Measuring bone metabolic activity in dialysis patients with renal osteodystrophy using [18F]-Sodium Fluoride positron emission tomography- comparison between static and dynamic measurements

AUTHORS

Louise Aaltonen, Niina Koivuviita, Marko Seppänen, Vesa Oikonen, Anna K. Kirjavainen, Heikki Kröger, Eliisa Löyttyniemi, Kaj Metsärinne

ABSTRACT

Background

Dynamic [18F]NaF PET has shown promising results in the measurement of bone metabolism in patients with renal osteodystrophy. Dynamic PET scans are challenging in clinical practice, and the objective of this study was to evaluate whether standardized uptake values measured by [18F]NaF PET could be a feasible method.

Methods

Twenty-eight patients on maintenance dialysis with confirmed renal osteodystrophy underwent a dynamic [18F]NaF PET scan. As a reference for bone metabolism, a bone biopsy was obtained from the anterior iliac crest (AIC). Tracer activity in bone was measured using Patlak analysis and standardized uptake values (SUV). SUV was also adjusted to tracer activity measured from the aorta 48–60 min after injection (SUVR).

Results

SUV measured in the lumbar spine (L1-L4) and at the AIC did not correlate with histomorphometric parameters obtained by bone biopsy. There was no statistically significant difference between SUV in different turnover groups. When adjusting the mean bone uptake of fluoride in the lumbar spine, there was a strong correlation with the blood clearance of tracer to bone (Ki). SUVR also correlated significantly with histomorphometric markers obtained by bone biopsy.

Conclusions

These results suggest that measurements of tracer activity in the blood 48–60 min after tracer injection could be used to correct SUVs from static [18F]NaF PET scans. However, further research and validation of the method is needed.

Retrospective Characterization of Bone Histomorphometric Findings in Clinical Patient Specimens

AUTHORS

Linnea Sellman, Xiaoyu Tong, Inari S Burton, Heikki Kröger

ABSTRACT

Background

Bone histomorphometry provides comprehensive information on bone metabolism and microstructure. In this retrospective study, we aimed to obtain an overview of the typical indications, referring hospitals, and histomorphometric quantification-based diagnoses of the bone tissue in our histomorphometry laboratory, the only laboratory in Finland carrying out histomorphometric examination of clinical bone biopsies.

Methods

Between January 1, 2005 and December 31, 2020, 553 clinical bone biopsies were sent to our histomorphometry laboratory for histomorphometric examination. The median age of the patients was 55 years (range, 0.2–89.9 years), 51% of them were males, and 18% comprised pediatric patients. We received bone biopsy specimens from 23 hospitals or healthcare units. The majority of the samples we sent by nephrologists.

Results

The most common bone biopsy indications were suspicion of renal osteodystrophy (ROD), unknown bone turnover status in osteoporosis, and several or untypical fractures. The most common quantitative bone histomorphometry-based diagnosis was ROD.

Conclusions

This study provides information on the clinical application of bone histomorphometry in Finland. Precise and quantitative ROD evaluation is the most common indication for bone histomorphometry, being crucial in clinical decision-making and targeted treatment of this patient group.