulation by the madreporic shank of this prosthesis. The authors were able to monitor this biological process in 9 patients with the aid of bone scintigraphy.

Topics: Aged; Calcinosis; Diphosphonates; Female; Femoral Neck Fractures; Femur; Hip Prosthesis; Humans; Male; Middle Aged; Osteolysis; Osteoporosis; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Wound Healing

In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using 85Sr and 99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Diphosphonates; Fractures, Spontaneous; Humans; Middle Aged; Multiple Myeloma; Osteoporosis; Pelvic Bones; Plasmacytoma; Radiography; Radionuclide Imaging; Ribs; Skull; Spinal Injuries; Spine; Technetium; Technetium Tc 99m Medronate

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Knee Joint; Male; Middle Aged; Osteoporosis; Pain; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibial Fractures

The 24 h-whole-body retention (WBR), determined by a whole-body counter, may be used to quantify exactly bone seeking properties of a radiopharmaceutical. The 24h-WBR of 99mTc-methylene-diphosphonate was determined in 200 patients and was found to be independent of kidney function if this function was normal or only slightly diminished. The 24h-WBR was slightly dependent on age since it decreased up to 20 years of age, reaching a minimum at 20-25 years, and then increased with increasing age. Normal values of 24h-WBR for individuals of more than 20 years of age were 31.8 +/- 5% of injected dose. Not more than two focal accumulations, i.e. skeletal metastases, failed to elevate the 24h-WBR significantly (p less than 0.1). However, a highly significant (p less than 0.001) difference to normals was found in patients with multiple metastases (24h-WBR: 38.2 +/- 7%), with diffuse osseous involvement as in primary hyperparathyroidism (24h-WBR: 49 +/- 11.7%, p less than 0.001) or with osteoporosis (24h-WBR: 45%). The 24h-WBR was found to be very sensitive in grading diffuse osseous involvement. This was shown in single-tumor patients by follow-up as the 24h-WBR in addition to bone scans was useful to describe progression or remission. Moreover, the 24h-WBR correlated closely with results of bone marrow biopsies in a small group of patients with malignancies of the lymphoreticular system.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Hyperparathyroidism; Leukemia; Lymphoma; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

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