Assessment of femoral neck bone metabolism using ¹⁸F-sodium fluoride PET/CT imaging

Rhodes, Sylvia<sup>1</sup>; Batzdorf, Alexandra<sup>1</sup>; Sorci, Olivia<sup>1</sup>; Peng, Matthew<sup>1</sup>; Jankelovits, Amanda<sup>1</sup>; Hornyak, Julia<sup>1</sup>; An, Jongyun<sup>1</sup>; Noël, Peter B.<sup>1</sup>; Høilund-Carlsen, Poul F.<sup>2</sup>; Alavi, Abass<sup>3</sup>; Rajapakse, Chamith S.<sup>1,4</sup>

Affiliations

¹Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA

²Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

³Division of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA, USA

⁴Departments of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

Abstract and keywords

Background: Standard of care metabolic bone disease assessment relies on changes to bone quantity, which can only be detected after structural changes occur.

Purpose: To investigate the usefulness of Bone Metabolism Score (BMS), derived from fluorine 18 labeled sodium fluoride (18F-NaF) PET/CT imaging as a biomarker of localized metabolic changes at the femoral neck.

Methods: In this retrospective study, 139 participants (68 females and 71 males, ages 21–75 years) that had undergone 18F-NaF PET/CT were included. BMS was calculated as the ratio of standard uptake value (SUV) in the bone region to that of the total region. Correlations and linear regressions of BMS with age, CT-derived bone mineral density (BMD), body mass index (BMI), height, and weight were conducted. Differences in BMS between women younger and older than the age of 50 years were assessed. Inter- and intra-operator reproducibility was evaluated by coefficient of variation (CV) and intra-class correlation coefficient (ICC).

Results: Among females, age was negatively correlated with left and right whole BMS (5.61% and 4.90% drop in BMS per decade of life) and left and right cortical BMS (10.50% and 10.09% drop in BMS per decade of life). BMS of women older than 50 years was lower than BMS of women younger than 50 years (P < .0001). Among males, age was negatively correlated with left and right whole BMS (4.29% and 4.25% drop in BMS per decade of life) and left and right cortical BMS (9.13% and 10.30% drop in BMS per decade of life). BMD was positively correlated with whole (r = 0.80, P < .0001) and cortical (r = 0.92, P < .0001) BMS.

Conclusions: BMS could provide functional insight regarding bone metabolism in the femoral neck to complement bone health status assessed through conventional structural imaging. The methodology described herein could be potentially useful for assessing hip fracture risk in individuals when BMD tests provide borderline determination of bone disease.

Keywords: Hip fracture; Femoral neck; 18F-Sodium fluoride; PET/CT; Bone metabolism

Links

DOI: 10.1016/j.bone.2020.115351

PubMed: 32276154

WoS: 000535131500012

History

Received: 2019-12-19

Revised: 2020-03-30

Accepted: 2020-03-30

Online: 2020-04-8

Cited Works (13)

Year	Entry
2013	Keyak JH, Sigurdsson S, Karlsdottir GS, Oskarsdottir D, Sigmarsdottir A, Kornak J, Harris TB, Sigurdsson G, Jonsson BY, Siggeirsdottir K, Eiriksdottir G, Gudnason V, Lang TF. Effect of finite element model loading condition on fracture risk assessment in men and women: the AGES-Reykjavik study. Bone. November 2013;57(1):18-29.
1980	Cann CE, Genant HK. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr. 1980;4(4):493-500.
1999	Cody DD, Gross GJ, Hou FJ, Spencer HJ, Goldstein SA, Fyhrie DP. Femoral strength is better predicted by finite element models than QCT and DXA. J Biomech. October 1999;32(10):1013-1020.
2013	Zysset PK, Dall'Ara E, Varga P, Pahr DH. Finite element analysis for prediction of bone strength. BoneKEy Rep. August 2013;2:386.
1988	Cann CE. Quantitative CT for determination of bone mineral density: a review. Radiology. February 1988;166(2):509-522.
2010	Burghardt AJ, Buie HR, Laib A, Majumdar S, Boyd SK. Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone. September 2010;47(3):519-528.
2002	Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. October 16, 2002;288(15):1889-1897.
1997	Ritzel H, Amling M, Pösl M, Hahn M, Delling G. The thickness of human vertebral cortical bone and its changes in aging and osteoporosis: a histomorphometric analysis of the complete spinal column from thirty‐seven autopsy specimens. J Bone Miner Res. January 1997;12(1):89-95.
1993	Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. May 1, 1993;137(9):1001-1005.
2005	Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, Hochberg MC, Vogt MT, Orwoll ES; Study of Osteoporotic Fractures Research Group. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. May 2005;90(5):2787-2793.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
1999	Bell KL, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M, Meggitt BF, Reeve J. Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res. January 1999;14(1):111-119.
2009	Holzer G, von Skrbensky G, Holzer LA, Pichl W. Hip fractures and the contribution of cortical versustrabecular bone to femoral neck strength. J Bone Miner Res. March 2009;24(3):468-474.