99mTc MDP Bone Scan Findings in CKD-MBD: Could the “Superscan” Image be Useful in Excluding Adynamic Bone Disease?

Objective: To explore the association of superscan image in technetium 99m-labeled methylene diphosphonate bone scans with chemical parameters of high turnover bone disease and bone mineral density measurement findings in chronic peritoneal dialysis patients.
Methods: Technetium 99m-labeled methylene diphosphonate bone scans of 15 chronic peritoneal dialysis patients with superscan images were matched by their age, gender, dialysis vintage, body mass index, and Kt/V values with 20 patients with no superscan image. Serum iPTH, Ca, P, 25(OH)D3, 1-25(OH)2D3, total and bone alkaline phosphatases, dual-energy X-ray absorptiometry-based bone mineral density results were measured.
Results: Serum iPTH levels were significantly higher in superscan patients (587.3 ± 515.9 pg/ml vs 214.8 ± 224.9 pg/ml, P = .001) and correlated with the existence of superscan image (P = .007, r = −0.450) in bone scans. Total alkaline phosphatase levels were also significantly higher in superscan patients (414.7 ± 400.6 vs 235.6 ± 117.6 U/L, P = .046). Ca, P, CaXP, 25(OH)D3, 1-25(OH)2D3, bone alkaline phosphatase levels, and bone mineral densities were not different between groups.
Conclusion: Superscan image in technetium 99m-labeled methylene diphosphonate bone scans correlated well with serum iPTH and total alkaline phosphatase levels, and therefore, it may be suggestive for high turnover bone disease in chronic peritoneal dialysis patients. Lack of any difference between groups regarding their bone mineral densities suggests that the main difference between groups may be a metabolic one, rather than being structural. We believe that superscan images may be a diagnostic tool for high turnover bone disease, and they may have a role as an excluding tool of a dynamic bone disease especially before the use of bisphosphonates.
Cite this article as: Sarı F, Karayalçın B, Süleymanlar G, et al. 99mTc MDP bone scan findings in CKD-MBD: Could the “superscan” image be useful in excluding adynamic bone disease? TurkJ Nephrol. 2021; 30(4): 308-315.