Help me understand my dad's bone scan, please!!

[Lynsi13]

Hi guys! So, my dad had a bone scan after his fractionated bone alkaline phosphatase levels was slightly elevated. The bone scan results came back and I'm confused! I'm going to take a scream shot and post here.. I was wondering if anyone could help me decipher what this means? My dad had a CT earlier this year and there was no indication of disease at that point. His PSA has only gone down since then.

****I can only upload one image at a time. I was able to just copy and paste the remaining information into the first comment. I apologize for my ignorance!**

Thanks so much!!

[Lynsi13]

Here is what the other screenshot said.. * * * Physician Interpretation * * * *

WHOLE BODY BONE SCAN

CLINICAL HISTORY: Elevated alkaline phosphatase.

TECHNIQUE: 20.8 mCi technetium 99m MDP IV. Planar images of the whole

body obtained in anterior and posterior views at approximately 3 hours

post injection. Static images of the lateral skull, oblique chest,

lateral chest were obtained.

COMPARISON: No prior bone scan

CORRELATION: No recent pertinent

RESULT:

Whole body and static images demonstrate intense horizontally oriented

uptake in the superior endplate of the L1 vertebral body may be related

to compression/pathologic fracture, and less likely degenerative changes.

Focal uptake in the medial right acetabulum, and the right inferior pubic

ramus.

Subtle uptake in the right approximately fifth anterior rib..

Increased uptake in the acromioclavicular joints, spine, left hip, knees,

ankles, feet is likely due to degenerative/arthritic changes.

[Tall_Allen]

Everything that showed up can be attributed to fracture or arthritis. Has he had a DEXA scan? Is he taking a bone-strengthening agent?

[Lynsi13 in reply to Tall_Allen]

That's wonderful news. No, I don't believe that he's had a DEXA scan. I can barely get him on board with the regular stuff... so I was just happy that he agreed to this one. He's getting more stubborn in his old age, lol. But yes, he's taking Fosamax weekly as well as calcium and Vitamin D. Thank you, Tall_Allen . I can sleep well!

[Tall_Allen in reply to Lynsi13]

DEXA is regular stuff. It's as cheap and easy as having a normal X-ray (which is what it basically is). It tells you if you have osteoporosis.

[Lynsi13 in reply to Tall_Allen]

Ohhh! Yes, he actually has! I was used to it being called a bone density scan. Here are the results from it:

IMPRESSION: Osteoporosis in the lumbar spine and both hips.

PROCEDURE REASON: Prostate Cancer

* * * * Physician Interpretation * * * *

PROCEDURE: BD DXA - AXIAL SKELETON

LUMBAR SPINE: The bone mineral density from L1 through L4 is 0.708 grams

per square centimeter which yields a T-score of -3.5. .

LEFT HIP: The bone mineral density of the total region of the hip is

0.681 grams per square centimeter which yields a T-score of -2.3. .

LEFT FEMORAL NECK: The bone mineral density of the femoral neck is 0.533

grams per square centimeter which yields a T-score of -2.9. .

RIGHT HIP: The bone mineral density of the total region of the hip is

0.698 grams per square centimeter which yields a T-score of -2.2. .

RIGHT FEMORAL NECK: The bone mineral density of the femoral neck is

0.470 grams per square centimeter which yields a T-score of -3.4. .

[Tall_Allen in reply to Lynsi13]

If Fosamax is not improving his BMD, perhaps he should be taking a stronger bone-strengthening agent, like Xgeva or Zometa. It may prevent those fractures.

[Lynsi13 in reply to Tall_Allen]

The last DEXA scan he had was in 2017. It was at that point (after the report I shared above) that he started on the Fosamax. He has not had a follow-up scan. Boy time has flown by.. it's no doubt time to check again to see what's happening! I'll talk with his oncologist about it. Dad's 78 years old.. not sure if what his scans are showing is normal for his age range or not?

[Tall_Allen in reply to Lynsi13]

It has nothing to do with "normal for age." They were below what they had to be for good bone health.

[Lynsi13 in reply to Tall_Allen]

Gotcha. I guess I supposed that some bone loss was expected with age. I'll bring it up to his doctor to ensure that we're doing all we can do. We certainly don't need dad breaking any bones. Thanks for your input!

[Roscoaus2000 in reply to Lynsi13]

I am 80 years of age with advanced metastatic bone cancer. I take Denosamab every 3 moths along with Zoladex and also Zytiga and Prednisolone daily. My body scan showed cancer in every bone in my body. My bone strength is good and my height 1.780 has not changed since I was 25. So I don’t think I have had much, if any bone loss with age.

[j-o-h-n in reply to Roscoaus2000]

Greetings Roscoaus2000, Good to see you posting. We need youngsters like you to participate.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 12/05/2020 10:22 PM EST

[SeosamhM]

Great post, Lynsi13. It is a part of my life to get these bone scan write-ups that rule-out-but-don't-entirely-rule-out active metastases...so get the CT to "correlate" as the radiologist suggests.

The good (?) news seems to be that as I age (4 years in, 53 y.o.) through this...er, disease journey... the bony "noise" in my bone scans is increasing from simple degenerative processes and are not signs of active metastases. However, I need to be vigilant through correlation with soft tissue scans and, of course, continuous monitoring of key indicators like PSA and ALP.

Keep up the great work and good luck to your father. May I ask what his ALP level was that triggered this review? - Joe M.

[lincolnj8]

I take calcium + D3 two times a day plus a multivitamin. Get Zometa infusions every 3 months to strengthen my bones, been doing this for 2 years.