Quantitative ultrasound calcaneus measurements: normative data and precision in the spanish population

QUS characteristics in Normal Population: a Mini Review and our experience

Objectives

Quantitative ultrasound (QUS) is a bone densitometry method that is less expensive and more portable than DXA. It is also noninvasive. QUS parameters include speed of sound (SOS), broad band ultrasound attenuation (BUA), and stiffness index (SI). This study defined normal values of QUS parameters in Iranian men and women.

Methods

QUS of heels measured in 258 Iranian men and women, aged 20-76 y/o. They were participants of Iranian Multicenter Osteoporosis study (IMOS), selected by randomized sampling. QUS device was an Achilles+ (GE-Lunar) device.

Results

Percentiles of SI (2.5%, 50%, and 97.5%) determined. We found a good agreement between the Iranian reference values and western reference (used by device) value in defining normal and osteoporotic people (κ = 0.875).

Conclusion

Results from this study suggest that QUS of the heel may be a good method for diagnosis of low bone mass in different regions.

Anthropometric Dimensions and Bone Quality in International Male Beach Handball Players: Junior vs. Senior Comparison

BACKGROUND

Beach handball is a recent team sport characterized by defensive and offensive actions on a sand surface. Scientific evidence has shown that body composition is fundamental in sports performance. The main objective of this study was to know the body composition, anthropometric characteristics, and bone mineral density of elite beach handball players. Furthermore, another purpose was to analyze the differences between categories (junior and senior) and playing position. Methods: A descriptive, cross-sectional study of 36 male players (18 juniors and 18 seniors) of the Spanish National Beach Handball Team was conducted. Full profile anthropometry and calcaneal ultrasound measurements were used. Results: Significant differences between categories (p < 0.05) were found in: height, body mass, arm span, BMI, muscle mass, fat mass, bone mass, skinfolds, and body perimeters. The somatotype changes depending on the playing position. Bone mineral density of the players was adequate. No significant differences were found by playing position. Conclusions: Senior players had a better body composition due to the presence of less fat mass than junior players. This study provides reference values of elite junior and senior beach handball players and by playing positions. This data is useful for the identification of talents and players who should be trained to improve their body composition.

The ability of calcaneal and multisite quantitative ultrasound variables in the identification of osteoporosis in women and men

Objectives

The aim of this study was to assess the ability of calcaneal and multisite quantitative ultrasound (QUS) parameters in the identification of osteoporosis in women and men.

Patients and methods

A total of 131 women (mean age 53.7±11.9 years; range, 21 to 79 years) and 109 men (mean age 57.8±13.7 years; range, 24 to 85 years) whose bone mineral density (BMD) at the spine and proximal femur was measured between January 2010 and January 2012, using dual-energy X-ray absorptiometry (DXA) were included. Acoustic bone properties were also examined using both a calcaneal and a multisite QUS. The receiver operating characteristic analysis with the calculation of areas under the curve (AUCs) to evaluate the ability of both QUS devices for the identification of osteoporosis. We also calculated a lower and an upper threshold at a specificity of 90% and at a sensitivity of 90%, respectively, for the identification of osteoporosis along with a threshold/cut-off value with the best compromise between sensitivity and specificity.

Results

All calcaneal QUS parameters showed significant AUCs within the range of 0.712 (for Broadband Ultrasound Attenuation [BUA]) and 0.764 (for Speed of Sound [SOS]) in women and ranging from 0.661 (for BUA) to 0.735 (for SOS) in men, while only radial SOS of the multisite QUS demonstrated a significant AUC value of 0.661 for identifying osteoporosis in women. A Quantitative Ultrasound Index T-score of -1.53 for women and -1.68 for men showed sensitivity and specificities around 70%.

Conclusion

Based on the results of this study, all calcaneal QUS parameters in both women and men and possibly radial SOS measurements of the multisite QUS in women may be helpful for the identification of osteoporosis.

The Prevalence of Osteopenia and Osteoporosis Among Malaysian Type 2 Diabetic Patients Using Quantitative Ultrasound Densitometer

Background:

Type 2 Diabetes Mellitus (T2DM) and osteoporosis are both chronic conditions and the relationship between them is complex.

Objective:

The aims of this study were to assess the prevalence of Low Bone Mineral density (LBMD, i.e., osteopenia and osteoporosis), as well as, the difference and associations between Quantitative Ultrasound Scan (QUS) parameters with socio-demographic data and clinical related data among T2DM in Penang, Malaysia.

Method:

An observational, cross-sectional study with a convenient sample of 450 T2DM patients were recruited from the outpatient diabetes clinic at Hospital Pulau Pinang (HPP) to measure Bone Mineral Density (BMD) at the heel bone using QUS. In addition, a self-reported structured questionnaire about the socio-demographic data and osteoporosis risk factors were collected. Moreover, the study included the retrospective collection of clinical data from patients’ medical records.

Results:

The mean value of T-score for normal BMD, osteopenic and osteoporotic patients’ were (-0.41±0.44), (-1.65±0.39) and (-2.76±0.27), respectively. According to QUS measurements, more than three quarters of T2DM patients (82%) were at high risk of abnormal BMD. The results showed that QUS scores were significantly associated with age, gender, menopausal duration, educational level and diabetic related data. Moreover, the QUS parameters and T-scores demonstrated significant negative correlation with age, menopausal duration, diabetic duration and glycaemic control, as well as, a positive correlation with body mass index and waist to hip ratio. The current study revealed that none of the cardiovascular disease risk factors appear to influence the prevalence of low BMD among T2DM Malaysian patients.

Conclusion:

The study findings revealed that the assessment of T2DM patients’ bone health and related factor are essential and future educational programs are crucial to improve osteoporosis management.

A Cross-Sectional Study of the Association between Autoantibodies and Qualitative Ultrasound Index of Bone in an Elderly Sample without Clinical Autoimmune Disease

Bone loss is characteristic of the ageing process and a common complication of many autoimmune diseases. Research has highlighted a potential role of autoantibodies in pathologic bone loss. The confounding effects of immunomodulatory drugs make it difficult to establish the contribution of autoantibodies amongst autoimmune disease sufferers. We attempted to examine the relationship between autoantibodies and bone mass in a population of 2812 elderly participants without clinical autoimmune disease. Serum samples were assayed for a panel of autoantibodies (anti-nuclear, extractable nuclear antigen, anti-neutrophil cytoplasmic, thyroid peroxidase, tissue transglutaminase, anti-cardiolipin, rheumatoid factor, and cyclic citrullinated peptide). Bone mass was measured using quantitative ultrasound (QUS) of the calcaneus. The relationship between each autoantibody and bone mass was determined using linear regression models. Anti-nuclear autoantibodies were the most prevalent, positive in approximately 11%, and borderline in roughly 23% of our sample. They were also the only autoantibody observed to be significantly associated with QUS index in the univariate analysis (n = 1628; r = -0.20; 95% CI: -0.40-0.00; p = 0.046). However, statistical significance was lost after adjustment for various other potential confounders. None of the other autoantibodies was associated with QUS index in either univariate or multivariate analysis. We are limited by the cross-sectional nature of the study and the low prevalence of autoantibodies in our nonclinical sample.

Osteoporosis among household women: A growing but neglected phenomenon

Background

Osteoporosis is associated with variable morbidity and socio-economic burden and referred as a "silent epidemic" with increasing risk among Indian women. The present study was conducted to find prevalence of osteoporosis.

Methods

A descriptive cross-sectional study was conducted in Ranchi city with household women as participants. Data was collected by means of pre-tested structured questionnaire in Hindi language and bone status was screened utilizing calcaneal quantitative ultrasound as a diagnostic tool to estimate bone mineral density from 223 participants and statistical analysis was performed with SPSS software.

Results

The mean age of the participants was 37.9 (5.63) and majority (52.5%) of them were vegetarian. The prevalence of osteoporosis was 8.5% (5.2-13%) while 45.7% (39-52.5%) had osteopenia. We found no significant association of osteoporosis and osteopenia with income, physical activity, and dietary patterns on univariate analysis. There was no statistical significant difference between mean age and BMI of participant among normal, osteoporosis, and osteopenia participant (p value >0.5). Multivariate logistic regression analysis shows that 20% increase chances of risk with five years increase in age, the protective effect of physical activity (22%) and non-vegetarian diet (18%) though not statistically significant.

Conclusion

This study shows that significant number of women had osteopenia/osteoporosis within 35-40 years age group. Intensive information, education, and communication activities with regard to osteoporosis causative factors and preventive measures targeted to household women may play an important role, if started at young age.

A Cross-Sectional Study of the Association of VDR Gene, Calcium Intake, and Heel Ultrasound Measures in Early Adulthood

The acquisition of a high adult peak bone mass (PBM) is considered an important determinant of osteoporotic risk later in life. Genetic and environmental factors determine optimal PBM acquisition in early adulthood. The aim of this study was to test the association of vitamin D receptor (VDR) gene polymorphisms and dietary calcium intake with the bone mass of young adults. The study population comprised a total of 305 individuals (mean age 20.41; SD 2.36) whose bone mass was assessed through heel ultrasound [quantitative ultrasound measurements (QUS)] measurements (BUA, dB/MHz). The FokI G/A, rs9729 G/T, and TaqI G/A polymorphisms were selected as genetic markers of VDR. A significant difference in BUA values was observed according to gender (females 82.96; SD 15.89 vs. males 97.72; SD 16.50; p < 0.00001). The mean dietary calcium intake of the study group (827.84 mg/day; SD 347.04) was lower than the dietary reference intake for young adults (1000 mg/day) and had no association with BUA. None of the three VDR polymorphisms tested showed an association with BUA. Similarly, the analysis of VDR 3' haplotypes, estimated using rs9729 and Taq1 as tag SNPs, did not reveal any significant association with QUS traits. Our results confirm the existence of different heel QUS for women and men, as well as a tendency towards low calcium consumption by young adults, and they also suggest that the VDR gene does not play a major role in the genetic determination of QUS parameter in early adulthood.

Serum uric acid is associated with quantitative ultrasound parameters in men: data from the Camargo cohort

This study analyzes the association between serum uric acid levels and heel quantitative ultrasound (QUS) parameters in men aged 50 or more from the Camargo cohort. We found that higher serum uric acid levels are positively associated with all QUS measurements, suggesting a better bone quality in men with elevated serum uric acid values.

INTRODUCTION

Higher serum uric acid concentrations have been associated with higher bone mineral density and lower prevalence of fractures. However, there are no studies that have assessed the bone quality properties in Caucasians. Therefore, we have analyzed the association between quantitative ultrasound (QUS) and serum uric acid levels in adult men from a population-based cohort.

METHODS

A total of 868 men older than 50 were recruited from a larger cohort (Camargo Cohort) after excluding those with any known condition or drug treatment with a possible influence on bone metabolism, or those with a previous diagnosis of gout or taking hipouricemic agents. Bone turnover markers (PINP and CTX), 25OH-vitamin D and PTH levels were measured by electrochemiluminiscence. BMD was determined by DXA, and heel QUS with a gel-coupled device.

RESULTS

Lumbar, femoral neck and total hip BMD was significantly higher in men with higher serum uric acid levels. QUS parameters were also significantly higher in men with high uric acid levels than those with lower values, and increased continuously across quartiles after adjustment for confounding variables. In multiple regression analysis, serum uric acid was significantly associated with all QUS parameters. Finally, men with serum acid levels above median showed higher values in all the QUS parameters than men with lower values.

CONCLUSIONS

Higher serum uric acid levels in men older than 50 years are positively associated with QUS parameters. These data might suggest a better bone quality in men with elevated serum uric acid values.

The influence of genetic variability and proinflammatory status on the development of bone disease in patients with Gaucher disease

Gaucher disease, the most common lysosomal storage disorder, is caused by β-glucocerebrosidase deficiency. Bone complications are the major cause of morbidity in patients with type 1 Gaucher disease (GD1). Genetic components strongly influence bone remodelling. In addition, chronic inflammation produced by Gaucher cells induces the production of several cytokines, which leads to direct changes in the bone remodelling process and can also affect the process indirectly through other immune cells. In this study, we analysed the association between bone mineral density (BMD), bone marrow burden score, and relevant genetic polymorphisms related to bone metabolism, as well as profiles of proinflammatory cytokines in a GD1 cohort. This study included 83 patients distributed according to bone status. BMD was measured with DXA and broadband ultrasound attenuation; bone marrow involvement was evaluated using MRI. We also analysed 26 SNPs located in 14 genes related to bone metabolism. To assess proinflammatory status, we analysed IL-4, IL-6, IL-7, IL-10, IL-13, MIP-1α, MIP-1β, and TNFα in plasma samples from 71 control participants and GD1 patients. SNP genotype proportions and BMD differed significantly between ESRI c.453-397T>C and VDR c.1024+283G>A variants. We also observed significant associations between GD1 genotypes and bone affectation. When patients were stratified by spleen status, we observed significant correlations between non-/splenectomized groups and Spanish MRI (S-MRI) score. Across genotype proportions of non-/splenectomized patients and S-MRI, we observed significant differences in ESRI c.453-397T>C, VDR c.-83-25988G>A, and TNFRSF11B c.9C>G polymorphisms. We observed different significant proinflammatory profiles between control participants, treatment-naïve patients, and patients on enzyme replacement therapy (ERT); between non-/splenectomized patients (between untreated and ERT-treated patients) and among those with differing GBA genotypes. The data suggest that patients with GD1 have increased susceptibility to developing bone disease owing to the coexistence of genetic variants, and that genetic background in GD1 is fundamental to regulate the impact of proinflammatory status on the development of bone disease.

Quantitative ultrasound measurements of the calcaneus and hand phalanges in elderly Spanish men: relationship with peripheral bone mineral density of the hand phalanges

OBJECTIVES

The aims of this pilot study were to describe quantitative ultrasound (US) measurements and peripheral bone mineral density (BMD) of the hand phalanges on dual-energy x-ray absorptiometry and to examine the correlations between them in elderly Spanish men.

METHODS

We studied 199 healthy men (mean age ± SD, 73.31 ± 5.10 years). The participants were not taking any medications, and they reported no diseases, including diseases that are associated with abnormalities in mineral metabolism. Phalangeal and calcaneal quantitative US measurements and phalangeal BMD measurements were performed in all participants.

RESULTS

A bivariate correlation analysis showed no association between quantitative US assessments at the phalanges or the calcaneus (P = .409). After adjustment for potential confounders, the correlation between phalangeal BMD and phalangeal quantitative US measurements was r = 0.417 (P < .0001), and the correlation for calcaneal quantitative US was r = 0.26 (P = .001). Further adjustment by percentage of body fat increased quantitative US correlations with phalangeal BMD: r = 0.450 (P < .0001) at the phalanges; r = 0.291 (P = .001) at the calcaneus.

CONCLUSIONS

There is a small correlation between quantitative US measurements at the calcaneus and phalangeal BMD that increases to a moderate level with quantitative US measurements at the phalanges in elderly Spanish men.

Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS)

BACKGROUND

Poverty is associated with a great number of diseases, but the prevalence of vitamin D deficiency, secondary hyperparathyroidism and the potential association of osteoporosis, osteoporotic fractures and metabolic syndrome in this situation are less well known.

OBJECTIVE

To evaluate the associations between poverty, bone density, fragility fractures and metabolic syndrome in a population of southern European postmenopausal women. Also, to assess the potential role of vitamin D and parathyroid hormone (PTH) levels in these associations.

METHOD

Cross-sectional study was carried out in 1 250 postmenopausal Caucasian Spanish women. The socio-economic status of the participants was determined after a personal interview, according to the criteria of the Spanish Institute of Statistics. Participants were divided into two socio-economic levels: low (poverty) and medium or high socioeconomic level. The study protocol included a health questionnaire, a complete physical examination, lateral radiograph of the dorsal and lumbar spine and measurement of bone mineral density (BMD) at the lumbar spine (L2-L4) and proximal femur. Fasting blood was obtained to measure 25-hydroxy-vitamin D (25-OHD), intact PTH and selected biochemical variables.

RESULTS

Low socio-economic status was associated with 25-OHD insufficiency, higher values of PTH, higher body weight and body mass index (BMI), lower values of BMD at the lumbar spine and a higher prevalence of fragility fractures, both vertebral and nonvertebral. Poverty was also associated with higher prevalence of metabolic syndrome, but this association was driven mainly by the higher BMI and not by poverty itself. Both vitamin D insufficiency and elevated PTH were consistently related to poverty and osteoporotic fractures.

CONCLUSIONS

Poor postmenopausal women in southern Europe have a high prevalence of metabolic syndrome and osteoporotic fractures. Poverty was associated with higher BMI and metabolic syndrome on the one hand and, on the other, with 25OHD insufficiency, higher PTH levels and osteoporosis. 25OHD insufficiency and/or secondary hyperparathyroidism do not have a significant influence on the presence of metabolic syndrome in this population.

Calcaneal ultrasound reference ranges for Australian men and women: the Geelong Osteoporosis Study

Heel ultrasound is a more portable modality for assessing fracture risk than dual-energy X-ray absorptiometry and does not use ionising radiation. Fracture risk assessment requires appropriate reference data to enable comparisons. This study reports the first heel ultrasound reference ranges for the Australian population.

INTRODUCTION

This study aimed to develop calcaneal (heel) ultrasound reference ranges for the Australian adult population using a population-based random sample.

METHODS

Men and women aged≥20 years were randomly selected from the Barwon Statistical Division in 2001-2006 and 1993-1997, respectively, using the electoral roll. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were measured at the heel using a Lunar Achilles Ultrasonometer. Gender-specific means and standard deviations for BUA, SOS and SI were calculated for the entire sample (men 20-93 years, n=1,104; women 20-92 years, n=914) and for participants aged 20-29 years (men, n=157; women, n=151). Associations between ultrasound measures and age were examined using linear regression.

RESULTS

For men, mean±standard deviation BUA, SOS and SI were 118.7±15.8 dB/MHz, 1,577.0±43.7 m/s and 100.5±20.7, respectively; values for women were consistently lower (111.0±16.4 dB/MHz, P<0.001; 1,571.0±39.0 m/s, P=0.001; and 93.7±20.3, P<0.001, respectively). BUA was higher in young men compared with young women (124.5±14.4 vs 121.0±15.1 dB/MHz), but SOS (1,590.1±43.1 vs 1,592.5±35.0 m/s) and SI (108.0±19.9 vs 106.3±17.7) were not. The relationships between age and each ultrasound measure were linear and negative across the age range in men; associations were also negative in women but non-linear.

CONCLUSION

These data provide reference standards to facilitate the assessment of fracture risk in an Australian population using heel ultrasound.

Bone quantitative ultrasound measurements in relation to the metabolic syndrome and type 2 diabetes mellitus in a cohort of elderly subjects at high risk of cardiovascular disease from the PREDIMED study

OBJECTIVE

The aim of this study is to determine whether metabolic syndrome, its individual components, or the presence of type 2 diabetes mellitus are associated with a better bone status estimated by quantitative ultrasound at the calcaneus.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinics.

PARTICIPANTS

251 elderly subjects at high cardiovascular risk from the PREDIMED study were included.

MEASUREMENTS

MetS was defined according to the ATPIII diagnosis criteria. Calcaneus quantitative ultrasound (QUS) assessment was performed using the Sahara system.

RESULTS

Subjects with MetS showed significantly lower 24-hour urinary deoxypyridinoline/creatinine (u-DPD/creatinine) levels and higher broadband ultrasound attenuation, and a tendency to higher bone mineral density (BMD) and quantitative ultrasound index (QUI) than their counterparts. Individuals with type 2 diabetes mellitus (T2DM) showed a significantly higher bone broadband ultrasound attenuation (BUA) and QUI than their non-diabetic counterparts, despite they shown a higher prevalence of osteoporotic fractures. Multiple linear regression analyses showed that quantitative ultrasound parameters were positively associated with the metabolic syndrome and T2DM. Of the bone biochemical markers, only u-DPD/creatinine was related to MetS, abdominal obesity, hypertriglyceridemia component of the MetS, and the number of features that define the MetS.

CONCLUSION

This is the first study showing a positive association between MetS or T2DM with better bone status and lower bone resorption markers measured by quantitative ultrasound. Our results suggest that metabolic abnormalities have a positive effect on healthy bone in elderly subjects at high risk of cardiovascular disease.

Discriminative ability of heel quantitative ultrasound in postmenopausal women with prevalent low-trauma fractures: application of optimal threshold cutoff values using CART models

Quantitative ultrasound (QUS) of the heel has been proposed as a screening tool to evaluate the bone status and risk of osteoporotic fragility fractures. The aim of this study was to define threshold values of QUS that would maximize the predictive ability of this technique to discriminate subjects with fragility fractures. A cross-sectional analysis was made of a cohort of 1132 postmenopausal women with a mean age of 58 yr. A total of 361 women (31.9%) presented with a history of osteoporotic fracture. Most fractures (74.1%) were nonvertebral. For all patients, a questionnaire of osteoporosis risk factors and measurements of the heel QUS and bone mineral density at the lumbar spine and the proximal femur obtained by dual-energy X-ray absorptiometry (DXA) were assessed. Spinal radiographs were assessed for fractures and historical nonvertebral fragility fractures. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operator characteristic (ROC) curve QUS values were calculated using the optimal threshold identified in the classification and regression trees (CART) models. Cutoff values calculated from the best CART model (i.e., a quantitative ultrasound index (QUI) greater than 88.5% in women aged 58 yr or older) yielded 88.8% (95% confidence interval [CI]: 81.4-93.5) for sensitivity, a negative predictive value of 93.8 (95% CI: 89.4-96.4), and 70.4% (95% CI: 64.6-75.7) for specificity. This cutoff value would obviate the need to perform DXA in 43.1% of the population. The area under the ROC curve of the best model was 0.8363 (95% CI: 0.8249-0.8477). In conclusion, QUS was shown to discriminate between women with and without a history of fragility fracture and constitutes a useful tool for assessing fracture risk. The application of decision trees (CART analyses) was helpful to define the optimal threshold QUS values.

Dietary vitamin K intake is associated with bone quantitative ultrasound measurements but not with bone peripheral biochemical markers in elderly men and women

BACKGROUND

Vitamin K may have a protective role against bone loss and osteoporotic fractures associated to aging, although data in humans are inconsistent and the mechanisms involved are still unknown. The main objective of the study was to assess the associations between vitamin K intake, bone density, bone structure quality and biochemical bone metabolism markers in elderly subjects. We also analyzed the relationship between changes in vitamin K intake and the evolution of bone quality markers after two years of follow-up.

METHODS

Cross-sectional analysis was carried out on 365 elderly subjects, 200 of whom were also included in a 2-year longitudinal follow-up study. Usual dietary intakes were assessed using a semi-quantitative 137-item food frequency questionnaire (FFQ). Vitamin K intake was estimated using the USDA database. Bone biochemical markers were measured in a subset of 125 subjects. Quantitative ultrasound assessment (QUS) was performed at the calcaneus to estimate bone mineral density (BMD), speed of sound (SOS), broadband ultrasound attenuation (BUA) and the quantitative ultrasound index (QUI).

RESULTS

Dietary intake of vitamin K was significantly associated with higher BMD and better QUS. No significant associations were found between vitamin K intake and bone biochemical markers. Those subjects who increased their vitamin K intake showed a lower loss of BMD, a lower decrease in SOS and a nonsignificant increase in BUA.

CONCLUSIONS

High dietary vitamin K intake was associated with superior bone properties. Moreover, an increase in dietary vitamin K was significantly related to lower losses of bone mineral density and smaller increases in the porosity and elasticity attributed to aging, which helps to explain the previously described protective effect of vitamin K intake against osteoporotic fractures.

Association between alcohol consumption and bone strength in Korean adults: the Korean Genomic Rural Cohort Study

Previous studies have reported an inconsistent relationship between alcohol consumption and bone health. A growing body of research has shown that chronic alcoholism leads to osteopenia and increased incidence of skeletal fractures, but some studies have concluded that alcohol consumption may be associated with higher bone mineral density in elderly populations. However, most studies showing a significant relationship between alcohol consumption and bone status have been in Western countries; and subjects have usually been postmenopausal women. The purpose of the present study was to investigate the association of alcohol consumption with bone strength in Korean adults. Data were from the Korean Genomic Rural Cohort Study, which is an ongoing population-based study of adults aged 40 to 70 years from 5 regions. A total of 7713 participants (3368 men, 4345 women) were surveyed about their annual consumption of alcohol such as soju, beer, makkolli, wine, and whisky. Bone strength was measured by stiffness index using the calcaneal quantitative ultrasound method. Overall, the annual age-specific decrease rate in the stiffness index of women was 2.7 times higher than that of men (0.463% for women, 0.169% for men).After adjustment for eligible covariates, the association between alcohol consumption and risk of reduced bone strength showed a J-shaped curve for both men and women. Compared with nondrinkers, the relative risk of reduced bone strength was 0.52 (95% confidence interval, 0.33-0.83) in men who drank 4 to 5 cups of soju for an amount of 29.626 to 49.375 g of alcohol per day and 0.61 (95% confidence interval, 0.38-0.86) in men who drank 6 to 7 cups of soju for an amount of 49.376 to 69.125 g of alcohol per day. We found no significant relationship between alcohol consumption and bone strength in any other group of men. For women, results suggested that the risk of reduced bone strength was lower in the moderate-consumption group; but no significant relationship was found between alcohol consumption at any level and bone strength. Among Korean adults, alcohol consumption has a J-shaped relationship with risk of reduced bone strength.

Vitamin D deficiency and high serum levels of vitamin A increase the risk of osteoporosis evaluated by Quantitative Ultrasound Measurements (QUS) in postmenopausal Spanish women

OBJECTIVES

Association between vitamin D deficiency and excess of vitamin A as a potential risk factor of osteoporosis and fracture has been evaluated.

DESIGN AND METHODS

232 healthy postmenopausal women were studied. Serum parameters were analyzed by standard methods and fat-soluble vitamins by an own HPLC method. QUS measurement of the calcaneal bone was carried out by Sahara.

RESULTS

124 patients were considered non-osteoporotic and 101 (44.9%) were osteoporotic. The prevalence of high serum levels of retinol was 36.4% and vitamin D deficiency was 70.1%. 60.4% of women with vitamin D deficiency have high serum levels of retinol. In the whole population, the increased risk of osteoporosis was up to three times higher for the highest retinol quintile, as compared with the lowest retinol quintile. Whereas in women with vitamin D deficiency the risk of osteoporosis increased was up 5 times higher than women in the lowest quintile of retinol.

CONCLUSIONS

Our results show that high retinol levels together with vitamin D deficiency are hitherto an overlooked risk factor for osteoporosis.

Anthropometric and gynaecological history according to the socioeconomic status of postmenopausal women: poverty and the menopause

Background

Less advantaged social classes usually have unhealthier lifestyles and have more difficult access to health resources. In this work we study the possible association between poverty and the prevalence of obesity and oophorectomy in a population of postmenopausal women.

Design

Cross-sectional observational study.

Objective

To study in a population of postmenopausal women in poverty the possible differences in the prevalence of obesity and oophorectomy, and to compare some other gynaecological data: age at menarche, age at menopause, fertile years, number of pregnancies, breastfeeding and the use of hormonal replacement therapy (HRT).

Method

All patients were interviewed personally. A questionnaire was used to find out about their lifestyles and the medication they were taking. Their medical records were reviewed to confirm the existence of some diseases. A complete physical examination was performed with every patient. Weight and height were measured with the patient dressed in light clothes. Blood was obtained in a fasting state in order to carry out some analyses. Poverty was defined according to the Spanish National Institute of Statistics criteria.

Results

We enrolled 1225 postmenopausal women; 449 (36.6%) were under the threshold of poverty, defined by the Spanish National Institute of Statistics. Postmenopausal women in poverty had higher body mass index (29.2 ± 4.8 versus 27.0 ± 4.7 kg/m2 P < 0.001), and a higher prevalence of obesity than postmenopausal women not in poverty (44.2% versus 24.3%, P = 0.001). The prevalence of oophorectomy was also higher in women in poverty (32.7% versus 27.2%, P < 0.04). Women in poverty had had a greater number of pregnancies (3 versus 2, P = 0.001). They also showed a higher rate of breastfeeding than women in medium and high social classes (65% versus 59%, P = 0.037). There were no statistically significant differences between the groups in either the age of menopause or fertile years, nor in the use of HRT.

Conclusions

Postmenopausal women in poverty have higher levels of obesity, and also a greater prevalence of oophorectomy than women of medium and high social classes. They also presented a higher rate of breastfeeding and a greater number of pregnancies than those women not in poverty.

Influence of Lifestyle Factors on Quantitative Heel Ultrasound Measurements in Middle-Aged and Elderly Men

We examined the distribution of quantitative heel ultrasound (QUS) parameters in population samples of European men and looked at the influence of lifestyle factors on the occurrence of these parameters. Men aged between 40 and 79 years were recruited from eight European centers and invited to attend for an interviewer-assisted questionnaire, assessment of physical performance, and quantitative ultrasound (QUS) of the calcaneus (Hologic; Sahara). The relationships between QUS parameters and lifestyle variables were assessed using linear regression with adjustments for age, center, and weight. Three thousand two hundred fifty-eight men, mean age 60.0 years, were included in the analysis. A higher PASE score (upper vs. lower tertile) was associated with a higher BUA (β coefficient = 2.44 dB/Mhz), SOS (β = 6.83 m/s), and QUI (β = 3.87). Compared to those who were inactive, those who walked or cycled more than an hour per day had a higher BUA (β = 3.71 dB/Mhz), SOS (β = 6.97 m/s), and QUI (β = 4.50). A longer time to walk 50 ft was linked with a lower BUA (β = -0.62 dB/Mhz), SOS (β = -1.06 m/s), and QUI (β = -0.69). Smoking was associated with a reduction in BUA, SOS, and QUI. There was a U-shaped association with frequency of alcohol consumption. Modification of lifestyle, including increasing physical activity and stopping smoking, may help optimize bone strength and reduce the risk of fracture in middle-aged and elderly European men.

Serum lipids and bone metabolism in Spanish men: the Camargo cohort study

There is growing evidence of a link between lipid and bone metabolism, although data on this association in European men are scarce. This cross-sectional study from a community-based prospective cohort aims to explore the association of serum lipids with different aspects of bone metabolism in Spanish men. Demographic and anthropometric measurements, biochemical parameters including serum lipids, bone remodelling markers and calciotropic hormones, bone mineral density (BMD) assessed by dual X-ray absorptiometry and heel quantitative ultrasound, and prevalent vertebral and non-vertebral fractures, were evaluated in 289 men. Calciotropic hormones or bone markers were not associated with serum lipids. Serum total (TC) and LDL cholesterol, as well as LDL/HDL ratio were positively correlated to BMD at lumbar spine and hip. No significant correlation was noted for triglycerides or HDL. We observed a positive association between triglycerides, LDL/HDL ratio and BUA, and between TC/HDL ratio and both, QUI and BUA. BMD at the femoral neck and total hip was significantly higher in men with hypercholesterolemia after controlling for all the covariates (p=0.007). We did not observe any association between serum lipids and prevalent vertebral fractures. However, we found that TC (p=0.03) and LDL (p=0.04) were lower in subjects with non-vertebral fractures. In conclusion, we have found that a more unfavorable lipid profile (mainly higher LDL-C levels) is associated with higher BMD at lumbar spine and hip in Spanish men. Moreover, we did not observe any association between hypercholesterolemia and prevalent vertebral fractures, but we found lower serum TC and LDL-C levels in men with prevalent non-vertebral fractures.

[Lifestyle, socioeconomic status and morbidity in postmenopausal women with grade II and III obesity]

BACKGROUND

Obesity has become a major public health problem in all western countries, and its prevalence is increasing. This condition is associated with a higher prevalence of diabetes mellitus, hypertension, and coronary heart disease; furthermore, obesity is a risk factor for mortality.

OBJECTIVE

To study the association of some prevalent diseases (diabetes mellitus, thyroid disease, obesity, hypertension, inflammatory rheumatic disease, urolithiasis), the distribution of some lifestyle factors (tobacco, alcohol and caffeine consumption and physical activity during leisure time) and the prevalence of poverty in a population of postmenopausal women in the Canary Islands with obesity class II or III (BMI>35).

METHOD

A personal interview was performed in all patients. A questionnaire was administered to assess their lifestyles and current medication use. The women's medical records were reviewed to confirm the existence of certain diseases. A complete physical examination was performed in all patients. Weight and height were measured with the patient dressed in light clothing. Blood samples were obtained with the patient in a fasting state for subsequent analysis. Poverty was defined according to the criteria of the Spanish National Institute of Statistics.

RESULTS

Women with obesity class II or III were older (56.8+/-11 vs 53.9+/-11.6 years, p=0.02), shorter (153.7+/-6.3 vs 156.9+/-36.1 cm, p=0.001), heavier (89.6+/-9.3 vs 66.6+/-10.4 kg, p=0.001) and had a greater body surface than controls (1.73+/-0.13 vs 1.54+/-0.13 m2, p=0.001). Alcohol and tobacco consumption were lower in obese women than in controls. Obese women drank more coffee and took less physical activity during leisure time than controls. The prevalence of hypertension -36% vs 17.9%, p=0.001, odds ratio [OR] [95% confidence interval (IC)]=2.57 (1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%, p=0.001, OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs 8%, p=0.04; OR=1.91 (0.99-3.68)-was higher in obese women than in controls. More than half lived in rural areas and were below the poverty threshold.

CONCLUSIONS

More than half of postmenopausal women with obesity class II or III were below the poverty threshold and lived in a rural area. In these women there was a lower consumption of alcohol and tobacco, lesser physical activity during leisure time, and a higher prevalence of diabetes mellitus, hypertension and hypothyroidism than in control postmenopausal women.

Poverty is a risk factor for osteoporotic fractures

This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures.

INTRODUCTION

Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures.

METHODS

This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <-2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2-L4) and proximal femur.

RESULTS

Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm(2) vs. 0.867 g/cm(2), p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81).

CONCLUSIONS

Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women.

Bone mineral density and risk of fractures in aging, obese post-menopausal women with type 2 diabetes. The GIUMO Study

BACKGROUND AND AIMS

Type 2 diabetes mellitus (DM) has a high prevalence in aging obese postmenopausal women. It is not clear whether or not diabetes produces an increase in bone mineral density or an increase in fracture rates.

OBJECTIVE

The main objective of this study was to investigate whether type 2 DM produces a higher prevalence of vertebral, hip and non-vertebral fractures in obese postmenopausal Caucasian women. A secondary objective was to study the influence of DM in quantitative ultrasound measurements of the heel (QUS) and bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA), in both lumbar spine (L2-L4) and proximal femur.

METHOD

This study was a prospective cohort of 111 patients with type 2 DM and 91 control individuals (CTR) over age 65 and obese, recruited from 16 centers in Spain.

MAIN OUTCOME MEASURES

Lateral dorsal and lumbar X-rays were performed to assess vertebral fractures. Hip and non-vertebral fractures were noted from medical records, written reports or Xray studies. QUS measurements were made of the calcaneus and BMD measurements of the lumbar spine (L2-L4) and proximal femur.

RESULTS

Patients had higher BMD in the lumbar spine (L2-L4) than controls (0.979 g/cm2 vs 0.927 g/cm2, p=0.035), but we found no statistically significant differences in the proximal femur. QUS measurements showed similar values in both groups: BUA (69.3 dB/Mhz vs 66.7 dB/Mhz, p=0.291), SOS (1537 m/sg vs 1532 m/sg, p=0.249) and QUI (87.5 vs 83.7, p=0.153). No statistically significant differences were found in any case. There was no association between vertebral, hip and non-vertebral fractures and DM. The crude odds ratio, without adjusting was 1.045 (CI 95% 0.531 ; 2.059), and the adjusted odds ratio was 0.927 (CI 95% 0.461 ; 1.863).

CONCLUSIONS

In obese postmenopausal Caucasian women, type 2 DM produces an increase in BMD of the lumbar spine without changes in BMD of the proximal femur or in QUS measurements of the heel. The prevalence of vertebral, hip and non-vertebral fractures did not increase in type 2 DM.

Relationship between bone quantitative ultrasound and mortality: a prospective study

In a cohort of 5,201 women [72.3 +/- 5.3 years] from 58 primary care centers in Spain, followed for three years, no relationship between heel QUS parameters and overall mortality was found. However, a significant relationship between a low speed of sound (SOS) and vascular mortality was observed.

INTRODUCTION

An inverse relationship between mortality and bone mineral density measured by dual-energy absorption densitometry or quantitative bone ultrasound (QUS) has been described. The aim of the present study was to test this relationship in the ECOSAP cohort, a 3-year prospective study designed to assess the ability of heel QUS and clinical risk factors to predict non-vertebral fracture risk in women over 64.

METHODS

A cohort of 5,201 women [72.3 +/- 5.3 years] was studied. QUS was assessed with the Sahara(R) bone sonometer. Women attended follow-up visits every 6 months. Physicians recorded if the patient died and cause of death. Hazard rates (HR) of all-cause and vascular mortality per one standard deviation reduction in QUS parameters were determined.

RESULTS

One hundred (1.9%) women died during a median of 36.1 months follow-up, for a total of 14,999 patient-years, 42 because of vascular events (both cardiovascular and cerebrovascular). After adjusting for age, none of the QUS variables showed statistically significant differences between the patients who died and the survivors. In the final multivariate model, adjusted for age, current thyroxine and hypoglycaemic drug use, chronic obstructive pulmonary disease and decreased visual acuity, SOS was marginally non-significant: (HR: 1.19; 0.97-1.45). However, each 1 SD reduction in SOS was associated with a 39% increase in vascular mortality (HR: 1.39; 1.15-1.66).

CONCLUSIONS

In our cohort, SOS was related with vascular mortality, but not overall mortality.

Defining cut-off values for the diagnosis of osteoporosis in postmenopausal women by quantitative ultrasonography of the phalanx

AIM

Quantitative ultrasound (QUS) of the phalanx is a non-invasive, inexpensive and portable method for bone assessment. We determined a cut off point for it in the diagnosis of osteoporosis.

METHODS

In 180 postmenopausal women, dual-energy X-ray absorptiometry (DEXA) of the spine and femur and QUS of the phalanx were performed. Then, the optimum cut-off point for QUS was determined.

RESULTS

Osteoporosis was found in 28.8% of women by DEXA (18.3% in L2-L4, 3.9-7.8% in different regions of the femur) and in 28.9% by QUS. Agreement of the methods (kappa value) was 0.317 for spine and 0.036-0.068 for femoral regions. Using receiver-operating characteristic (ROC) curves, we found T-score of -2.0 as the optimum cut-off point of QUS in diagnosing osteoporosis in the spine (sensitivity and specificity were 78.8% and 55.9%, respectively). We did not find a cut-off point for femoral regions because the 95% confidence interval of the area under the ROC curve contained the diagonal line (p = 0.150, 0.179 and 0.05 for femoral neck, trochanter and total femur, respectively). We defined -2.5 as the other T-score cut-off point under these different conditions; more specificity is needed.

CONCLUSION

Agreement was weak to moderate between the two methods. Thus QUS of the phalanx is not a good replacement for DEXA in defining osteoporosis, but it may be used as a screening method.

Reference data for quantitative ultrasound values of calcaneus in 2927 healthy Chinese men

Quantitative ultrasound (QUS) is a bone densitometry technique that is rapidly gaining popularity for the assessment of bone status. However, few QUS data are available for men, especially in China. In the present study, a random stratified sample of 2927 Chinese men (10-90 years) was recruited, and bone status was established using measurements by Achilles ultrasonometer. The peak stiffness index (SI) value for Chinese men was 103.0 +/- 20.8, which presented in the age group of 20-24 years. Pearson correlation analysis showed that there was significant correlation between SI and age (P < 0.001), and multivariate regression analysis indicated that weight was also an important factor for SI. In addition, in comparison with the normal data of Italian and Japanese males, the SI value for Chinese males in each age group was lower than those of Italians but higher than Japanese, except for the 20-29 years age group. The descending velocity of curves for Chinese men was lower than that of Italian and Japanese men. In conclusion, QUS values of the calcaneus provided by the present study may be used as normal reference values for Chinese men.

Quantitative ultrasound calcaneous measurements: normative data for the Italian population. the ESOPO study

Quantitative ultrasound (QUS) is a reliable technique to evaluate skeletal status, to identify osteoporotic subjects, and to estimate the risk of fractures. The purpose of this study was to generate QUS normative data for Italian females and males aged 60-79 yr participating in the Epidemiologic Study on the Prevalence of Osteoporosis (ESOPO) study, using the Achilles Plus apparatus. ESOPO is a cross-sectional study conducted in 2000, aiming at assessing risk of osteoporosis in a random sample of 11,011 women and 4981 men, representative of the Italian population. All participants were administered a questionnaire on the most relevant risk factors for osteoporosis and fractures; 3 QUS parameters were also measured: broadband ultrasound attenuation (BUA); speed of sound (SOS); and Stiffness Index (SI). We studied the age-dependent changes in QUS values, and their correlation with body size. For both men and women, weight was the variable with the highest correlation with BUA and SI; for SOS, age among women and body mass index (BMI) among men presented the highest correlation coefficients. Average decreases of 3.0% in BUA, 0.8% in SOS, and 9.1% in SI from 60 to 79 yr were detected for females, whereas no significant changes with age in males were observed. Our data show lower QUS values for women, and a decline at a greater rate than in men.

More acidic dietary acid-base load is associated with reduced calcaneal broadband ultrasound attenuation in women but not in men: results from the EPIC-Norfolk cohort study

BACKGROUND

Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone density.

OBJECTIVE

We investigated the relation between a measure of dietary acid-base load, potential renal acid load (PRAL), and calcaneal broadband ultrasound attenuation (BUA) after adjustment for confounders and also compared the results with different estimates of acid-base load.

DESIGN

A cross-sectional study was conducted in 14 563 men and women aged 42-82 y living in Norfolk, United Kingdom, in which measures of calcaneal BUA and dietary PRAL were estimated by using the European Prospective Investigation into Cancer and Nutrition Norfolk (EPIC-Norfolk) food-frequency questionnaire.

RESULTS

A more acidic dietary intake (high PRAL) was significantly associated with lower calcaneal BUA in women but not in men; there was a difference of approximately 2% in BUA between the highest and lowest quintiles of PRAL, independent of age, body mass index, smoking habit, physical activity, diagnosed osteoporosis, and history of fracture, and (in women) hormone replacement therapy. No relation was observed between history of fracture or incident fracture and PRAL. Those with the greatest PRAL had higher intakes of meat, fish, eggs, and cereal and cereal products and lower intakes of fruit and vegetables, tea, and coffee.

CONCLUSION

PRAL was inversely associated with bone ultrasound measures in women, but the magnitude of the association was relatively small compared with other known risk factors. Further longitudinal studies are required to establish whether, in the long term, these small effects are important in overall fracture risk in populations.

Identifying osteoporosis in a primary care setting with quantitative ultrasound: relationship to anthropometric and lifestyle factors

Dual-energy X-ray absorptiometry (DXA), the "gold standard" for diagnosis of osteoporosis, is not recommended for population screening, and thus quantitative ultrasound (QUS) of the calcaneus is gaining popularity. The aim of the present study was to evaluate the relationship between QUS values and anthropometric and lifestyle factors, and to assess the diagnostic performance of QUS in predicting DXA-defined osteoporosis. Eight hundred and thirty-two women and 87 men aged 40-88 years were included in the study. Anthropometric measurements, the questionnaire, and QUS and DXA measurements were performed by trained physicians. Both QUS and DXA T-scores were lower for women than for men. Postmenopausal women had significantly lower QUS T-scores compared to premenopausal women (P < 0.001). Age over 50, female sex, sedentary lifestyle, fracture history, presence of chronic disease, and > or =5 years since menopause were associated with QUS T-scores lower than -1.00 by multivariate analysis. Low QUS T-scores were related to lack of direct sun exposure, high parity, fair skin color, and no education by univariate analysis (P < 0.005). A weak correlation was found between calcaneal QUS and DXA T-scores at lumbar spine (r = 0.310, P < 0.001) and femoral neck (r = 0.288, P < 0.001). The sensitivity and specificity of the QUS test were 73.7% and 57.4%, respectively, regarding the identification of osteoporotic patients. Lower QUS T-scores were associated with several osteoporotic risk factors, and the sensitivity and specificity of QUS for predicting DXA-defined osteoporosis were at optimum values at ages between 50 and 59 years. We conclude that, even though the accuracy of QUS for predicting DXA-defined osteoporosis is not remarkably high, it can be applied to identify subjects at risk in this age group in developing countries and rural districts who should be the focus of fracture prevention.

Comparison of the femoral neck bone density, quantitative ultrasound and bone density of the heel between dominant and non-dominant side

Our study was initiated to evaluate whether there are differences between the two sides, depending on hand dominance, in densitometry values and quantitative ultrasound parameters (QUS) of the lower limb. One hundred and six women and 44 men were involved. The hand dominance was determined by interview. The bone mineral density (BMD) of the left and the right femoral necks and the calcanei were measured by dual-energy X-ray absorptiometry (DXA). The QUS examination consisted of measuring the attenuation (BUA), the speed of the ultrasound (SOS) and quantitative ultrasound index (QUI) transversing the left and right calcanei. The density of the neck of femur of the non-dominant side did not differ from that of the dominant side. On the other hand, BMD, BUA and the QUI of the calcaneus were higher on the non-dominant side in both genders (p<0.05 for each parameter). No similar differences were seen for the SOS values. Our study has confirmed the side-to-side differences of the calcaneus in both genders, lower values were found on the dominant side. No similar differences were seen on the femur. The AUC values seemed to be higher on the dominant side, however, these differences were not strictly significant. In the case of peripheral site (heel) measurements, the practical significance of our observations is that they raise the possibility of performing peripheral DXA and QUS examinations of the calcaneus on the dominant side of the patient according to handedness.

Quantitative ultrasound of the calcaneus in long-term liver or cardiac transplantation patients

Bone loss is one of the most common complications after solid-organ transplantation, but it is frequently under-diagnosed. Our purpose was to evaluate quantitative ultrasound of calcaneus (QUS) in comparison with dual-energy X-ray absorptiometry (DXA) to identify transplant recipients with osteoporosis. We have cross-sectionally evaluated 140 transplant recipients (85 liver and 55 cardiac transplantations; mean age: 53.6 years, time since transplantation: 67.9 months). Devices used were Hologic 4500 QDR for DXA measurements and Sahara Clinical Sonometer (Hologic Inc, Bedford, MA) for calcaneal QUS. Quantitative ultrasound index (QUI) was calculated from speed of sound (m/s) and broadband ultrasonic attenuation (dB/MHz). QUI T-score and bone mineral density (BMD) T-score (spine and hip) were obtained from Spanish normative data. According to World Health Organization criteria, defined either at lumbar spine or femoral neck, 61% of the females had osteopenia and 32% had osteoporosis, whereas 52% of the males had osteopenia and 11% had osteoporosis. Calcaneal QUS parameters (speed of sound, broadband ultrasonic attenuation, and QUI) were positively correlated with lumbar and femoral BMD (p<0.001). In receiver operator characteristic analysis, a T-score QUI<or=-1.4 standard deviation (SD) had 68% sensitivity and 72% specificity for osteoporosis diagnosis by DXA criteria. However, to obtain maximal sensitivity (5% of false-negative), QUI T-score cutoff should be -0.6 SD, but specificity drops to 42%. In conclusion, a positive correlation exists between lumbar and femoral BMD and QUS parameters in long-term liver or cardiac transplant recipients. QUS could be recommended for screening of osteoporosis in long-term transplanted patients.

Assessment of low quantitative ultrasound values of calcaneus in Chinese mainland women

Calcaneus quantitative ultrasound (QUS) assessment is a safe and reliable method for evaluating skeletal status. Until now, considerable data have been accumulated on the distribution of QUS in Caucasian populations, whereas such data are still insufficient in Asian populations, especially in Chinese mainland. The present study aimed to obtain the distribution characteristic of calcaneus QUS in healthy Chinese women, and to further investigate the distribution of low bone mass by QUS stiffness index (SI). This study included 2,498 healthy Chinese females aged 10-87 yr. The QUS exhibited a characteristic mild rise and then fall pattern with increasing age. Age, body height, and weight were significant influencing factors on SI, especially age and weight. The prevalence of osteoporosis detected using instrument-derived T-score or internal T-score was different from that calculated according to calcaneus bone mass density (BMD) previously reported. Furthermore, between instrument-derived T-scores and internal T-scores, there were also significant differences. We concluded that the World Health Organization criteria from BMD may not be appropriate for QUS, and the instrument-derived T-score may also not be appropriate for the studied population. The results will be useful for predicting fracture risk of Chinese women and determining diagnostic criteria of osteoporosis by QUS.

Quantitative calcaneal ultrasonometry: normative data and age-related changes for stiffness index in the Turkish population

The aim of this cross-sectional study was to define the normative data for stiffness index in a large sample of Turkish population and to clarify sex differences as well as age-related changes. A total of 10,435 subjects (aged 18-89 yr) were screened with calcaneal ultrasound and were requested to complete a detailed questionnaire listing all important risk factors, diseases, and treatments affecting bone metabolism. To be included in the study, subjects had to be free of any disease and any medical treatment known to affect bone metabolism. A total of 8,156 subjects (1,389 males and 6,767 females) were included in the study. Normative data was expressed using two statistical models including mean and 95th percentile, and regression analysis. The mean value of stiffness index in females peaked in the third decade, whereas in males it peaked in the age group of 18-29 yr. The stiffness index of females decreased by 24.26%. The total age-related decrease was 17.8% for stiffness index in the males. Stiffness index in males was a function of age (negatively) and body mass index (positively). Stiffness index in females was a function of age (negatively) and weight (positively). The results of this study could be useful as a guide for comparing the data of individual studies and may serve as reference normative data for the Turkish population.

Inhaled steroids do not decrease bone mineral density but increase risk of fractures: data from the GIUMO Study Group

Although the negative effect of systemic steroids on bone is well documented, there is not clear evidence about possible adverse effects of inhaled steroids on bone metabolism and fractures. A cross-sectional study was performed on 105 women suffering from bronchial asthma treated with inhaled steroids and 133 controls. Bone mineral density (BMD) was measured by quantitative ultrasonography (QUS) at the calcaneus and by dual X-ray absorptiometry (DXA), at both the lumbar spine and proximal femur. Patients suffering from bronchial asthma showed no statistically significant changes in BMD as measured by DXA or QUS, compared with controls. A higher prevalence of fractures was found in the group of women with bronchial asthma, with an age-adjusted odds ratio of 2.79 (95% CI: 1.19-6.54). Inhaled steroids do not appear to decrease BMD, but are associated with an increased risk of fracture in women.

Calcaneus ultrasound in males: normative data in the Croatian population (ECUM study)

Limited number of dual X-ray absorptiometry (DXA) devices in Croatia makes this diagnostic technique unavailable to the majority of the population. Quantitative ultrasound (QUS) of the calcaneus could be an alternative tool for assessing fracture risk. However, age-specific normative data should be obtained before using the QUS in everyday clinical practice. The aim of our Epidemiology of Calcaneus Ultrasound in Males (ECUM) study is to establish the normative QUS data in a healthy sample of Croatian males. A total of 1002 male participants, aged 20-99, recruited in different Croatian counties, were included in the study. In each subject broadband ultrasound attenuation (BUA), speed of sound (SOS) and quantitative ultrasound index (QUI) of the left calcaneus were measured using the Sahara ultrasound device (Hologic). The coefficients of variation were 2.85 for BUA, 0.37 for SOS and 2.49 for QUI. Significant declining with age was found for all three parameters, BUA (p<0.001), SOS (p<0.001) and QUI (p<0.001), with respective r values 0.14, 0.27 and 0.23. The peak SOS (1,562.8+/-28.5 m/sec) and QUI (103.6+/-16.5) values were observed in the third decade, whereas the peak BUA value (86.2+/-19.2 db/MHz) was observed in the fourth decade. A subgroup of 103 participants, aged 20-29, was used to estimate young adult mean and SD for QUI and calculate the T-scores. Using the World Health Organization diagnostic criteria the rates of osteoporosis (T-score<-2.5) in the males aged 50 and older was 5.8%. However, when we used the cut-off value of the T-score<-1.8, as previously suggested, prevalence of osteoporosis in Croatian males >50 yr was 16.2%. Although further studies might improve our understanding of the QUS role in the fracture prediction, we hope that the results presented here will improve the clinical management of osteoporosis in males.

Characteristics of calcaneus quantitative ultrasound normative data in Chinese mainland men and women

INTRODUCTION

Quantitative ultrasound (QUS) assessment at the calcaneus, as a safe and reliable method for evaluating skeletal status, is rapidly gaining in popularity. Assessment by QUS provides three parameters of skeletal status: broadband ultrasound attenuation (BUA), speed of sound (SOS) and derived data-stiffness index (STI). The objective of the present study was firstly to determine the normative QUS data on healthy Chinese mainland men and women and secondly to investigate the effects of sex, age and body size on these three QUS parameters.

METHODS

A study cohort consisting of 725 healthy Chinese women and 568 men aged 10-83 years participated in this investigation. The three QUS parameters all exhibited a characteristic mild rise-then-fall pattern with increasing age in both sexes. Younger men and women had similar QUS values, while older women had lower values than older men. Age-related differences were more pronounced among females. Pearson's correlation and regression analysis showed that weight was a major determinant of QUS in both sexes, along with age.

RESULTS

There were some discrepancies between our data and results from other populations, even when the same type of QUS instrument was used, probably as a result of various factors, including ethnic, life-style environment and diet, among others.

CONCLUSIONS

These normative data will be useful for comparing the results of individual studies, predicting fracture risk of Chinese men and women and determining diagnostic criteria of osteoporosis by QUS.

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound

BACKGROUND

It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear.

METHODS

A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device.

RESULTS

Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined.

CONCLUSIONS

Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.

Bone measurements of infants in the first 3 months of life by quantitative ultrasound: the influence of gestational age, season, and postnatal age

BACKGROUND

There are a few quantitative ultrasound (QUS) studies of bone status for Chinese children.

OBJECTIVE

To evaluate the clinical application and to investigate the bone status of neonates and young infants with QUS.

MATERIALS AND METHODS

An ultrasound bone sonometer was used to measure the bone speed of sound (SOS) of the tibia in 542 neonates within 3 months of birth.

RESULTS

At birth, no significant difference of SOS was found between boys and girls, but there was a significant difference of SOS between premature infants and full-term infants. The SOS in neonates born during spring and summer was significantly lower than those born during autumn and winter. There were significant correlations between SOS and gestational age, and between bone SOS and birth weight in appropriate for gestational age (AGA) infants. Multiple regression analysis found that gestational age and infant birth season were two important factors influencing SOS. During the first 3 months, there was no significant difference in SOS between sexes. The SOS of infants showed an inverse correlation with postnatal age, and the decrease of bone SOS with age in premature infants was more marked than in full-term infants.

CONCLUSIONS

QUS is suitable for evaluating bone status in infants with high precision. The study offers some basic data for neonates and young infants.

Contralateral differences in quantitative ultrasound of the heel: the importance of side in clinical practice

Quantitative ultrasound (QUS) of the heel is becoming increasingly popular for the assessment of skeletal status, although there appears to be a general lack of agreement regarding which side to measure. The purpose of the present study was to evaluate possible side differences (right versus left) in heel QUS within the general population, including children (10-15 years old, n=406), adults (26-33 years old, n=339), and elderly subjects (60-75 years old, n=455) of both genders (818 females and 382 males), and to examine the impact of these differences on prevalence estimates of osteoporosis and individual fracture risk assessment. All participants had both their heels measured twice with the Sahara device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS) through the os calcis; a composite parameter, that is, quantitative ultrasound index (QUI) and an estimate of heel BMD (eBMD) were also derived. Significant side differences were detected for BUA and SOS (P<0.05), but not for QUI or eBMD. Contralateral differences were rather small in absolute terms, but were in the order of 12.6% for BUA, 0.72% for SOS, 7.9% for QUI, and 9.9% for eBMD, when expressed as percentage of the mean values for the two heels. Bilateral differences appeared to vary across age and gender. Significant correlations between QUS indices of the right and left heel were observed (r=0.75-0.85; P<0.001), which seemed to be stronger among the elderly and among male individuals. Prevalence rates of osteopenia and osteoporosis were not significantly different when estimated from eBMD T-scores for the one or the other foot (chi(2)=1.781, df=2, P=0.410). However, cross-classification analysis revealed that only 84% of the subjects classified into each risk category by the two calcanei were actually the same persons. In conclusion, results from the present study strongly suggest that QUS measurements of opposite heels may not be equivalent with respect to the evaluation of bone status and classification of individual fracture risk assessment, although the degree of discrepancy appears to be related to the primary outcome of interest.

Quantitative ultrasound calcaneus measurements: normative data for the Greek population

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity, and is widely used worldwide for the assessment of skeletal status. This, however, generally occurs in the absence of adequate clinical guidelines. As accurate interpretation of the results and correct classification in individual fracture risk assessment are of great value, the present study was carried out to establish a reference database for calcaneal QUS measurements across age group and gender in Greece. A total of 1205 subjects (821 females and 384 males) from three age groups (409 children, 341 adults and 455 elderly) were recruited. QUS measurements were performed at the heel with the Sahara device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS), and then combines these variables into a single parameter, the quantitative ultrasound index (QUI). Overall, gender-related differences were more pronounced among the elderly, while age-related differences were more pronounced among females. Elderly men had higher QUS parameters than women of peer age, but no major gender differences were observed in children and adults. In males, only BUA showed a variation with age, being higher in adult and elderly men compared to boys. On the other hand, all QUS parameters varied significantly with age in females, the general trends being mildly positive from childhood to adulthood, when peak levels were observed, and negative thereafter. The results for the Greek population were in the range reported previously for other populations, but some discrepancies were evident, probably resulting from ethno-specific characteristics and different QUS instrumentation. Importantly, using the manufacturer's or the local database as the reference population for computing T-scores led to significantly different classification of subjects into conventional categories of risk. These data could be useful as a guide for comparing the results of individual studies, as well as for the assessment of Greek men and women at risk of fracture.

Postmenopausal women with colles' fracture have lower values of bone mineral density than controls as measured by quantitative ultrasound and densitometry

Measurement of ultrasonographic parameters provides information concerning not only bone density but also bone architecture. We investigated the usefulness of ultrasonographic parameters and bone mineral density (BMD) to evaluate the probability of Colles' fracture. Two-hundred eighty-nine postmenopausal women (62.3 +/- 8.7 yr) with (n = 76) and without (n = 213) Colles' fracture were studied. BMD of lumbar spine and proximal femur was evaluated in all women by dual-energy X-ray absorptiometry (DXA) and speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness in the calcaneus were measured by a Sahara ultrasonometer (Hologic). Patients suffering from Colles' fracture had lower values of BMD adjusted by height at the lumbar spine, L2-L4 (0.797 g/cm2 vs 0.860 g/cm2), femoral neck (0.685 g/cm2 vs 0.712 g/cm2 ), SOS (1518 m/sg vs 1525 m/sg), and stiffness (74.6 vs 77.7) (p < 0.05). Nevertheless, BUA values were similar in both groups. After stepwise logistic regression analysis, the area found under receiver operating characteristic (ROC) curves was 0.60 for L2L4 and 0.63 for a formula combining L2L4 and height. Our data suggest that patients suffering from Colles' fracture have lower values of BMD by DXA, SOS, and stiffness. However, the ability of these techniques to discriminate is low because the values for the area under ROC curve are 0.60 for L2-L4 and 0.63 for a formula derived of the combination of L2-L4 and height.

Allele-frequency determination of BsmI and FokI polymorphisms of the VDR gene by quantitative real-time PCR (QRT-PCR) in pooled genomic DNA samples

The vdr gene is a candidate for osteoporosis susceptibility, with conflicting results in association studies. We have designed and optimized an individual allele-specific and DNA pooling PCR-based methodology to quantitate BsmI and FokI polymorphisms of the vdr gene and studied single-nucleotide polymorphisms (SNPs) from pooled DNA samples. The allele frequency in DNA pooling experiments has been analyzed by kinetic PCR: quantitative real-time PCR (QRT-PCR). A Spanish cohort of 225 healthy postmenopausal women was studied. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound calcaneous densitometry. Allele-specific PCR amplification of BsmI and FokI genes showed full concordance with the PCR-RFLP approach. The prevalence of the three BsmI VDR genotypes was 19.1, 44.9 and 36.0% for BB, Bb and bb, respectively. In the case of the FokI locus, the prevalence of genotypes was 40.4, 48.0 and 11.6% for FF, Ff and ff, respectively. No positive correlation was found between polymorphism and BMD. The DNA pooling procedure was validated. No differences were found in allele frequencies and T-score data obtained using the high throughput DNA pooling approach, as compared to known individual frequencies. In our hands, this is a very useful approach to study quantitative (thus polygenic) traits like osteoporosis susceptibility.

[Quantitative bone ultrasound: impact of the application of two different reference databases to a population of 5.195 postmenopausal women]

BACKGROUND AND OBJECTIVE

The application of different reference databases to calculate the T-score values of the bone mineral density (BMD) using dual-energy X-ray absorptiometry techniques may result in variations in the number of subjects diagnosed with osteoporosis. There are no similar dataregarding quantitative bone ultrasound. To compare the results of the application of two different reference databases: the manufacturer's normal range and the Spanish normative data.

PATIENTS AND METHOD

Evaluation of the heel ultrasound with a Sahara sonometer in 5,195 women >= 65 year-old who were attended for any reason in primary care centers.

RESULTS

Bone ultrasound estimated BMD T-score mean values were 1.27 and 1.29 when applying the manufacturer's normal range and the Spanish normative data, respectively (p = 0.001). Percentages of women with a T-score below 2.50 standard deviations were 12.7% and 12.8% respectively.

CONCLUSIONS

The application of these two reference databases shows very similar results which, although statistically different, are clinically irrelevant.