Whole-body Bone Research Articles

127 Utilizing predictive models for bone mineral content and bone mineral density as a tool to assess dietary phosphorous

Abstract Dietary phosphorous is a necessary nutrient for bone development in pigs at all stages of its growing. Deficiencies in phosphorous decrease bone mineral content (BMC) and bone mineral density (BMD) and may be a causative of lameness. However, the normal range expected in whole body (WB) and individual bones for BMC and BMD in commercial pigs has been poorly defined. Therefore, our objectives were to 1) model normal WB bone density at multiple timepoints in wean to finish pigs, and 2) determine the extent to which individual bone (femur and 3rd metatarsal) BMC and BMD could predict WB BMC and BMD. Mixed sex pigs [Camborough (1050) x 337, PIC] were utilized and included freshly weaned ~21 d (n = 8), ~44 d of age (n = 24), ~84 d of age (n = 24) and ~154 d of age (n = 24). Pigs were individually penned. Excluding weaning age, at each age group pigs were randomly assigned to diets adequate, marginally deficient, or deficient in available phosphorus (avP) and fed for 3, 4, and 6 wk (age group 44, 84, 154, respectively). Within each age group, diets were formulated to meet nutrient and energy requirements except for avP and pigs fed ad libitum. On-test and off-test body weight (BW) and feed intake and gain to feed ratio were assessed for each age group. At the end of each feeding period, all pigs were euthanized and WB, femur (F) and 3rd metatarsal (M) BMC and BMD determined by dual X-ray absorptiometry (DXA). Data were analyzed using linear and generalized additive models that predicted response variables (BMC or BMD) as a function of BW or age. Only pigs fed adequate avP diets were used in the model fit. Pigs fed adequate avP diets increased BMD with age (0.22, 0.42, 0.84 and 1.10 g/cm2, days of age 21, 44, 84 and 154 respectively, P < 0.001). Within day of age 84, marginally and deficient avP diets reduced BMC and BMD by 21 to 41% (P = 0.002) and 12 to 25% (P = 0.006), respectively. Within day of age 154, marginally and deficient avP diets reduced BMC and BMD by 9% (P = 0.05) and 6 to 8% (P = 0.06), respectively. Body weight record and individual bone (F and M) BMC and BMD from pigs fed deficient avP diets were used to predict WB BMC and BMD and the mean square error of prediction was selected as a criterion to evaluate the ability of the models to detect these inadequately fed pigs. Using the selected models, pigs fed nutritionally deficient diets were detected due to 2- to 7-fold increase in MSE of predicted WBMD or WBMC compared with pigs fed adequate diets. These models can be used to assess bone development and strength in growing pigs and to infer the adequacy of avP level supplied in their diets.

Satisfied quantitative value can be acquired by short-time bone SPECT/CT using a whole-body cadmium\u2013zinc\u2013telluride gamma camera

The aim of this study was to evaluate the quantitative values of short-time scan (STS) of metastatic lesions compared with a standard scan (SS) when acquired by whole-body bone SPECT/CT with cadmium–zinc–telluride (CZT) detectors. We retrospectively reviewed 13 patients with bone metastases from prostate cancer, who underwent SPECT/CT performed on whole-body CZT gamma cameras. STSs were obtained using 75, 50, 25, 10, and 5% of the list-mode data for SS, respectively. Regions of interest (ROIs) were set on the increased uptake areas diagnosed as metastases. Intraclass correlation coefficients (ICCs) of standardized uptake values (SUVs) for the ROIs were calculated between the SS and each STS, and ICC ≥ 0.8 was set as a perfect correlation. Moreover, the repeatability coefficient (RC) was calculated, and RC ≤ 20% was defined as acceptable. A total of 152 metastatic lesions were included in the analysis. The ICCs between the SS vs. 75%-STS, 50%-STS, 25%-STS, 10%-STS, and 5%-STS were 0.999, 0.997, 0.994, 0.983, and 0.955, respectively. The RCs of the SS vs. 75%-STS, 50%-STS, 25%-STS, 10%-STS, and 5%-STS were 7.9, 12.4, 19.8, 30.8, and 41.3%, respectively. When evaluating the quality of CZT bone SPECT/CT acquired by a standard protocol, 25%-STS may provide adequate quantitative values.

Does whole-body bone SPECT/CT provide additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence?

BackgroundTo assess whether whole-body (WB) bone SPECT/CT provides additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence (PC-BR).MethodsPatients referred for a PC-BR and whom benefited from a WB bone SPECT/CT and FCH PET/CT were retrospectively included. Tests were classified as positive, equivocal, or negative for bone metastases. A best valuable comparator (BVC) strategy including imaging and follow-up data was used to determine the metastatic status in the absence of systematic histological evaluation.ResultsBetween January 2011 and November 2017, 115 consecutive patients with a PC-BR were evaluated. According to the BVC, 30 patients had bone metastases and 85 patients did not present with bone lesions. The sensitivity, specificity, positive and negative predictive values were respectively 86.7% [69.3–96.2], 98.8% [93.6–100.0], 96.3% [78.7–99.5], and 95.5% [89.4–98.1] for WB bone SPECT/CT and 93.3% [77.9–99.2], 100.0% [95.8–100.0], 100.0 and 97.7% [91.8–99.4] for FCH PET/CT. There was no significant difference in diagnostic accuracy of bone metastases between WB Bone SPECT/CT (AUC 0.824 [0.74–0.90]) and FCH PET/CT (AUC 0.829 [0.75–0.90], p = 0.41).ConclusionDespite good performances for the diagnosis of bone metastases in PC-BR, WB bone SPECT/CT does not provide additive diagnostic information over concomitant FCH PET/CT.

Bone mineral density and specific physical performance in Korean national amateur male boxers

Background The objective of this study was to investigate the relationships between bone mineral density, the level of anaerobic capacity and muscle strength in Korean national amateur male boxers. Methods We carried out a cross-sectional population-based study where fifty-six Korean national amateur male boxers were enrolled. The participants’ whole-body bone and regional mineral density (BMD) and bone mineral content (BMC) were assessed using dual-energy X-ray absorptiometry as the main outcome. The anaerobic capacity was assessed using the Upper and lower Wingate test, and muscle strength was assessed using Isokinetic muscle strength and Maximal strength. Results Of the fifty-six boxer, 37.5% were classified as LWC, 32.1% as MWC, and 30.3% as HWC. Linear regression analyses showed that the severity of bone variable was associated with upper and lower-body anaerobic capacity. Isokinetic muscle strength and Maximal strength were positively associated with bone variables. Conclusions Within athletes of Korean national amateur male boxers, anaerobic capacity, and muscle strength measurements were positively associated with bone variables. Further research is needed to elucidate mechanisms underlying this positive association that is, undertaking studies involving effective exercise and nutrition supplements treatments, and developing the study designs to facilitate analysis of this relationship.

F-18-Dopa Positron Emission Tomography/Computed Tomography Is More Sensitive Than Whole-Body Magnetic Resonance Imaging for the Localization of Persistent/Recurrent Disease of Medullary Thyroid Cancer Patients.

Background: Elevated postoperative serum calcitonin (Ctn) level indicates persistent/recurrent disease in patients with medullary thyroid carcinoma (MTC). Its location is a challenge. The aim of our study was to compare the disease detection rates of F-18-Dopa (fluoro dihydroxyphenylalanine) positron emission tomography (PET)/computed tomography (CT), whole-body (WB) magnetic resonance imaging (MRI), F-18-FDG (fluorodeoxyglucose) PET/CT, WB CT scanning, neck ultrasonography, and bone scintigraphy in MTC patients with increased Ctn levels and unknown localization of the source. Methods: We compared the independent reading of each imaging procedure with a reference assessment for structural disease defined by pathology or concordance between two imagings or with subsequent follow-up. The detection rate of each imaging modality was determined in per patient, per organ, and per lesion analysis. Results: Thirty-six consecutive patients (21 females, mean age: 57 years, sporadic MTC in 26 cases, median serum Ctn level: 760 pg/mL; range: 21-10,121) were analyzed. The reference assessment localized disease in 24 (64%) patients with 74 lesions detected in the thyroid bed (8), in neck lymph nodes (15), mediastinal lymph nodes (6), lungs (1), liver (2), bones (3), and other site (1). At the patient level, the detection rates were 64% (CI 0.48-0.80) for F-18-Dopa PET/CT with early acquisitions, 40% (CI 0.24-0.56) for F-18-FDG PET/CT, 40% (CI 0.24-0.56) for WB MRI, and 48% (CI 0.31-0.66) for WB CT scan. Conclusions: In MTC patients with increased Ctn and no known distant metastases, F-18-Dopa PET/CT is more sensitive to detect structural disease than any other imaging modality, including WB MRI.

Fortified Milk Supplementation Improves Vitamin D Status, Grip Strength, and Maintains Bone Density in Chinese Premenopausal Women Living in Malaysia.

This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-Inulin versus regular milk on serum parathyroid hormone (PTH), vitamin D status, grip strength (GS), as well as bone density in Chinese premenopausal women over 52 weeks. Premenopausal women (n = 133), mean age 41 (±5.1) years were randomized into control (n = 66; regular milk at 500 mg calcium per day) or intervention (Int; n = 67; fortified milk at 1200 mg calcium, 15 μg vitamin D, and 4 g FOS-Inulin per day) groups. Assessments were at baseline, weeks 12, 24, 36, and 52 for changes in vitamin D status, levels of PTH, and GS. Bone mineral densities (BMDs) of the lumbar spine (LS), femoral neck (FN), and whole body (WB) were assessed at baseline and week 52 using GE Lunar iDEXA (GE Healthcare, Madison, WI). At baseline, WB lean mass was positively associated with LS BMD (r = 0.30, p < 0.001) and FN BMD (r = 0.33, p = 0.003). Baseline 25(OH) vitamin D3 levels were 48.6 and 53.2 nmol/L (p = 0.57), respectively, and after the 12 months at 60.8 nmol/L (Int) versus 55.0 nmol/L (controls; p < 0.05 for change from baseline for both groups; no difference between groups at week 52). PTH levels decreased in both groups compared to baseline (p < 0.001), with no significant difference between groups. WB bone mineral content (BMC) and FN Z-score increased significantly in the Int group (p = 0.024 and p = 0.008). GS was positively associated with body weight, increasing in both groups over 52 weeks. Fortified milk improved vitamin D status, WB BMC, and Z-score of the FN, while regular milk maintained BMD. In addition, vitamin D status and GS improved.

Associations between inflammatory markers and bone mineral density in lean pubertal girls

We investigated whether common inflammatory markers are associated with bone accumulation in lean pubertal girls. Thirty-four 10–12-yearold lean girls at pubertal stages 2–4 were studied. Twelve inflammatory parameters [interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor, interferon-gamma (IFN-γ), tumour necrosis factoralpha, IL-1α, IL-1β, monocyte chemotactic protein-1 (MCP-1) and epidermal growth factor] were measured from plasma samples. Whole body (WB), lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD), and WB bone mineral content (BMC) were assessed by DXA. Plasma IFN-γ concentration was negatively correlated (p&lt;0.05) with WB BMC (r=–0.45), WB BMD (r=–0.46) and FN BMD (r=–0.43). In addition, plasma IL–6 (r= –0.37; p&lt;0.05), IL-1α (r=–0.40; p&lt;0.05) and MCP-1 (r=–0.38; p&lt;0.05) concentrations were also negatively correlated to measured BMD values. The stepwise regression analysis showed that IFN-γ alone and together with IL-1α explained 18.6% and 27.6%, respectively, of the variability in WB BMD, while IL-1α and MCP-1 together explained 25.5% of the variability in LS BMD, and IL-1α together with IFN-γ explained 34.1% of the variability in FN BMD. In conclusion, plasma IFN-γ, IL-6, IL-1α and MCP-1 concentrations were associated with BMD variables, suggesting that these cytokines may participate in bone accumu lation in lean pubertal girls.

Estimating bone mass in children: can bone health index replace dual energy x-ray absorptiometry?

BackgroundBisphosphonates have been shown to increase metacarpal cortical width. Bone health index is computed from hand radiographs by measuring cortical thickness, width and length of the three middle metacarpals, and may potentially help predict fracture risk in children.ObjectiveTo compare bone health index with bone mineral density as measured from dual energy X-ray absorptiometry scans in patients with and without bisphosphonate treatment.Materials and methodsTwo hundred ninety-three Caucasian patients (mean age: 11.5±3.7 years) were included. We documented absolute values and z-scores for whole-body less head and lumbar spine bone mineral density then correlated these with the bone health index, which were acquired on the same day, in different patient groups, depending on their ethnicity and diagnosis.ResultsBone health index showed moderate to strong correlation with absolute values for whole-body (r=0.52) and lumbar spine (r=0.70) bone mineral density in those not treated with bisphosphonates and moderate correlation absolute values for whole-body (r=0.54) and lumber spine (r=0.51) bone mineral density for those treated with bisphosphonates. There was weak correlation of z-scores, ranging from r=0.11 to r=0.35 in both groups.ConclusionThe lack of a strong correlation between dual energy X-ray absorptiometry and bone health index suggests that they may be assessing different parameters.

A prospective study determining and comparing the diagnostic accuracy of fluoride-PET/CT, choline-PET/CT, whole-body bone SPECT/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer

BackgroundTo determine and compare the diagnostic accuracy of fluoride-PET/CT (NaF-PET/CT), choline-PET/CT, whole-body bone SPECT/CT (WB-SPECT/CT) and whole-body MRI (WB-MRI) for the detection of bone metastases in patients with prostate cancer.MethodsFrom April 2014 to April 2016, 230 patients with prostate cancer referred for bone imaging were included in the study and underwent three index tests: A routine NaF-PET/CT, a WB-MRI, and half of the patients a WB-SPECT/CT and the other half of the patients a choline-PET/CT. Experienced specialist assessed whether 0, 1–5 or > 5 bone metastases were present. In the absence of a histological reference standard, the final diagnosis was determined by an expert panel based on a review of the index tests, patient files and clinical follow-up images for a minimum of 1.5 years.ResultsTwo hundred thirteen patients constituted the final study population. Sixty-two patients (29%) were classified with metastatic bone disease as their final diagnosis. The proportion of patients misclassified was (false positive vs false negative): NaF-PET/CT 5% vs 1%, choline-PET/CT 1% vs 1%, WB-SPECT/CT 6% vs 0% and WB-MRI 7% vs 3%. Patient-based diagnostic performances were (sensitivity, specificity, overall accuracy): NaF-PET/CT (95%, 93%, 93%), choline-PET/CT (97%, 99%, 98%), WB-SPECT/CT (100%, 91%, 94%) and WB-MRI (89%, 90%, 90%). No significant differences in the diagnostic performances were detected.A trend towards overestimating the number of bone metastases was observed for NaF-PET/CT only (p = 0.04).ConclusionsAll three nuclear medicine methods and WB-MRI had favourable diagnostic performances for the detection of bone metastases with no significant difference between them.

An Investigation Into the Differences in Bone Density and Body Composition Measurements Between 2 GE Lunar Densitometers and Their Comparison to a 4-Component Model

We describe a study to assess the precision of the GE Lunar iDXA and the agreement between the iDXA and GE Lunar Prodigy densitometers for the measurement of regional- and total-body bone and body composition in normal to obese healthy adults. We compare the whole-body fat mass by dual-energy X-ray absorptiometry (DXA) to measurements by a 4-component (4-C) model. Sixty-nine participants, aged 37 ± 12 yr, with a body mass index of 26.2 ± 5.1 kg/cm2, were measured once on the Prodigy and twice on the iDXA. The 4-C model estimated fat mass from body mass, total body water by deuterium dilution, body volume by air displacement plethysmography, and bone mass by DXA. Agreements between measurements made on the 2 instruments and by the 4-C model were analyzed by Bland-Altman and linear regression analyses. Where appropriate, translational cross-calibration equations were derived. Differences between DXA software versions were investigated. iDXA precision was less than 2% of the measured value for all regional- and whole-body bone and body composition measurements with the exception of arm fat mass (2.28%). We found significant differences between iDXA and Prodigy (p < 0.05) whole-body and regional bone, fat mass (FM), and lean mass, with the exception of hip bone mass, area and density, and spine area. Compared to iDXA, Prodigy overestimated FM and underestimated lean mass. However, compared to 4-C, iDXA showed a smaller bias and narrower limits of agreement than Prodigy. No significant differences between software versions in FM estimations existed. Our results demonstrate excellent iDXA precision. However, significant differences exist between the 2 GE Lunar instruments, Prodigy and iDXA measurement values. A divergence from the reference 4-C observations remains in FM estimations made by DXA even following the recent advances in technology. Further studies are particularly warranted in individuals with large FM contents.

Comparison between clinical significance of height-adjusted and weight-adjusted appendicular skeletal muscle mass

BackgroundThis study aimed to compare relationships between height- or weight-adjusted appendicular skeletal muscle mass (ASM/Ht2 or ASM/Wt) and risk factors for cardiometabolic diseases or osteoporosis in Japanese men and women.MethodsSubjects were healthy Japanese men (n = 583) and women (n = 1218). The study population included a young group (310 men and 357 women; age, 18–40 years) and a middle-aged and elderly group (273 men and 861 women; age, ≥41 years). ASM was measured by dual-energy X-ray absorptiometry. The reference values for class 1 and 2 sarcopenia in each sex were defined as values one and two standard deviations below the sex-specific means of the young group, respectively.ResultsThe reference values for class 1 and 2 sarcopenia defined by ASM/Ht2 were 7.77 and 6.89 kg/m2 in men and 6.06 and 5.31 kg/m2 in women, respectively. The reference values for ASM/Wt were 35.0 and 32.0% in men and 29.6 and 26.4% in women, respectively. In both men and women, ASM/Wt was negatively correlated with higher triglycerides (TG) and positively correlated with serum high-density lipoprotein cholesterol (HDL-C), but these associations were not found in height-adjusted ASM. In women, TG, systolic blood pressure, and diastolic blood pressure in sarcopenia defined by ASM/Wt were significantly higher than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Ht2. Whole-body and regional bone mineral density in sarcopenia defined by ASM/Ht2 were significantly lower than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Wt.ConclusionsWeight-adjusted definition was able to identify cardiometabolic risk factors such as TG and HDL-C while height-adjusted definition could identify factors for osteoporosis.

Monostotic osteitis deformans of lumbar vertebra: A rare phenomenon in Eastern Asia

Osteitis deformans, also known as Paget's disease, is characterized by accelerated osteoclastic activity followed by ineffective osteoblastic activity resulting in a deformed and fragile bone. It is more prevalent in Western Europe and relatively rare in Eastern Asia. It predominantly involves the lumbar spine, pelvis, and femur, frequently as polyostotic and rarely as monostotic disease. Here, we report a 64-year-old female, who presented with severe progressive back pain with no neurological symptoms. Radiographs revealed a picture frame L1 vertebra which was deformed and enlarged with loss of normal alignment. Magnetic resonance imaging revealed bone marrow changes involving all columns of L1 vertebra. Whole-body technetium-99 bone scan showed a solitary increased uptake of radioisotope by L1 vertebra. Considering the possibility of metastatic tumors, blood investigations were drawn for tumor markers which were within normal limits. A computed tomography-guided biopsy was done to facilitate diagnosis. Histopathology sections showed a mosaic pattern of bony trabeculae with multinucleated osteoclasts causing erosions and tunneling. A diagnosis of monostotic Paget's disease was made which satisfactorily responded to single-dose zoledronic acid treatment. A comprehensive literature review is provided.

Adipocytokine and ghrelin levels in relation to bone mineral density in prepubertal rhythmic gymnasts entering puberty: a 3-year follow-up study.

To investigate changes in bone mineral density (BMD) in rhythmic gymnasts (RG) entering puberty and their age-matched untrained controls (UC) over the 36-month period, and associations with leptin, adiponectin and ghrelin over this period. Whole body (WB), lumbar spine (LS) and femoral neck (FN) BMD, WB bone mineral content (BMC), and leptin, adiponectin and ghrelin were measured in 35 RG and 33 UC girls at baseline and at 12-month intervals over the next 3 years. The change over the 36 months was calculated (∆ score). The pubertal development over the next 36 months was slower in RG compard to UC, while there was no difference in bone age development between the groups. BMD at all sites was higher in RG in comparison with UC at every measurement point. ∆LS BMD and ∆FN BMD, but not ∆WB BMD and ∆WB BMC, were higher in RG compared with UC. None of the measured hormones at baseline or their ∆ scores correlated with ∆BMD and ∆BMC in RG. Baseline fat free mass correlated with ∆WB BMD and ∆WB BMC in RG, while baseline leptin was related to ∆WB BMC, ∆WB BMD and ∆LS BMD in UC. Measured baseline hormones and their ∆ scores did not correlate with increases in bone mineral values in RG entering puberty. Although the pubertal development in RG was slower than in UC, high-intensity training appeared to increase BMD growth and counterbalance negative effects of slow pubertal develpment, lower fat mass and leptin in RG.

WHOLE BODY AND REGIONAL BONE MINERAL CONTENT AND DENSITY IN WOMEN AGED 20-75 YEARS.

Dual-energy X-ray absorptiometry (DXA) allows measurement of whole body (WB) and regional bone mineral content (BMC) and density (BMD). To measure WB and regional bone area, BMC and BMD (arms, legs, ribs and pelvis) in women of different ages. 140 women participated (age range 20-75 yrs). Three subgroups were built: 20-44 yr (30 premenopausal women), 45-59 (80 women), and 60-75 (30 women). WB DXA was performed on a Hologic QDR 4500 A bone densitometer (Hologic Inc., Bedford MA). WB BMD T-scores were calculated by using the manufacturer-provided and the NHANES 1999-2004 reference databases, while the WB BMC Z-scores - based on the latter. Statistical analysis was performed on an IBM SPSS Statistics 19.0 for Windows platform (Chicago, IL). WB BMC and BMD Z-scores were consistently lower than the reference databases showing a difference of about 0.4 - 0.5 SD. The arms, legs and ribs lost more BMC after the age of 50-55, while the pelvis - much earlier. The total decreases in BMC were highest in the pelvis (26.36 %), followed by the arms (16.81 %) and whole body (15.91 %), while the bone area decreased mostly in the pelvis (13.23 %). The age-related declines in regional BMC, bone areas and BMD follow different patterns in appendicular and axial bones.

Whole-Body MRI versus bone scintigraphy: which is the best diagnostic tool in patients with chronic recurrent multifocal osteomyelitis (CRMO)?

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder of unknown etiology with a wide range of clinical manifestations. Since CRMO is a systemic disorder that can affect multiple skeletal sites, whole-body imaging techniques (whole body bone scintigraphy -WBBS- or whole body magnetic risonance -WBMRI-) provide major contribution to the initial diagnostic approach, as well as during follow-up.

The effect of prepubertal calcium carbonate supplementation on skeletal development in Gambian boys-a 12-year follow-up study.

Calcium intake during growth is essential for future bone health but varies widely between individuals and populations. The impact on bone of increasing calcium intake is unknown in a population where low calcium intake, stunting, and delayed puberty are common. To determine the effect of prepubertal calcium supplementation on mean age at peak velocity for bone growth and mineral accrual. Prospective follow-up of boys in rural Gambia, West Africa, who had participated in a double-blind, randomized, placebo-controlled trial of calcium supplementation. Eighty boys, initially aged 8.0-11.9 years, were followed up for 12 years. Subjects received 1 year of calcium carbonate supplementation (1000 mg daily, 5 d/wk). Dual-energy x-ray absorptiometry measurements were carried out for whole body (WB), lumbar spine, and total hip bone mineral content, bone area (BA), and WB lean mass. Super imposition by translation and rotation models was made to assess bone growth. Age at peak velocity was consistently earlier in the calcium group compared to the placebo group, for WB bone mineral content (mean, -6.2 [SE, 3.1]; P = .05), WB BA (mean, -7.0 [SE, 3.2] mo; P = .03), lumbar spine and total hip BA. By young adulthood, supplementation did not change the amount of bone accrued (mineral or size) or the rate of bone growth. Twelve months of prepubertal calcium carbonate supplementation in boys with a low calcium diet advanced the adolescent growth spurt but had no lasting effect on bone mineral or bone size. There is a need for caution when applying international recommendations to different populations.

Bone Mineral Content and Density in Obese , Overweight and Normal Weight Adolescent Boys

The aim of this study was to compare bone mineral content (BMC), bone mineral density (BMD) and bone mineral apparent density (BMAD) in obese, overweight and normal weight adolescent boys. This study included 23 obese, 19 overweight and 25 normal weight adolescents (aged 14-20 years) boys. The three groups (obese, overweight and normal weight) were matched for age and maturation index. Body composition, BMC and BMD were assessed by dual-energy X-ray absorptiometry (DXA). The expressions whole body (WB) BMC/height and WB BMD/height were used to adjust for WB bone size. BMAD was calculated for the WB. WB BMC, WB BMC/height, total hip (TH) BMD, femoral neck (FN) BMD and ultra distal (UD) radius BMD) were higher in obese and overweight boys in comparison to normal weight boys (p < 0.05). WB BMAD was lower in obese boys in comparison to overweight and normal weight boys (p < 0.05). After adjustment for either weight or lean mass, obese boys displayed lower WB BMC, WB BMC/height and WB BMD values in comparison to overweight and normal weight boys (p < 0.05). This study suggests that WB BMC, WB BMC/height and WB BMD do not adapt to the increased body weight in obese adolescent boys.

Cerebral Infarction on 99mTc-MDP SPECT/CT Imaging

A 70-year-old man with lung cancer underwent whole-body MDP bone scintigraphy to evaluate bone metastases that showed marked tracer uptake in the right side of the head, suggestive of skull metastasis. SPECT/CT imaging was performed for further evaluation. The SPECT images demonstrated increased MDP activity in the region of the brain perfused by the right middle cerebral artery. On CT images, there was a large hypoattenuation area corresponding to elevated MDP accumulation. At the same day, magnetic resonance angiography of the brain revealed occlusion of the right middle cerebral artery.

P.2.18 Bone mineral density and bone mineral content as measures of bone health in ambulatory boys with Duchenne Muscular Dystrophy

Osteoporosis is a major problem in Duchenne Muscular Dystrophy (DMD) due to long term glucocorticoid (GC) therapy and impaired mobility. Dual-energy xray absorptiometry (DXA) assessment of bone health in DMD boys is challenging, as interpretation is affected by height, delayed bone maturation, puberty, and vertebral fractures. Accurate detection and intervention of osteoporosis are important for improving clinical care in DMD. To assess changes in bone mineral density (BMD) and bone mineral content (BMC) by functional status in ambulatory GC-treated DMD boys. Retrospective study of whole body (WB) and lumbar spine (LS) BMD and BMC by DXA in ambulatory GC-treated DMD boys, assessed from 2/2009 to 7/2012. Bisphosphonate-treated boys were excluded. Age-adjusted z-scores (Z) and height-adjusted z-scores (HAZ) were derived using normal values. Generalized linear modeling was used to analyze changes in BMD and BMC by functional status (functional mobility score, FMS1, 2 or 3, by worsening status). 277 ambulant DMD boys were grouped by FMS (mean ages ±SD for FMS1, 2 and 3; 7.6±2.2, 8.3±2.6 and 11.2±2.6yrs). GC durations for FMS1, 2 and 3 were 2.7±1.7, 2.9±2.1 and 5.3±2.6yrs. For whole body, BMD-Z, BMD-HAZ, BMC-Z and BMC-HAZ all decreased with worsening FMS (p<0.05 for FMS3 vs. FMS1 or FMS2). WB BMC was consistently lower than WB BMD for each FMS group. For spine, BMD-Z was similar between FMS groups, but BMC-Z was lower for FMS3 than FMS1 or FMS2 (<i>p</i><0.05). LS BMD-HAZ was surprisingly higher for FMS3 than the other groups, but LS BMC-HAZ remained similar between groups. WB bone indices worsened with declining mobility and increased GC duration. BMC was consistently lower than BMD, and spine BMC showed a relative decrease compared to BMD in weaker boys. Our study suggests that BMC may be a more sensitive indicator of bone health in DMD, and should be considered in conjunction with BMD as part of clinical care.

Liver and lymph node metastases of prostate cancer visualized on post-therapy imaging after treatment with 188Re-HEDP

A 76-year-old man with bone metastases of prostate cancer diagnosed a year ago was admitted for relief of bone pain (visual analogue scale: 90%) most markedly in cervical spine and upper extremities due to skeletal metastases. His serum prostate specific antigen level was markedly increased (351 ng/ml). After documentation of sufficient tracer uptake in multiple bone metastases on whole-body 99mTc-MDP bone scan, we treated him with a single intravenous injection of 2.4 GBq 188Re-HEDP. Quality control of 188Re-HEDP was performed with TLC within 30 min prior to injection, radiochemical purity was >95%, free rhenium and colloid ratios were less than 3%. For pain, he was taking Novalgin 30 drops t.i.d. and used Fentanyl patch 50 g/72 h. Fig. 1 shows increased activity localization in multiple bone metastases and the liver lesion after treatment with 188Re-HEDP, as well as on the whole-body scans obtained a week prior to treatment. This metastatic liver lesion was diagnosed on a conventional CT scan 6 months before treatment. The SPECT/CT study (obtained at 24 h after injection) shows tracer accumulation in the liver lesion, in abdominal lymph nodes (in the hepatoduodenal ligament) and in stomach (Fig. 2A and B). An abdominal section of the SPECT/CT study shows that the area of activity localization on right side of abdomen on whole body image corresponds to intestinal contents (Fig. 2C). Liver metastases of various malignant tumors such as breast cancer have been reported to show accumulation on bone scintigraphy with 99mTc-MDP. Limouris and Skukla reported 186Re-HEDP uptake in the stomach in two patients with osseous metastases because of prostate and breast cancer1; however, we could not find any reports on visualization of lymph node metastases on posttherapy scan after administration of 188Re-HEDP. Accumulation of