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Alendronate Does Not Interfere with ^99mTc-Methylene Diphosphonate Bone Scanning

Nuclear Medicine Department, Warren G. Magnuson Clinical Center; and Clinical Pharmacokinetics Section, Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

Several studies have found that administration of etidronate results in competitive interference with ^99mTc-labeled bone scanning reagents. In contrast, in other studies this problem was not encountered with other bisphosphonates. Methods: We prospectively studied 9 patients with hormone-refractory prostate cancer. ^99mTc-methylene diphosphonate (MDP) bone scanning was performed before they received alendronate, and scanning was repeated a mean of 16.6 d afterward, when the patients had been receiving 40 mg alendronate daily for a mean of 6 d. In addition, 7 patients who underwent delayed scanning when they had been receiving alendronate for a mean of 111 d were also restudied. Quantitative whole-body bone scanning was performed, and radioactivity deposited in the bone metastasis was determined using region-of-interest analysis. Results: A <6% increase in whole-body retention of ^99mTc-MDP was seen on the initial postalendronate scan compared with the baseline scan. No significant differences in activity were seen in the bone lesion evaluated on the baseline and initial postalendronate studies. The delayed postalendronate scan generally showed similar or higher tracer accumulation compared with the baseline scan. Conclusion: Alendronate did not competitively inhibit uptake of ^99mTc-MDP in the skeleton or tumor metastasis. Use of alendronate before bone scanning is unlikely to result in decreased detection of lesions or falsely decreased ^99mTc-MDP activity at metastatic bone tumor sites.

Key Words: prostate • bisphosphonate • ^99mTc-methylene diphosphonate • bone metastasis

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