PET/CT for the Opportunistic Screening of Osteoporosis and Fractures in Cancer Patients

In this review, we outline the different etiologies of osteoporosis in the oncologic setting and describe the basis for using PET/CT as screening tool for osteoporosis with a focus on the radiotracers [¹⁸F]FDG and [¹⁸F]NaF.

Osteoporosis is a condition commonly affecting cancer patients due to their age, cancer-specific treatment agents, and effects of cancer. In terms of the unifying mechanism, decreased ratio of osteoblast-bone formation to osteoclast-bone resorption is responsible for causing osteoporosis. PET/CT, a crucial metabolic imaging modality in the oncologic imaging, could be a useful tool for the opportunistic screening of osteoporosis.

There are two approaches with which osteoporosis could be identified with PET/CT—using either the (1) CT- based or (2) PET- based approaches. While the CT-based approach has been used with [¹⁸F]FDG PET/CT, both CT- and PET-based approaches can be employed with [¹⁸F]NaF-PET/CT as [¹⁸F]NaF is a radiotracer specific for osteoblast activity.