Abstract
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 5 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.
References
Harrison HE, Harrison HC. Rickets and osteomalacia. In Schaffer AJ, Markowitz M, eds.Disorders of calcium and phosphate metabolism in childhood and adolescence, Philadelphia: W.B. Saunders, 1979 (Major Prob Clin Pediatr 20: 141–256).
Parfitt AM. Osteomalacia and related disorders. In: Avioli LV, Krane SM, eds.Metabolic bone disease and clinically related disorders, 2nd edn, Philadelphia: W.B. Saunders; 1990; 329.
Pitt MJ. Ricketts and osteomalacia. In: Resnick D, Niwayama G, eds.Diagnosis of bone and joint disorders, 2nd edn. Philadelphia, W.B. Saunders, 1988.
Pitt MJ. Rickets and osteomalacia are still around in diagnostic radiology. In: Gooding CA, ed. San Francisco: Radiology Research and Education Foundation, 1990.
Cosman F, Schnitzer MB, McCann PD, Parisien MV, Dempster DW, Lindsay R. Relationships between quantitative histological measurements and noninvasive assessments of bone mass.Bone 1992; 13: 237–242.
Koo WW, Walters J, Bush AJ. Technical considerations of dual-energy X-ray absorptiometry-based bone mineral measurements for pediatric studies.J Bone Miner Res 1995; 10: 1998–2004.
Verrotti A, Chiarelli F, Montanaro AF, Morgese G. Bone mineral content in girls with precocious puberty treated with gonadotropin-releasing hormone analog.Gynecol Endocrinol 1995; 9: 277–281.
Gutin B, Litaker M, Islam S et al. Body-composition measurement in 9–11-y-old children by dual energy X-ray absorptiometry, skinfold thickness measurements, and bioimpedance analysis.Am J Clin Nutr 1996; 63: 287–292.
Lazarus R, Baur L, Webb, Blyth F. Body mass index in screening for adiposity in children and adolescents: systematic evaluation using receiver operating characteristic curves.Am J Clin Nutr 1996; 63: 500–506.
Hori C, Tsukahara H, Fujii Y et al. Bone mineral status in preterm-born children: assessment by dual energy X-ray absorptiometry.Biol Neonate 1995; 68: 254–258.
Fogelman I, Mckillop JH, Greig WR, Boyle IT. Pseudofracture of the ribs detected by bone scanning.J Nucl Med 1977; 18: 1236–1237.
Fogelman I, Mckillop JH, Bessent RG, Boyle IT, Turner JG, Greig WR. The role of bone scanning in osteomalacia.J Nucl Med 1978; 19: 245–248.
Fogelman I, Citrin DL. Bone scanning the metabolic bone disease: a review.Appl Radiol 1981; 10: 158–166.
Fogelman I. The bone scan in metabolic bone disease. In: Fogelman I, ed.Bone scanning in clinical practice. New York: Springer, 1987.
El-Desouki M. Bone mineral density of the spine and femur in the normal Saudi population.Saudi Med J 1995; 16: 30–35.
Sedrani SH. Are Saudis at risk of developing vitamin D deficiency?Saudi Med J 1986; 7: 247–433.
El Idrissy ATH. Vitamin D deficiency rickets in a sunny country: pathogenesis, clinical picture and management.Ann Saudi Med 1987; 7: 119–124.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
El-Desouki, M., Al-Jurayyan, N. Bone mineral density and bone scintigraphy in children and adolescents with osteomalacia. Eur J Nucl Med 24, 202–205 (1997). https://doi.org/10.1007/BF02439554
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02439554