{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:02:09Z","timestamp":1784523729927,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Background<\/jats:title>\n \n 18<\/jats:sup>\n F-NaF PET\/CT is widely used in prostate cancer for detecting skeletal metastases, but the examination also contains structural and metabolic information potentially relevant to bone health assessment.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study evaluated feasibility of this dual-parameter approach for opportunistic bone health assessment in prostate cancer.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This was a retrospective cross-sectional.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 105 men with prostate cancer without bone metastasis underwent\n 18<\/jats:sup>\n F-NaF PET\/CT. Stand-alone diagnostic CT-L1 was available in 76 patients and was used as an external structural reference for feasibility analysis and gray-zone stratification. Patient-level analyses used mean lumbar SUV\n avg<\/jats:sub>\n and mean PET\/CT-derived trabecular attenuation across L1-L4. Vertebra-level analyses used all available same-level SUV\n avg<\/jats:sub>\n and same-level PET\/CT-derived trabecular attenuation measurements. Patient-level metabolic-structural discordance on\n 18<\/jats:sup>\n F-NaF PET\/CT was assessed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n PET\/CT-derived L1 trabecular attenuation agreed strongly with stand-alone diagnostic CT-L1, with a correlation coefficient of 0.929 and an intraclass correlation coefficient of 0.916. In the paired diagnostic CT, cross-validated discrimination for low diagnostic CT-L1 thresholds was already high with low-dose CT alone, and adding SUV did not improve performance. However, among 41 patients in the stand-alone diagnostic CT gray zone of 110\u2013160 HU, 19 (46.3%) were classified as low\n 18<\/jats:sup>\n F-NaF uptake. At the patient level, mean SUV\n avg<\/jats:sub>\n across L1-L4 correlated positively with mean PET\/CT-derived trabecular attenuation across L1-L4 (r = 0.521, p&lt;0.001). In the vertebra-level mixed-effects model, each 10-HU increase in trabecular attenuation was associated with a 0.084-unit increase in SUV\n avg<\/jats:sub>\n (95% CI: 0.058 to 0.110; p&lt;0.001). Nine patients showed a higher-TA but low-uptake phenotype, whereas 30 showed low TA with higher uptake.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In prostate cancer,\n 18<\/jats:sup>\n F-NaF PET\/CT may feasibly support opportunistic bone health assessment by integrating low-dose CT-derived trabecular attenuation and\n 18<\/jats:sup>\n F-NaF uptake within the same examination. The clinical contribution of\n 18<\/jats:sup>\n F-NaF uptake appears to lie more in refining gray-zone stratification and identifying metabolically discordant patients. These feasibility findings are hypothesis-generating and require prospective validation against DXA and fracture endpoints before clinical use.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1865099","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:21:24Z","timestamp":1784521284000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of opportunistic bone health assessment using low-dose CT trabecular attenuation and 18F-NaF uptake from PET\/CT in prostate cancer"],"prefix":"10.3389","volume":"17","author":[{"given":"Cailing","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenghua","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuguo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2020.100311","article-title":"Guidance for the assessment and management of prostate cancer treatment-induced bone loss. 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