How to Understand the Results of a Bone Scan

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A bone scan is an imaging test that helps to detect bone diseases and injuries. Your doctor may recommend a bone scan if they suspect you have osteoporosis (brittle bones), a fracture, bone cancer, arthritis, or bone infection. The procedure involves injecting some radioactive material (radiotracer) into your vein and then taking a picture of your body with a special camera that's sensitive to radiation. [1] Your doctor will explain the findings to you, but it's helpful to learn more about it so you can better understand the results of a bone scan.

Part 1
Part 1 of 3:

Interpreting Bone Scans

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  1. A doctor who specializes in reading bone scans (radiologist) will send their interpretation of your results to your family doctor who will then explain them to you — hopefully, in simple terms. If you want to take a closer look, you can ask to see the original scan at your doctor's office or ask for a copy to take home.
    • Although your doctor will likely be reluctant to give you the original bone scan to take home, he must legally provide you with a copy if you ask. The office might charge you a small copying fee.
    • A bone scan is done to show problems with bone metabolism — the process of building and recycling bone tissue. [2] Some activity is normal, but too much or too little bone remodeling is a sign of disease or injury.
  2. Most bone scans take an image of the entire skeleton, but sometimes they're more focused on an injured or painful area, such as the wrist or spine. [3] As such, learn a little about basic anatomy, especially the names of most of the bones in your bone scan. Search online for information or borrow a book from your local library.
    • You don't need to learn detailed physiology or anatomy, but you should know what bones the radiologist is referring to in her written report of your bone scan results.
    • The most common bones that are noted on bone scans are the vertebrae (spinal bones), pelvis (ilium, ischium, and pubis), ribs, wrists (carpal bones), and leg bones (femur and tibia).
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  3. Once you have an idea of the bones that are problematic on your bone scan, you also need to know on which side of your body it is. You often can't tell just by looking at your body image, but all diagnostic images including bones scans have to be labelled in terms of which side is the patient's right and which is left. [4] As such, look for words such as left, right, front or back on the image to get orientated.
    • Bone scan images can be taken from either your front or back. Looking at the head, you can sometimes see from which direction it was taken, but not always.
    • Instead of words, bone scans and other diagnostics images may be orientated by marker letters, such as L (left), R (right), F (front), or B (back).
  4. If you have more than one bone scan taken over time, which is common when following the progression of a bone disease or condition, then determine the dates (and times) that each was taken by looking at the label. Study the earlier one first, then compare it to later ones and take note of all the changes. If there isn't much difference, then it's likely your condition hasn't progressed (or improved).
    • If you have osteoporosis, for example, your doctor will likely recommend a yearly or bi-yearly bone scan to monitor progression of the disease.
    • If a bone infection is suspected, images may be taken shortly after the radio-tracer is injected into you and again three to four hours later when it's collected in your bones — this is called a 3-phase bone scan. [5]
  5. " The test results of a bone scan are considered normal when the radioactive dye is spread and absorbed evenly throughout your skeleton; however, a bone scan is considered abnormal when it shows darker colored "hot spots" in your bones. [6] Hot spots show areas in your skeleton where an excess of dye accumulates, which could signify bone destruction, inflammation, fractures or tumor growth. [7]
    • Diseases that cause bone destruction include aggressive types of cancer, bacterial bone infection, and osteoporosis (leads to weakening and fractures).
    • Some bones can normally appear slightly darker than other bones because of their increased metabolic activity. Examples include your sternum (breastbone) and parts of your pelvis. Don't mistake these for diseases.
    • In some cases, as with lesions resulting from multiple myeloma, hot spots will not appear on a bone scan. A CT or PET scan may be more helpful to identify signs of this type of cancer.
  6. " Test results are also considered abnormal when there are lighter colored "cold spots" in your bones. [8] Cold spots indicate areas that absorb less radioactive dye (or none) compared to surrounding bones due to reduced activity and remodeling. In general, cold spots are usually a sign of decreased blood flow to an area for some reason.
    • Lytic lesions — associated with multiple myeloma, bone cysts, and certain bone infections — may show up as cold spots.
    • Cold spots can indicate poor circulation due to a blood vessel blockage (atherosclerosis) or benign tumor.
    • Cold spots and hot spots can appear simultaneously on a bone scan and represent different but concurrent diseases or conditions.
    • Although lighter cold spots are abnormal, they typically represent conditions that are less serious than those represented by darker hot spots.
  7. The radiologist will interpret your bone scan results and send a report to your doctor, who will use that information along with other diagnostic studies and/or blood tests to establish a diagnosis. Common diagnoses that stem from abnormal bone scan results include: osteoporosis, bone fractures, bone cancer, bone infection, arthritis, Paget's disease (a bone disorder involving thickening and softening of bones) and avascular necrosis (death of bone due to lack of blood supply. [9]
    • With the notable exception of avascular necrosis, which shows up as cold spots on a bone scan, all the other above-mentioned conditions show up as hot spots.
    • Common osteoporosis hot spots to see on a bone scan include the upper thoracic spine (mid-back), the hip joints and/or the wrists. Osteoporosis leads to fractures and bone pain.
    • Cancer hot spots can be seen in virtually any bone. Bone cancer often spreads (metastasizes) from other cancer sites, such as the breasts, lungs, liver, pancreas, and prostate gland.
    • Paget's disease causes hot spots along the spine, pelvis, long bones and skull. [10]
    • Bone infections are most common in the leg, feet, hand, and arm bones.
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Part 2
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Preparing for a Bone Scan

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  1. Although you don't need to make any special preparations before taking a bone scan, you should dress in comfortable, easily removed clothes and refrain from wearing any jewelry. [11] Metal jewelry and watches, in particular, should be left at home or removed just prior to the bone scan because they can affect the results.
    • Like other diagnostic imaging tests, such as x-rays, any metal on your body will make the bone scan images look white or lighter than surrounding areas.
    • Tell the radiologist and/or technician if you have any metal fillings in your mouth or metal implants in your body, so they can make note of it and not confuse them with disease processes.
    • Wearing clothes that are easily removed is a good idea because you may be asked to wear a hospital gown.
  2. Inform your doctor if your pregnant or potentially pregnant because the radiation exposure from the radiotracer can be harmful to the baby. As such, bone scans aren't often performed on pregnant people or nursing mothers — the breast milk can become slightly radioactive and harm the baby also.
    • There are other imaging tests for bone that are safer for pregnant people, such as MRI studies and diagnostic ultrasound.
    • Short-term osteoporosis is not uncommon with pregnant people who are malnourished because minerals are leached from their bones to provide for the growing baby.
  3. Although you can eat and drink normally just prior to your bone scan, tell your doctor about the medications you're taking, as these may affect your test. For example, medicines that contain barium or bismuth affect bone scan test results, so you should avoid taking them for at least four days prior to your appointment. [12] [13]
    • Bismuth is found in a variety of medicinal products, such as Pepto-Bismol, Kaopectate, Devrom, and De-Nol.
    • Bismuth and barium can cause areas of your body to look too light on bone scans
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Part 3
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Understanding the Risks

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  1. The amount of radiotracer injected into your vein just prior to getting a bone scan is not very much, but it still produces radiation in your body for up to 3 days. [14] Radiation increases the risk of healthy cells mutating into cancer cells, so make sure you weigh all the pros and cons with your doctor before getting a bone scan.
    • It's estimated that a bone scan exposes you to no more radiation than a conventional full-body x-ray does and less than half that of a CT scan. [15]
    • Drinking lots of water and fluids starting immediately after a bone scan for 48 hours can help to flush out any radioactive tracer left in your body. [16]
    • If you must have a bone scan while breastfeeding, pump and throw away your breast milk for two to three days so your baby isn't harmed.
  2. Allergic reactions related to the radiotracer dye are rare, but they do happen and can be life-threatening. [17] In most cases, the reaction is mild and causes some pain and inflammation at the injection site and a related skin rash. In severe cases, anaphylaxis is triggered and leads to a widespread allergic reaction causing swelling, breathing difficulty, hives, and reduced blood pressure.
    • Call your doctor immediately if any signs of an allergic reaction become obvious once you get home after your appointment.
    • The radioactive tracer takes between one to four hours to be absorbed by your bones, although most allergic reactions occur within 30 minutes of the injection.
  3. There is a slight risk of infection or excessive bleeding when the needle is inserted into your vein to inject the radioactive dye. [18] Infections usually take a couple of days to develop and include pain, redness, and swelling at the injection site. Call your doctor immediately if you notice these signs. You may need to go on antibiotics to combat the infection.
    • Signs of a more significant infection include severe throbbing pain and pus drainage at the injection site, numbness and tingling in your involved arm, fatigue, and a fever.
    • Make sure the doctor or technician cleans your arm with an alcohol swab or wipe just prior to the injection.
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Expert Q&A

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  • Question
    What will a bone scan tell me?
    Kevin Stone, MD
    Board Certified Orthopaedic Surgeon
    Dr. Kevin Stone is an orthopaedic surgeon and the founder of The Stone Clinic, a leading orthopaedic surgery, sports medicine, and rehabilitation clinic in the San Francisco Bay Area. With over 30 years of experience, Dr. Stone specializes in knee, shoulder, and ankle repair, using biologic reconstruction and joint replacement. He holds a BS in Biology from Harvard University and a Doctor of Medicine (MD) from the University of North Carolina at Chapel Hill. Dr. Stone completed his residency in Internal Medicine and Orthopaedic Surgery at Harvard University and in General Surgery at Stanford University. He then completed a fellowship in Orthopaedic Research and Surgery at the Hospital for Special Surgery and Tahoe Orthopaedics. He lectures around the world as an expert in cartilage and meniscal growth, replacement, and repair and holds over 40 U.S. patents on novel inventions to improve healthcare. Dr. Stone is a physician for Smuin Ballet and has served as a physician for the U.S. Ski Team, the U.S. Pro Ski Tour, the United States Olympic Training Center, and World Pro Ski Tour.
    Kevin Stone, MD
    Board Certified Orthopaedic Surgeon
    Expert Answer
    A bone scan will show areas in your body where there is increased blood flow or cell turnover. These hot spots can indicate an injury, such as a fracture or damaged joint.
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  • Question
    What does uptake mean?
    Chris M. Matsko, MD
    Family Medicine Physician
    Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.
    Chris M. Matsko, MD
    Family Medicine Physician
    Expert Answer
    Uptake means that the dye is being absorbed by the bone. This usually occurs at hairline fractures or infections of the bone.
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  • Question
    Should I be worried if there are spots on my bone scan?
    Chris M. Matsko, MD
    Family Medicine Physician
    Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.
    Chris M. Matsko, MD
    Family Medicine Physician
    Expert Answer
    Yes, you should be concerned. If you are a runner you may have a stress fracture. If you are ill you may have an infection of the bone. Talk to your doctor about your results for a diagnosis.
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      Tips

      • You need to lie very still during a bone scan, otherwise the images may be blurred. You may have to change positions during the scan.
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      • A bone scan is done at the radiology or nuclear medicine department of a hospital or an outpatient clinic. You'll need a referral from your doctor.
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      • During a bone scan, you lie on your back and the camera moves slowly around your body, taking pictures of all your bones.
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      Warning

      • Bone scans are good at finding bone abnormality, but not specific for what's causing the abnormality. As such, follow up tests and exams are needed before a definitive diagnosis can be made.

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      References

      1. ↑ Kevin Stone, MD. Board Certified Orthopaedic Surgeon. Expert Interview. 19 November 2020.
      2. ↑ http://www.mayoclinic.org/tests-procedures/bone-scan/basics/why-its-done/prc-20020302
      3. ↑ http://www.mayoclinic.org/tests-procedures/bone-scan/multimedia/hot-spots/img-20008193
      4. ↑ http://www.racgp.org.au/afp/2012/september/bone-scans/
      5. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm
      6. ↑ http://www.mayoclinic.org/tests-procedures/bone-scan/multimedia/hot-spots/img-20008193
      7. ↑ Kevin Stone, MD. Board Certified Orthopaedic Surgeon. Expert Interview. 19 November 2020.
      8. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm
      9. ↑ http://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/bone_scan_92,P07663/
      1. ↑ http://orthoinfo.aaos.org/topic.cfm?topic=a00076
      2. ↑ http://www.mayoclinic.org/tests-procedures/bone-scan/basics/how-you-prepare/prc-20020302
      3. ↑ http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/bone-scan
      4. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm
      5. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm
      6. ↑ http://www.mayoclinic.org/tests-procedures/bone-scan/basics/risks/prc-20020302
      7. ↑ http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/bone-scan
      8. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm
      9. ↑ https://www.nlm.nih.gov/medlineplus/ency/article/003833.htm

      About This Article

      Article Summary X

      If you're trying to understand the results of a bone scan, start by having your radiologist explain the results to you using clear, simple language. If you want to know more or take a closer look, ask to see the original scan or get your own copy to take home, which they are legally obligated to provide if you request it. You can also ask for a copy of the radiologist's report so you can read it yourself and look up any language or terminology that you don't understand. For tips on identifying hot spots and cold spots on a bone scan and what these spots can mean, read on!

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