Abstract 18F-fluoride positron emission tomography
(18F-PET) allows the assessment of regional bone formation
and could have a role in the diagnosis of adynamic
bone disease (ABD) in patients with chronic kidney disease
(CKD). The purpose of this study was to examine bone
formation at multiple sites of the skeleton in hemodialysis
patients (CKD5D) and assess the correlation with bone
biopsy. Seven CKD5D patients with suspected ABD and
12 osteoporotic postmenopausal women underwent an 18FPET
scan, and bone plasma clearance, Ki, was measured at
ten skeletal regions of interest (ROI). Fifteen subjects had a
transiliac bone biopsy following double tetracycline
labeling. Two CKD5D patients had ABD confirmed by
biopsy. There was significant heterogeneity in Ki between
skeletal sites, ranging from 0.008 at the forearm to
0.028 mL/min/mL at the spine in the CKD5D group. There
were no significant differences in Ki between the two study
groups or between the two subjects with ABD and the other
CKD5D subjects at any skeletal ROI. Five biopsies from
the CKD5D patients had single tetracycline labels only,
including the two with ABD. Using an imputed value of
0.3 lm/day for mineral apposition rate (MAR) for biopsies
with single labels, no significant correlations were
observed between lumbar spine Ki corrected for BMAD
(Ki/BMAD) and bone formation rate (BFR/BS), or MAR.
When biopsies with single labels were excluded, a significant
correlation was observed between Ki/BMAD and MAR
(r = 0.81, p = 0.008) but not BFR/BS. Further studies are
required to establish the sensitivity of 18F-PET as a diagnostic
tool for identifying CKD patients with ABD.
Keywords Adynamic bone disease 18F-fluoride
PET Chronic kidney disease Osteoporosis Bone
histomorphometry Bone formation
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