Whole body and regional retention of99mTc-labeled pyrophosphate at 24 hours: Physiological basis of the method for assessing the metabolism of bone in disease

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Abstract
The retention of99mTc-labeled pyrophosphate (PPi) at 24 h was measured in 235 patients, 119 of whom had a normal bone metabolism. The mean retention in the group of normal subjects is 52% of the injected dose. Reproducibility of the measurement in a given person is 5.5% coefficient of variation (CV). The value depends strongly on sex (higher in males) and age (higher with increasing age, especially in cortical bone). Retention increases slowly with the decrease in glomerular filtration rate (GFR) between 50 and 120 ml/min; it rises very rapidly with values below 50 ml/min. The slowing down of the GFR with age does not account for the increase in PPi retention with age. When expressed as a percentage of the expected value for sex and age, retention is frequently low in osteoporosis (P<.001), more so when urinary hydroxyproline is low; it is normal or high in osteomalacia, and in some cases rises after vitamin D treatment is started; it is high in hyperparathyroidism (P<.01). The PPi retention is correlated with bone calcium accretion rate, alkaline phosphatase level, and above all, the urinary hydroxyproline level. The lower the bone mineralization (Ca/hydroxyproline ratio in biopsy), the higher the retention value. We conclude that the PPi retention is an index of bone metabolism when GFR is higher than 50 ml/min. It allows for classification of metabolic bone diseases according to the bone turnover rate. It has the advantage over the usual biologic examinations in that it affords better observation of highly localized bone disorders and can be used in combination with a morphologic record, the bone scintigraphy.