Hello, Thanks for writing in. Your clinical information is: 1. Lobular carcinoma in situ breasts treated with double mastectomy in 2005. 2. Vitamin D deficiency with low PTH. Calcium high to normal. 3. Hot spot in tibia on nuclear bone scan. With the above information, The X ray can throw some light on the problem with your tibia. You have not mentioned about any pain over leg though. Usually bone lesions appear later on X ray than on nuclear scan. Nuclear scan is much more sensitive. If desired a MRI scan of leg can also be done. Since you had lobular carcinoma in situ breasts treated with double mastectomy in 2005, its less likely that there is any malignant process in the light of Vitamin D deficiency and low PTH. However, we cannot play guessing games need to surely rule out any new neoplastic process in your tibia. Hope this helps.