Detection of an Asymptomatic Early Skeletal Metastasis on routine Dual-energy X-ray absorptiometry (DEXA) scan: A case report

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 199-223-Disorders of Bone & Calcium Homeostasis: Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-219
Jennifer Tinloy1 and Pamela Taxel*2
1Pennsylvania State University, 2University of Connecticut Health Center
Skeletal metastases can change skeletal morphology through dysregulation of the normal bone remodeling process. They  are typically diagnosed through CT, MRI, and PET; although,these imaging modalities are typically not sensitive enough to detect early, asymptomatic bone metastases. We report the unusual case of a significant increase in BMD in a solitary vertebrae in an asyptomatic patient who recently completed 5 years of aromatase inhibitor therapy for hormone recptor-positive breast cancer. 

A 71 yo woman with a 2.1 cm infiltrating ductal ER/PR+ breast  cancer (stage IIb), underwent a right breast lumpectomy, axillary node dissection, radiation, and 4 cycles of chemotherapy.  A post-op PET scan showed no evidence of metastases and she was started on anti-estrogen therapy  with anastrozole (aromatase inhibitor) for 5 years. A baseline bone mineral density (BMD) revealed normal spine and hip BMD with mild-moderate degenerative changes L1-4. Serial BMDs from 2007-2010 showed an overall 10% decline in the spine (Table). She was maintained on clacium and vitamin D for bone health, and declined anti-resorptive medication with bisphosphonate.  Anastrozole was completed in June, 2012 and a repeat BMD revealed a significant increase in BMD at the L-spine of over 15% and L1 increase of 55% with new diffuse L1 sclerotic changes. The patient reported no back pain, fevers/chills. On exam, there was no pain/tenderness over L-spine. A plain film showed an L1 radiodense vertebral body, and a PET scan showed a mixed osteoblastic and osteolytic process involving L1. The differential diagnosis included metastatic bony lesion, compression fracture, acquired bone tumor, and osteomyelitis. A bone biopsy confirmed recurrence of the primary tumor.

Clinicians need to carefully evaluate BMD images for unusual gains or losses in cancer patients, as they may herald the onset of asymptomatic metastatic disease.

Nothing to Disclose: JT, PT

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