The most important features of bone scintigraphy in metabolic bone disease are its high sensitivity and its capacity to easily image the whole body. Although in the early stages of evolution bone scintigraphy may present difficulties in disease detection because of its usual discrete generalized increased uptake, as the disease progresses, bone scintigraphy has well-recognized appearances, and with the knowledge of the different patterns of abnormality its highest diagnostic value can be obtained. Currently, the main clinical value of bone scan in metabolic bone disease is the detection of focal conditions or focal complications of such generalized disease, its most common use being the detection of fractures in osteoporosis, pseudofractures in osteomalacia and the evaluation of Paget's disease.