Biokinetik osteotroper Radiopharmaka bei metabolischen Osteopathien—Vergleich von ⁴⁷Ca und ^99mTc-Methylen-Diphosphonat (MDP)^[*]

Bei 11 Patienten mit Osteoporose, 7 Patienten mit Hyperparathyreoidismus (HPT), 4 Patienten mit Osteomalazie (OM) und 3 Patienten ohne Störung des Knochenstoffwechsels wurden die Anreicherungsraten von ^99mTc-Methylendiphosphonat (MDP) in die Lendenwirbelsäule (LWS) bestimmt und zusätzlich bei 19 Patienten die ⁴⁷Ca-Kinetik gemessen. Die ^99mTc-MDP-Anreicherungsraten in die LWS waren nur bei den Patienten mit HPT und OM erhöht (p ≦ 0,01). Die Plasma-Elimination von ^99mTc-MDP innerhalb der ersten Stunde nach der Applikation war bei allen Patienten normal. Die Ergebnisse der ⁴⁷Ca-Kinetik zeigten bei der Mehrzahl der Patienten mit Erkrankungen des Knochenstoffwechsels Störungen im inneren Kalziumumsatz; sie waren bei Patienten mit Osteoporose gering ausgeprägt. Der Vergleich der Anreicherungsraten von ^99mTc-MDP mit den Parametern des inneren Kalziumumsatzes ergab signifikante Beziehungen zum austauschbaren Weichteilund Knochenkalzium. Die Korrelationen zum gesamten Kalziumumsatz und zur Kalziumakkretion in das Skelett waren schwach. Nur bei der Hälfte der Patienten waren ^99mTc-MDP-Anreicherungsraten und Kalziumakkretionen normal oder gleichsinnig erhöht. ^99mTc-MDP ist mit Einschränkung zur kinetischen Analyse eines pathologisch veränderten Knochenstoffwechsels geeignet. Unterschiedliche Anreicherungsmechanismen von ^99mTc-MDP (Knochenmatrixbildung) und ⁴⁷Ca (Mineralumsatz) im Knochengewebe mögen Ergebnisunterschiede erklären.

Plasma clearance and osseous accumulation rates of ^99mTc methylene diphosphonate (MDP) in the lumbar spine were measured in 11 patients with osteoporosis (OP), 7 patients with hyperparathyroidism (HPT), 4 patients with osteomalacia (OM) and in 3 patients (N) who were studied to exclude metabolic bone disease. The findings in 19 patients were compared with the results of ⁴⁷Ca kinetics. The plasma elimination of ^99mTc-MDP during the first hour after application was normal in almost all the patients. The ^99mTc-MDP accumulation rates in the lumbar spine were raised in patients with HPT and OM (p ≦ 0,01) and normal in patients with OP and N (p > 0,05).⁴⁷Ca kinetics were disturbed in most of the patients with metabolic bone disease, with minimal deviations in OP. The comparison of ^99mTc-MDP accumulation rates with the results of ⁴⁷Ca kinetics revealed significant correlations with exchangeable bone and soft tissue calcium. The correlations with total calcium turnover and calcium accretion were poor. Only half of the patients had equal results of ^99mTc-MDP accumulation rates and bone calcium accretion rates. It is concluded that the ^99mTc-MDP uptake by bone is an index of bone metabolism presumably of the organic matrix, whereas ⁴⁷Ca kinetics represent the mineral metabolism of bone.

^* Mit Unterstützung der DFG, Sonderforschungsbereich 34 „Endokrinologie”.

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