What bone scan looks for

Overview

A bone scan is a type of imaging test that uses a small amount of radioactive material to look at your bones. It helps doctors find problems with your bones, such as fractures (broken bones), infections, arthritis, or cancer that has spread to the bones. The radioactive material is injected into a vein and collects in areas where the bone is damaged or healing, making them show up brightly on a special camera picture.

Bone scans are a fairly common test, used in many hospitals around the world for people with suspicious bone pain, fractures, or known cancer.

Anyone can need a bone scan, but they are most often done for people with bone pain that hasn’t been explained, those at risk of bone infections, or people with a history of cancer that might have spread.

Symptoms

Common symptoms

• Unexplained bone pain that does not go away
• Pain after a fall or injury that does not get better
• Swelling or redness over a bone
• Unexplained limping or trouble moving a joint

Symptoms in children

• Limping or refusing to put weight on a leg
• Fever with bone pain (possible infection)
• Unexplained bone pain that wakes the child at night

Symptoms in older adults

• New or worsening bone pain, especially in the hips, back, or ribs
• Pain with movement that feels unlike arthritis
• Unexplained weight loss with bone pain

Causes

Main causes

• Fractures – broken bones that may not be easy to see on a regular X-ray, such as stress fractures from overuse
• Bone infections (osteomyelitis) – caused by bacteria that get into the bone, often through a wound or from another infection in the body
• Arthritis – inflammation of the joints that can also affect the nearby bone, such as in rheumatoid arthritis or osteoarthritis
• Cancer that has spread to the bones (bone metastases) – most often from breast, lung, thyroid, or prostate cancer

Risk factors

• Age – older adults are more likely to have bone problems like arthritis or cancer spread
• Known cancer diagnosis that can spread to bone
• High-impact sports or activities that can cause stress fractures
• Poor blood circulation or infections that can travel to the bone
• Long-term use of steroid medications, which can weaken bones

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe bone pain without a clear cause
• If you have bone pain and a fever, which can be a sign of infection
• If you cannot put weight on a leg or use an arm after an injury

Book a routine appointment if:

• If you have ongoing bone pain that does not get better with rest or over-the-counter pain relief
• If you have a history of cancer and develop new bone pain
• If your doctor advises a bone scan as part of a check-up for a known condition

Diagnosis

A bone scan is not a diagnosis on its own – it is a test that can show areas of bone that might be abnormal. Your doctor will combine the scan results with your symptoms, other tests (like blood tests) and any X-rays to make a diagnosis. Areas that show up brighter (called 'hot spots') could be due to a fracture, infection, arthritis, or tumor. Your doctor may need to do further tests, such as a biopsy (taking a small sample of bone), to find the exact cause.

Tests that may be done

• Bone scan (nuclear medicine scan)
• X-rays of the painful area
• CT scan or MRI for more detailed images of the bone and surrounding tissue
• Blood tests to check for infection, inflammation, or signs of cancer

What to expect at your appointment

For a bone scan, you will have a small injection of a radioactive tracer into a vein in your arm. You then wait about 2 to 3 hours for the tracer to travel through your body and reach your bones. During this time you need to drink plenty of water. The scan itself takes about 30 minutes to an hour. You lie still on a table while a camera moves slowly over you. The test is painless. After the scan, you can go back to normal activities. The tracer leaves your body through your urine within a day. Tell the doctor if you are pregnant or breastfeeding, as special precautions may be needed.

Treatment

Treatment depends on what the bone scan shows. If it shows a fracture, you may need to rest and protect the bone until it heals. If it shows an infection, antibiotics are usually given. If it shows arthritis, pain management and physical therapy can help. If it shows cancer spread, treatment may include radiation therapy, hormone therapy, or other cancer treatments to control the growth. Your doctor will talk with you about the best plan based on your specific condition.

Self-care at home

• Rest the painful area and avoid putting weight on it until you know the cause
• Use ice packs for pain and swelling (for a fracture or injury)
• Take over-the-counter pain relievers as recommended by your doctor or pharmacist
• Stay active as much as you can without making the pain worse – gentle movement can help with arthritis

Medical treatments

Medical treatments may include antibiotics if an infection is found, pain medications (like non-steroidal anti-inflammatory drugs) to control pain and swelling, injections of corticosteroids or other medicines into a painful joint, or therapies such as radiation therapy for bone cancer. Always follow your doctor’s advice on which treatment is right for you.

When is surgery considered?

Surgery is sometimes needed if a bone is badly broken and cannot heal on its own, if there is an infection that does not clear with antibiotics, or to remove a tumor from a bone. Your doctor will explain the risks and benefits of surgery if it is an option for you.

Living with this condition

If you have a bone condition found by a scan, you may need to make some adjustments. For a fracture, you might need to use crutches or a cast. For arthritis, you may need to do gentle exercises and take breaks. If you have cancer that has spread to bone, you may need to manage pain and fatigue. Talk to your healthcare team about what to expect and how to stay comfortable.

Lifestyle tips

• Get regular, gentle exercise like walking or swimming to keep bones and joints strong
• Eat a balanced diet rich in calcium (milk, yogurt, leafy greens) and vitamin D (sunlight, fortified foods)
• Avoid smoking and limit alcohol – they can weaken bones
• Use good posture and body mechanics when lifting or moving heavy objects

Diet and exercise

A healthy diet with enough calcium and vitamin D helps keep bones strong. Aim for 2-3 servings of dairy or fortified alternatives daily. Gentle weight-bearing exercise like walking, dancing, or hiking can help maintain bone density. Always check with your doctor before starting a new exercise program, especially if you have a known bone condition.

Mental health and emotional wellbeing

Living with bone pain or a serious diagnosis like bone cancer can be stressful. It is normal to feel worried, frustrated, or sad. Talk about your feelings with your doctor, a counsellor, or a support group. Managing stress helps you cope better with physical symptoms.

Prevention

Not all bone conditions can be prevented, but you can take steps to keep your bones strong and reduce risks. To prevent fractures, avoid falls by keeping your home safe and doing balance exercises. To prevent infections, keep wounds clean and see a doctor if you have signs of infection. For cancer, regular check-ups and a healthy lifestyle can help, but many cancers are not fully preventable.

Screening programmes

Routine bone scans are not used for screening healthy people. They are done only when there are symptoms or a known risk. For osteoporosis (weak bones), a different test called a bone density scan (DEXA) is used. Talk to your doctor if you are worried about your bone health.

Complications

If left untreated

• Bone infections can spread to the blood and become life-threatening
• Stress fractures can become complete fractures if not rested
• Cancer that has spread to bones can cause severe pain and weaken bones, leading to fractures
• Arthritis can cause permanent joint damage and disability if not managed

Long-term outlook

With proper care, many bone conditions improve or can be managed well. Fractures usually heal with rest and protection. Infections clear up with antibiotics. Arthritis can be controlled with medications and lifestyle changes. Even when cancer has spread to bones, treatments can slow its growth, relieve pain, and help you maintain a good quality of life. Your doctor will work with you to give you the best possible outcome.

Find support

International organisations

• International Osteoporosis Foundation
• Bone Cancer Research Trust

Local organisations

• Royal Osteoporosis Society (UK) · UK
• Arthritis Foundation (US) · US

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