Can spinal bone scan hot spots be confused with osteoarthritis bone spurs?

Please, I have just a couple of questions that would help me out immensely. GP's really don't know about this. I would really appreciate any input on this subject.

(1) Can compression fractures on bone scans be confused with osteoarthritis anterior endplate bone spurring?

(2) Do bone scans determine spinal compression fractures by noting the increased density in the area (the bone has compressed and it therefore more dense). What defines a "hot spot"?


(3) Do osteophytes and bone spurs increase the "density" that the bone scan reads?

(4) Alternatively, can "anterior endplate bone spurring" on radiographs be confused with compression fractures?

thank you!

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Regarding no. (3) I was advised by a medic that osteoarthritis can make things look better than they really are. I also happened to read the other day and osteoarthritis gives a somewhat protective advantage in OP, but did not go on to explain how this is so. I am assuming it's because it thickens the outside of the bone somewhat.
Dxaguru will probably give you more accurate answers to your questions.

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1) Sometimes yes, unless a SPECT scan of the spine is done to determine if the increased uptake of the radiotracer is in the vertebral body itself or only in the region of the osteophytic spurs. (You can have both). Also, older fractures will often develop anterior osteophytes and is often a sign that the fracture is older.

2) Nuclear bone scan "hot spots" indicate areas of increased blood flow so more of the radioactive tracer (chemically similar to bisphosphonates) it taken up. But inflammation from arthritis, cancers, and fractures all increase the blood flow and will cause hot spots. This is different from DXA of compression fractures where not only is more bone in a smaller area, but the acute phase of bone healing will cause a callous of dense woven bone to form (just like any other broken bone). Interesting to note that if you trend the BMD of a compression fracture over time, it goes up markedly in the first few years post fracture, but then the bone remodels, absorbing the callous, and the bone density returns to the pre=fracture density by about 10 years after the fracture, but the shape of the bone is permanently deformed, and osteophytes begin to develop.

3. Osteophytes can increase the density on a DXA scan, and bone spurs, depending on their density can either increase or decrease the BMD unless the technologist is aware enough to recognize a bone spur (typically on the greater trochanter of the hip) and delete that region from the analysis. Anterior osteophytes cannot be completely deleted from a PA spine DXA and so it is standard practice to eliminate the offending vertebral body from the T-score calculations. E.g., if there are large osteophytes at L3, then only L1,L2,L4 are reported.

4. Endplate anterior bone spurring can be confused with compression fractures, especially on a VFA (lateral DXA image of the spine) by inexperienced physicians and technologists who attempt to do the analysis. A good radiologist on a regular spine x-ray with higher resolution will probably be able to distinguish the two. Note that it is possible to have both a compression fracture and anaterior spurring. If anterior spurring affects three or more continous vertebral levels, especially in the thoracic spine, it is called DISH disease. (Diffuse idiopathic sclerosing hypertrophy). It can cause the same type of kyphosis (dowagers hump) that compression fractures cause, but no fractures are present.

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Thank you very very much DXAguru!

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also thank you very much CharlotteB!

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