Ultrasound of the skeleton: review of its clinical applications and pitfalls

Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases

Secondary osteoporosis is an important co-morbidity related to inflammatory rheumatic diseases that is attributed to several factors including inflammatory cytokines, inactivity and glucocorticoid treatment. Quantitative ultrasound (QUS) has been utilized in osteoporosis research due to its detectability of bone density as well as bone quality. The current narrative review is to address the potential utilities of QUS in secondary osteoporosis of inflammatory rheumatic diseases, focusing on the clinical aspects of QUS in these diseases, based on the conformity of QUS with dual emission X-ray absorptiometry (DXA), the relationship with disease characteristics, and its capability of fracture prediction. Although limited data demonstrate that QUS had moderate to strong correlation with DXA, and might be useful as a potential imaging tool to screen for osteoporosis, further research is still required for QUS to be utilized effectively for the best outcome in these patients with rheumatic diseases.

Osteoporosis and osteopathy markers in patients with mastocytosis

Objective:

Osteoporosis, osteosclerosis, and lytic bone lesions have been observed in patients with systemic mastocytosis (SM). We examined bone mineral density (BMD) biochemical turnover markers and serum tryptase levels in SM, which is considered a rare disease.

Materials and Methods:

Seventeen adult patients (5 females, 12 males; median age: 33 years, range: 20-64) with mastocytosis were included in this study. We investigated the value of quantitative ultrasound (QUS) of the calcaneus in the assessment of BMD in SM patients, as well as BMD of the lumbar spine (L1-L4), femoral neck, and distal radius using dual energy x-ray absorptiometry (DXA) and plasma tryptase levels, biochemical markers of bone turnover.

Results:

At lumbar spine L1-L4, the femoral neck, and the distal radius or as calcaneus stiffness, 12 of 17 patients had T-scores of less than -1 at least at 1 site, reflecting osteopenia. Three of 17 patients had T-scores showing osteoporosis (T-score <-2.5). There was no relationship between DXA and bone lesion severity. We also found a significant positive correlation between tryptase levels and disease severity, as well as between disease severity and pyridinoline (p<0.01 by Spearman’s test).

Conclusion:

DXA and calcaneal QUS may not be appropriate techniques to assess bone involvement in SM patients because of the effects of osteosclerosis. This study further shows that the osteoclastic marker pyridinoline is helpful in patients with severe disease activity and sclerotic bone lesions to show bone demineralization.

Saturated and monounsaturated fatty acid status is associated with bone strength estimated by calcaneal ultrasonography in Inuit women from Nunavik (Canada): a cross-sectional study

OBJECTIVE

The aim of this study is to examine the relationship between the status in selected saturated (SFAs) and monounsaturated (MUFAs) fatty acids and the Stiffness Index (SI) in Inuit women from Nunavik (Northern Quebec, Canada).

DESIGN

Cross-sectional descriptive study.

SETTING

Inuit population from 14 communities who participated to Qanuippitaa? How are we? Nunavik Inuit Health Survey in 2004.

PARTICIPANTS

187 Inuit women aged 35-72 years.

MEASUREMENTS

SI was determined by ultrasonography (Achilles InSight device) at the right calcaneus of participants. SFAs and MUFAs contents of erythrocyte membrane phospholipids were measured after transmethylation by gas chromatography coupled with a flame ionization detector. Several factors known to be associated with bone strength were concomitantly recorded. Multiple linear regression was used to investigate relations between selected SFAs, MUFAs and SI, taking into consideration several potential confounders and covariates.

RESULTS

Total SFAs, in particular behenic acid, and cis-vaccenic acid among MUFAs were negatively associated with SI (β = -0.028, SE = 0.011, p = 0.0084; β = -0.060, SE = 0.023, p = 0.0093 and β = -0.087, SE = 0.019, p <0.0001, respectively), whereas total cis-MUFAs and specifically oleic acid were positively associated with SI (β = 0.036, SE = 0.011, p = 0.0008; β = 0.037, SE = 0.011, p = 0.0014, respectively) after adjustment for several covariates.

CONCLUSION

Saturated and monounsaturated fatty acid status is associated with bone strength estimated by calcaneal SI values in Inuit women from Nunavik.

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Several studies have reported that the status in omega-3 polyunsaturated fatty acid (PUFA) and the omega-3/omega-6 PUFA ratio are positively related to bone health. This study aimed at examining the relationship between the status of different PUFAs and bone strength expressed by the stiffness index (SI) among indigenous women in northern Canada and Greenland, whose diets are rich in PUFAs compared to those of non-Aboriginals. Our study includes 118 Inuit women from Nuuk (Greenland), 195 Inuit women from Nunavik (Canada), and 249 Cree women of from East James Bay (Canada). Projects in Nunavik and in the Cree communities had a cross-sectional design and the Greenland project, a longitudinal design. The content of some PUFAs phospholipids of erythrocyte membranes was measured after transmethylation by gas chromatography coupled with a flame ionization detector. Stiffness index was measured by ultrasound at the right calcaneus with a water-bath Achilles Lunar instrument (Greenland) or an Achilles Insight instrument (Nunavik, East James Bay). Relations between SI and various PUFAs were studied using multiple linear regression analyses. Eicosapentaenoic acid (EPA) was positively and significantly associated with SI (log), even after adjustment for several confounders and covariates in all three projects. A high EPA status, resulting mainly from the consumption of fatty fish or marine mammal fat, seems to have a positive effect on bone strength measured by ultrasonography among Aboriginal women from three different populations.

Dioxin-like compounds and bone quality in Cree women of Eastern James Bay (Canada): a cross-sectional study

BACKGROUND

Aboriginal populations living in Canada's northern regions are exposed to a number of persistent organic pollutants through their traditional diet which includes substantial amounts of predator fish species. Exposure to dioxin-like compounds (DLCs) can cause a variety of toxic effects including adverse effects on bone tissue. This descriptive cross-sectional study was conducted to investigate the relationship between plasma concentrations of DLCs and bone quality parameters in Cree women of Eastern James Bay (Canada).

METHODS

Two hundred and forty-nine Cree women from seven communities in Eastern James Bay (Canada), aged 35 to 74 years old, participated in the study. In order to determine the total DLC concentration in plasma samples of participants, we measured the aryl hydrocarbon receptor-mediated transcriptional activity elicited by plasma sample extracts using a luciferase reporter gene assay. Plasma concentrations of mono-ortho-substituted dioxin-like polychlorinated biphenyls (DL-PCBs) 105, 118 and 156 were measured by gas chromatography-mass spectrometry. Bone quality parameters (speed of sound, m/s; broadband ultrasound attenuation, dB/MHz; stiffness index, %) were assessed by quantitative ultrasound at the right calcaneus with the Achilles InSight system. Several factors known to be associated with osteoporosis were documented by questionnaire. Multiple linear regression models were constructed for the three ultrasound parameters.

RESULTS

DL-PCBs 105 and 118 concentrations, but not the global DLC concentration, were inversely associated with the stiffness index, even after adjusting for several confounding factors. The stiffness index (log) decreased by -0.22% (p=0.0414) and -0.04% (p=0.0483) with an increase of one μg/L in plasma concentrations of DL-PCB 105 and DL-PCB 118, respectively. Other factors, including age, height, smoking status, menopausal status and the percentage of omega-6 polyunsaturated fatty acids (PUFAs) in erythrocyte membranes were negatively associated with one of the ultrasound parameters, while the percentage of omega-3 PUFAs in these membranes and levels of physical activity and education were positively associated with them.

CONCLUSIONS

Our results show that an increase in plasma concentrations of DL-PCBs 105 and 118 was negatively associated with stiffness index, a measure of bone quality/strength, in women of this population. In addition to environmental contaminants, future studies should also consider PUFA intake as a factor influencing bone quality.

Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada): results of a cross-sectional study

BACKGROUND

Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs) through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility.

OBJECTIVE

This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI) and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs) in Inuit women of Nunavik (Northern Quebec, Canada).

METHODS

SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35-72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor-mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography-mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders.

RESULTS

Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates.

CONCLUSION

Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik.