The Potential Role of Radionuclide Imaging in Osteoporotic Vertebral Fracture and Sacral Fracture

Vertebral fractures (VF) and sacral insufficiency fractures (SIFs) are very common in osteoporotic patients with low-back pain and are often overlooked in clinical practice. Plain radiography is usually the first examination. However, on many occasions, further evaluation with CT scan, MRI and nuclear medicine studies is necessary. Nuclear medicine examinations have important applications for the detection and timing of fractures and prediction of response to therapy. Bone scan is a simple study for the evaluation of osteoporotic patients with low-back pain to detect VF or SIFs, to identify an alternative diagnosis, to assess the age of fracture, and to predict the response to vertebroplasty. Bone scan is also helpful to detect other foci of insufficiency fractures, or other co-existent disease in the rest of the total body. Other radionuclide studies such as 67Ga, 99mTc-MIBI, and 18F-FDG PETCT are also useful to diagnose co-existent diseases or other alternative conditions such as osteomyelitis or primary and metastatic bone diseases. The purpose of this article is to review the potential role of nuclear medicine studies in osteoporotic vertebral fractures and sacral fractures.