Bone density measured by CT increases at metastatic sites after zoledronic acid treatment, regardless of the type of metastasis, in contrast to apparently normal bone.

The semiautomated technique we report appears to be accurate for identifying neoplastic tissue and for mapping perfusion parameters, with the added value of a consistent measurement of perfusion parameters on colour-coded maps.

PurposeTo evaluate bone density changes at the level of normal bone and bone metastases after zoledronic acid (ZA) treatment in oncologic patients.Materials and methodsWe retrospectively evaluated 72 consecutive adult patients with histologically confirmed solid tumors with at least 1 newly diagnosed bone metastatic lesion. Bone metastases were diagnosed by bone scans and confirmed with computed tomography (CT). Patients received intravenous ZA, 4 mg, by 15-min infusion every 28 day through a peripheral or a central venous access and were monitored for at least 3 months and a maximum of 24 months. Bone density was determined at the level of bone metastases and at the level of normal trabecular and cortical bone using a ROI-based approach.ResultsA significant increase was demonstrated at the level of normal trabecular bone of the calvarium and the femoral neck. No significant increase of density was observed at the level of the normal cortical bone. Bone metastases showed a significant increase in CT density as compared to baseline up to 24 months after zoledronic acid.ConclusionWe have found that long term treatment with ZA increases trabecular bone density in oncologic patients whereas normal cortical bone changes are not detectable.

Dear Editor, We read with great interest the article published in your journal by Quattrocchi et al. presenting a retrospective analysis of the computed tomography (CT) appearance of bone metastases in breast cancer patients [1]. A higher incidence of osteosclerotic bone metastases was reported in the period 2001-2005 compared with the period 1996-2000. More specifically, during the 1996-2000 period, CT evaluation revealed that 53.6% of patients had lytic, 32.1% mixed and 14.3% sclerotic bone metastases. The corresponding values for the 2001-2005 period were 9.4%, 71.9% and 18.7%, respectively. No significant correlation was found between the radiological appearance of bone metastases and histological type or grade or systemic treatments such as chemotherapy or antiestrogens. The higher prevalence of osteoblastic lesions in the years 2001-2005 was attributed to the use of zoledronic acid treatment [1].We recently published two studies in which CT was used to group patients according to type of bone metastases (recruitment period 2003-2006) [2, 3]. Of these patients, 34 suffered from metastatic bone disease due to breast cancer, and the percentage of patients with lytic, mixed and sclerotic bone lesions was 26.5%, 44.1% and 29.4%, respectively. From these patients, 29/34 had undergone hormonal therapy in the past, and all had received at least one cycle of chemotherapy. None of the patients had received bisphosphonates prior to the baseline evaluation with CT. These results suggest that systemic treatments such as chemotherapy and hormonal therapy may also alter the radiological appearance of bone metastases. This is also suggested by other literature data, as Bonadonna et al. found that breast cancer patients who received chemotherapy had mostly mixed or sclerotic bone metastases, which were asymptomatic in 66% of cases [4]. In contrast, 66% of breast cancer patients with metastatic bone disease who had not received chemotherapy had lytic lesions, and 70% were symptomatic [5].Another important aspect that should be noted is that the above results show that the level of bone resorption at metastatic bone sites correlates with patient morbidity levels, something that was also revealed in the study investigating the correlation between types of bone metastases and patients' clinical status [2]. Consequently, systemic treatments may not only modify the radiologic appearance of bone metastases but also the level of suffering. It would be very interesting if the authors of the study on which we are commenting could provide data on patients' symptoms (pain) for the years 1996-2005. We agree with the authors that further studies are required to assess the impact of systemic treatment on the radiologic appearance of bone metastases.Yours sincerely, Vassilios Vassiliou and Dimitrios Kardamakis. LETTER TO THE EDITOR LETTERA ALL'EDITORE

Purpose. Vertebral fractures represent one of the major complications of osteopororis. Diagnosis is followed by a pharmacological, interventional or surgical treatment. Up to day there are non practice guidelines for a screening evaluation of bone fractures in elderly and most of the fractures remain undiagnosed. We prospectively evaluated the prevalence of vertebral fractures on chest X-rays to determine the diagnostic and prognostic roles of chest Xray in predicting new bone fractures 2 years after the initial radiogram. Materials and methods. Between March 2004 and October 2005, 4,045 women underwent chest X-ray in our radiology department for any indication. We identified 166 women with the presence of at least one vertebral fracture. A questionnaire was administered to these women to collect information about diagnosis of osteoporosis, history of malignancy, systemic diseases, osteoporosis-inducing drugs and pharmacological, radiological or surgical treatment received. Results. Out of the 166 women (age 73±10.5 years) with vertebral fractures, we interviewed 101 women; 13 had died and 52 were not found. Most of the patients were on menopause (97.1%, 98/101) with an average age of menopause of 48,2 years (±6 years). Among the patients on menopause, 15,8% (16/101) had undergone hysterectomy. All patients received a diagnosis of osteoporosis, which was reached with a chest X-ray report Riassunto Obiettvo. Le fratture vertebrali rappresentano una delle maggiori complicanze dell'osteoporosi, la cui diagnosi è seguita dall'instaurazione di un trattamento medicochirurgico. Attualmente non esistono linee guida che raccomandino uno screening nella popolazione di età avanzata e molte fratture rimangono non diagnosticate. L'obiettivo del nostro studio è quello di valutare prospetticamente la prevalenza delle fratture vertebrali visualizzate alla radiografia del torace e determinarne il ruolo diagnostico e prognostico calcolando il rischio di nuove fratture due anni dopo la prima diagnosi radiologica. Materiali e metodi. Da marzo 2004 ad ottobre 2005, presso il nostro dipartimento di Diagnostica per Immagini, sono state eseguite 4045 radiografie del torace su donne che si sottoponevano a tale esame per svariate indicazioni. Dallo studio di tali referti sono state individuate 166 donne con fratture vertebrali secondarie ad osteoporosi. In base ai referti ottenuti, ci si è proposti di intervistare tali pazienti attraverso un questionario allo scopo di comprendere quante di loro fossero a conoscenza della malattia, di verificare l'esistenza di patologie concomitanti e di ricercare eventuali fattori che possano aver predisposto allo sviluppo delle lesioni vertebrali e l'eventuale terapia in atto. Risultati. Delle 166 pazienti individuate (età media 73 anni±10,5), con diagnosi di deformazioni o fratture MUSCULOSKELETAL RADIOLOGY RADIOLOGIA MUSCOLO-SCHELETRICA Radiol med (2010) 115:815-825 in 23.7% (24/101) of cases. A new skeletal fracture occurred in 20.5% (5/27) of patients receiving treatment against a frequency of 20.8%...