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Metabolic Bone Disease

Gabriel Soudry, MD
J Stevan Nagel, MD

June 16, 1994

Presentation

A 43-year-old black man was admitted for subtotal parathyroidectomy. He had a 12-year history of end stage renal disease with secondary hyperparathyroidism. A Tc-99m MDP bone scan was obtained for evaluation of an abnormality seen on the thoracic spine radiograph.

Imaging Findings

Lateral radiograph of the lumbar spine
Radiograph of the hand
Bone Scintigraphy

The lateral radiograph of the lumbar spine reveals a classic "rugger jersey spine" with diffuse bands of osteosclerosis (arrows) alternating with normal bone in the vertebral bodies.

Radiograph of the hand reveals osteopenia and subperiostal bone resorption with loss of the tufts of the fingers (arrows).

Bone scintigraphy shows increased radiotracer uptake at the ostochondral junctions, mandible, skull, sternum, ribs, and juxta-articular areas of the long bones. The sternum has a "flared" appearance (arrow). The bone/soft tissue activity ratio is increased with little or no renal activity.

Diagnosis

Renal osteodystrophy

Discussion

Many types of metabolic bone disease share similar scan appearances. These types include such diseases as primary hyperthyroidism, renal osteodystrophy, and osteomalacia. Their presence is suggested by the constellation of several scan findings that reflect the increased bone remodeling common to those metabolic disorders. This case is a classic example of renal osteodystrophy.

References

1. Palmer EL, Scott JA, Strauss HW. Practical Nuclear Medicine. Philadelphia: WB Saunders, 1992:163.

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