J Bone Metab.  2023 Nov;30(4):329-337. 10.11005/jbm.2023.30.4.329.

Predicting Fractures Using Vertebral ¹⁸F-NaF Uptake in Prostate Cancer Patients

• Chesnais H
• Bastin N
• Miguez S
• Kargilis D
• Kalluri A
• Terry A
• Rajapakse CS

• KMID: 2548588
• DOI: http://doi.org/10.11005/jbm.2023.30.4.329

Abstract

Background
Patients with prostate cancer tend to be at heightened risk for fracture due to bone metastases and treatment with androgen-deprivation therapy. Bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) is the standard for determining fracture risk in this population. However, BMD often fails to predict many osteoporotic fractures. Patients with prostate cancer also undergo 18F-sodium fluoride (¹⁸F-NaF)-positron emission tomography/computed tomography (PET/CT) to monitor metastases. The purpose of this study was to assess whether bone deposition, assessed by ¹⁸F-NaF uptake in ¹⁸F-NaF PET/CT, could predict incident fractures better than DXA- or CT-derived BMD in patients with prostate cancer.
Methods
This study included 105 males with prostate cancer who had undergone full body ¹⁸F-NaF PET/CT. Standardized uptake value (SUVmean and SUVmax) and CT-derived Hounsfield units (HU), a correlate of BMD, were recorded for each vertebral body. The average SUVmean, SUVmax, and HU were calculated for cervical, thoracic, lumbar, and sacral areas. The t-test was used to assess significant differences between fracture and no-fracture groups.
Results
The SUVmean and SUVmax values for the thoracic area were lower in the fracture group than in the no-fracture group. There was no significant difference in cervical, thoracic, lumbar or sacral HU between the 2 groups.
Conclusions
Our study reports that lower PET-derived non-metastatic bone deposition in the thoracic spine is correlated with incidence of fractures in patients with prostate cancer. CT-derived HU, a correlate of DXA-derived BMD, was not predictive of fracture risk. ¹⁸F-NaF PET/CT may provide important insight into bone quality and fracture risk.

Keyword

Fractures, bone · Positron emission tomography computed tomography · Prostatic neoplasms · Spine