Failure of bone scanning to detect fractures in a woman on chronic steroid therapy

Osteopenic bones in patients on chronic steroid therapy are often difficult to assess for occult fractures. Such patients are also at greater risk for fractures. Technetium 99m bone scan is currently thought to represent the most sensitive method of diagnosing these lesions. We present a case of failure of diagnosis of a subtle fracture by Tc-99m bone scan and speculate on the role of steroid therapy in the mechanism of this failure.