The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients

E. E. Schulz, C. Flowers, Donald Sauser, B. N. Brin, J. E. Wergedal, D. J. Baylink

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

We previously described new bone formation in fluoride-treated osteoporotic patients. Since then, several investigators have contended that fluoride-induced "hot spots," as seen on bone scintigrams, represent stress fractures. To further evaluate this issue we analyzed scintigrams, radiographs, and quantitative computer tomography (CT) scans of the spine and femoral condyles from 129 patients, obtained before and during therapy. Hot spots, new or of increased intensity, were more than twice as common in the weight-bearing peripheral skeleton than in nonweight-bearing sites (p <0.001). The hot spots were usually diffuse, multiple, bilateral, and mostly seen early in therapy, a pattern quite different from that expected of stress fractures. Previously, we postulated that mechanical stress and fluoride act synergistically to stimulate new bone formation. If this hypothesis were correct, we would expect to see a greater increase in femoral condyle bone density in patients with hot spots. Consistent with this hypothesis, patients who developed hot spots in the knees had a greater increase in condylar density (22 ± 2.5 vs. 9 ± 3.3 mg/cc) than those without hot spots and stress fractures were not seen in either group. Additionally, patients with more than 5 hot spots in the peripheral skeleton had greater increases in spinal and condylar density than those with fewer than 5 hot spots. Finally, stress fractures were found in less than 2% of our patients. While we do not exclude the possibility that some additional patients may have had stress fractures, our data support the hypothesis that the great majority of hot spots seen on the scintigrams are the sites of new bone formation.

Original languageEnglish (US)
JournalJournal of Bone and Mineral Research
Volume5
Issue numberSUPPL. 1
StatePublished - Mar 1990
Externally publishedYes

Fingerprint

Fluorides
Stress Fractures
Bone and Bones
Osteogenesis
Thigh
Skeleton
Mechanical Stress
Weight-Bearing
Secondary Prevention
Bone Density
Knee
Spine
Tomography
Research Personnel

ASJC Scopus subject areas

  • Surgery

Cite this

Schulz, E. E., Flowers, C., Sauser, D., Brin, B. N., Wergedal, J. E., & Baylink, D. J. (1990). The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients. Journal of Bone and Mineral Research, 5(SUPPL. 1).

The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients. / Schulz, E. E.; Flowers, C.; Sauser, Donald; Brin, B. N.; Wergedal, J. E.; Baylink, D. J.

In: Journal of Bone and Mineral Research, Vol. 5, No. SUPPL. 1, 03.1990.

Research output: Contribution to journalArticle

Schulz, EE, Flowers, C, Sauser, D, Brin, BN, Wergedal, JE & Baylink, DJ 1990, 'The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients', Journal of Bone and Mineral Research, vol. 5, no. SUPPL. 1.
Schulz EE, Flowers C, Sauser D, Brin BN, Wergedal JE, Baylink DJ. The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients. Journal of Bone and Mineral Research. 1990 Mar;5(SUPPL. 1).
Schulz, E. E. ; Flowers, C. ; Sauser, Donald ; Brin, B. N. ; Wergedal, J. E. ; Baylink, D. J. / The causes of bone scintigram hot spots in fluoride-treated osteoporotic patients. In: Journal of Bone and Mineral Research. 1990 ; Vol. 5, No. SUPPL. 1.
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