Abstract
A patient with osteomalacia secondary to vitamin D deficiency after gastrectomy for gastric cancer is presented. Initial bone scintigrams showed both asymmetric and symmetric focal areas of intense uptake due to pseudofractures reminiscent of bone metastases. Radiographs only confirmed the presence of pseudofractures at some, but not all, of the abnormal sites demonstrated by bone scintigraphy. At first, metastatic bone disease was suspected. However, the appearance of repeated bone scintigram was normalized after treatment with vitamin D. A diagnosis of osteomalacia was established. The present case serves to illustrate that symmetric focal lesions are important features of pseudofractures secondary to osteomalacia, and comparison with radiographs and repeated bone scintigraphy are necessary in distinguishing between bone metastases and pseudofractures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nilas L, Christiansen C, Christiansen J. Regulation of vitamin D and calcium metabolism after gastrectomy.Gut 26: 252–257, 1985.
Bisballe S, Eriksen EF, Meisen F, Mosekilde L, Sørensen OH, Hessov I. Osteopenia and osteomalacia after gastrectomy: interrelations between biochemical markers of bone remodelling, vitamin D metabolites, and bone histomorphometry.Gut 32: 1303–1307, 1991.
Fogelman I, Mckillop JH, Greig WR, Boyle IT. Pseudofractures of the ribs detected by bone scanning.J Nucl Med 18: 1236–1237, 1977.
Fogelman I, Mckillop JH, Bessent RG, Boyle IT, Turner JG, Greig WR. The role of bone scanning in osteomalacia.J Nucl Med 19: 245–248, 1978.
Singh BN, Kesala BA, Mehta SP, Quinn JL. Osteomalacia on bone scan simulating skeletal metastases.Clin Nucl Med 5: 181–183, 1977.
McAfee JG. Radionuclide imaging in metabolic and systemic skeletal diseases.Semin Nucl Med 17: 334–349, 1987.
Beeson PB, McDermott W.Textbook of Medicine, Philadephia, London, WB Saunders Company, p. 1832, 1975.
Mosekilde L, Meisen F, Hessov I. Low serum levels of 1,25-dihydroxyvitamin D and histological evidence of osteomalacia after jejuno-ileal bypass for obesity.Gut 21: 624–633, 1980.
Seto H, Ihara F, Futatsuya R, Kamei T, Kakishita M, Noda M. Simultaneous measurements of twenty-four-hour whole body retention of47Ca-chloride and99mTc-MDP: early differentiation of metabolic bone diseases in rat models.Nucl Med Biol 20: 337–342, 1993.
Singh BN, Spies SM, Mehta SP, Kesala BA, Quinn JL. Unusual bone scan presentation in osteomalacia: symmetrical uptake—a suggestive sign.Clin Nucl Med 3: 292–295, 1978.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wu, Yw., Seto, H., Shimizu, M. et al. Postgastrectomy osteomalacia with pseudofractures assessed by repeated bone scintigraphy. Ann Nucl Med 9, 29–32 (1995). https://doi.org/10.1007/BF03165005
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03165005