Imaging of Site Specific Bone Turnover in Osteoporosis Using Positron Emission Tomography

The functional imaging technique of dynamic fluorine-18 labeled sodium fluoride positron emission tomography (F-18-NaF PET) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. F-18-NaF PET provides a novel and noninvasive method of studying site-specific bone formation at the hip and spine, as well as areas of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers and bone biopsy as a tool to investigate new treatments for osteoporosis, and holds promise of a future role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing F-18-NaF PET scan data, and outlines a simplified approach that uses 5-minute static PET scan images combined with venous blood samples to estimate F-18-NaF plasma clearance at multiple sites in the skeleton with a single injection of tracer.