What is the role of nuclear imaging in the workup of osteoporosis?

Updated: Jan 19, 2021
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Other than single-photon absorptiometry (SPA) and dual-photon absorptiometry (DPA), as discussed above, nuclear medicine is not used to measure bone-mineral density (BMD). However, bone scans may be useful in diagnosing insufficiency fractures that are not visible on plain radiographs. [50]

Schmitz and associates used fluorodeoxyglucose (FDG) positron emission tomography (PET) in an attempt to differentiate patients with osteoporosis or preclinical osteoporosis from those with other pathologic fractures. [51]  Results indicated that acute vertebral fractures originating from osteoporosis or preclinical osteoporosis tend to have no pathologically increased FDG uptake. Because high FDG uptake is characteristic of malignant and inflammatory processes, FDG-PET may be potentially useful for differentiating osteoporotic vertebral fractures and pathologic ones.

Radionuclide bone scans are particularly useful for screening the whole skeleton for abnormal activity at a site of osteoporotic fractures. The activity pattern is usually different in bony metastases. [52] Radionuclide scans are particularly helpful in the diagnosis of sacral insufficiency fractures, for which the appearances may be characteristic.

Although isotopic bone scans have high sensitivity, their specificity is low because areas of increased uptake may be seen at the sites of fractures, infection, metabolic bone disease, and metastases. The sensitivity of isotopic bone scans in the detection of osteoporotic fractures drastically decreases in elderly patients with osteoporotic fractures and in patients taking steroids.

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