Significance of bone scintigraphy to confirm vertebral compression fractures in elderly osteoporotic population

Learning Objectives 1.To understand the various modalities for evaluating vertebral compression fractures. 2. To understand the unique challenges that the elderly osteoporotic population might pose and the significant role of bone scintigraphy.

Summary: Vertebral compression fractures represent a common cause of severe back pain among the elderly osteoporotic population. X-ray, CT scan, MRI and bone scan are the various modalities available for diagnosis of vertebral compression fractures. Vertebroplasty, kyphoplasty or sacroplasty are the interventions used to manage compression fractures. Bone scintigraphy is used to confirm the presence of fracture, estimate the acuteness of the fracture or to predict response to intervention. The elderly osteoporotic population presents a diagnostic challenge with non-specific or ill-localized pain, claustrophobia, motion artifact, multiple fractures, medical implants, severe pain and atypical radiological findings. Bone scan is frequently helpful in such equivocal cases. The following scintigraphic presentations might be encountered: 1) A classical vertebral compression fracture on both CT scan and bone scintigraphy, 2) In elderly patients with multiple radiographic fractures, bone scintigraphy will be able to detect the most acute lesion likely responsible for the patient’s symptoms and guide management appropriately. 3) The reactive bone response might be delayed and variable in elderly osteoporotic population and a negative exam merits close follow up and re-evaluation as indicated. Examples of various scintigraphic patterns and correlative radiological images for vertebral compression fractures in the elderly osteoporotic population will be included for illustration.