Metabolic Bone Diseases and Drug Induced Osteoporosis

Bone scintigraphy has traditionally been considered to be not as useful as radiography in the study of metabolic bone diseases including senile or postmenopausal osteoporosis, osteo-dystrophy, drug-induced osteoporosis, and rickets and osteomalacia. However, aided by the pinhole technique, 99mTc-MDP bone scin-tigraphy has been shown to be able to portray characteristic features in systemic and local osteoporosis or osteopenia, which is defined as a state of reduced bone mass with increased cavity. Rickets and osteomalacia, a state of deficient formation of inadequately mineralized osteoid, can also be efficiently diagnosed by bone scintigraphy. Indeed, it is well known that bone scintigraphy is highly sensitive and reli-

Metabolic Bone Disease Cats

Fig. 15.1 Usefulness of whole-body bone scintigraphy in the study of systemic osteoporosis. Anterior (left) and posterior (right) whole-body scans in a 78-year-oM wom- Fig. 15.2 Usefulness of whole-body bone scintigraphy in an with advanced °steop°rosis show generally dimin- osteomalacia. Anterior (left) and posterior (right) whole-ished skeletal uptake body scans in a 77-year-old man with primary hyper-

parathyroidism show generally increased skeletal uptake due to osteodystrophy with avaricious tracer uptake. Note well-functioning left kidney

Fig. 15.1 Usefulness of whole-body bone scintigraphy in the study of systemic osteoporosis. Anterior (left) and posterior (right) whole-body scans in a 78-year-oM wom- Fig. 15.2 Usefulness of whole-body bone scintigraphy in an with advanced °steop°rosis show generally dimin- osteomalacia. Anterior (left) and posterior (right) whole-ished skeletal uptake body scans in a 77-year-old man with primary hyper-

parathyroidism show generally increased skeletal uptake due to osteodystrophy with avaricious tracer uptake. Note well-functioning left kidney

Fig. 15.3 Renal osteodystrophy. Anterior whole-body bone scintigraphy in a 73-year-old woman with end-stage renal failure and congestive heart failure shows generally increased tracer uptake with the most prominent uptake occurring in the skull. Note that both kidneys are not visualized and ribs are fractured (arrows)

Fig. 15.3 Renal osteodystrophy. Anterior whole-body bone scintigraphy in a 73-year-old woman with end-stage renal failure and congestive heart failure shows generally increased tracer uptake with the most prominent uptake occurring in the skull. Note that both kidneys are not visualized and ribs are fractured (arrows)

able for detecting fractures and infractions in porosis and Looser's zone (pseudofracture, osteoid seam) in osteomalacia, which often defy radiographic diagnosis when pathological changes are extensive. In addition and importantly, refined whole-body scintigraphy can uniquely demonstrate systemic involvement pattern of porosis and malacia. For example, whole-body scintigraphy shows generally decreased bone uptake in postmenopausal and senile osteoporosis (Fig. 15.1), increased tracer uptake in osteodystrophy of primary hyper-parathyroidism with visualized kidneys (Fig. 15.2), increased tracer uptake in renal os-teodystrophy without visualized kidneys (Fig. 15.3), and decreased tracer uptake in hepatic osteodystrophy (Fig. 15.4). Such valuable information can easily be extracted from a pair of anterior and posterior views, which are routinely obtainable at no additional expense.

Man With Osteodystrophy

Fig. 15.4A, B Hepatic osteodystrophy with systemic osteoporosis. A Anterior (left) and posterior (right) whole-body bone scans in a 60-year-old man with alcoholic hepatopathy shows generalized low uptake with numerous bone infractions (arrowheads). B Anterior radiograph of the pelvis reveals a typical infraction in the lateral cortex of the right proximal femoral shaft (courtesy of Dr. H. Ohta, Department of Radiology, Osaka Medical School, Japan)

Fig. 15.4A, B Hepatic osteodystrophy with systemic osteoporosis. A Anterior (left) and posterior (right) whole-body bone scans in a 60-year-old man with alcoholic hepatopathy shows generalized low uptake with numerous bone infractions (arrowheads). B Anterior radiograph of the pelvis reveals a typical infraction in the lateral cortex of the right proximal femoral shaft (courtesy of Dr. H. Ohta, Department of Radiology, Osaka Medical School, Japan)

Metabolic bone diseases result from a number of etiologies including endocrine disorders, renal and hepatic failure, disturbed calcium-phosphorus metabolism, and vitamin C and D deficiency or D excess, and general under nourishment. The clinical entities of metabolic bone diseases are diverse, and symptoms and signs are complex. The present discussion is confined to (a) the involutional (senile and postmenopausal) osteoporosis, (b) disuse and immobilization osteoporosis, (c) osteodystrophy associated with primary and secondary hyperparathoidism, (d) drug-induced osteoporosis, and (e) osteomalacia and rickets since these conditions are considered to be more common and can be easily approached dia-gnostically by radiography and scintigraphy. Regional osteoporosis related to hypervascula-rity and disuse have already been given full and partial accounts in the foregoing sections.

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