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Blythe CS, Reynolds MS, Gregory LS. Identifying Calcaneal Anatomical Regions of Interest (ROI) for Quantitative Ultrasound Application in Subadults. Calcif Tissue Int 2022; 111:559-570. [PMID: 36044069 PMCID: PMC9613548 DOI: 10.1007/s00223-022-01018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 11/02/2022]
Abstract
Whilst quantitative ultrasound can be reliably used to assess bone health in adults, the fixed location of the transducers in current devices may result in inaccurate and unreliable measurements in bone assessment in children due to the variation in foot size during growth. To improve positioning for paediatric assessment, Jaworski et al. (1995) created an anatomical method to identify the region of interest (ROI), however, there have been no medical imaging studies to confirm that the Jaworski method results in consistent placement of the transducer on the centre of the calcaneal body to avoid edge artefacts. In this study, computed tomography scans of the tarsus were collected from 498 individuals (258 females; 240 males) aged 2 to 20 years and used to create three novel anatomical methods to identify ROI on the calcaneus using palpable landmarks. In addition, the established Jaworski method was applied to the same scans and compared to our novel methods. The maximum ROI significantly increased with age with males having significantly greater diameters, supporting the recommendation that ½ inch diameter transducers should be used on individuals younger than 7 years of age. We identified that 79% of the 'Jaworski points' lied anterosuperior to the ROI centre point identified in this study, with 10% of the points lying outside the ROI. Of the three novel methods, only the calcaneal insertion method demonstrated small measurement variance between individuals of the same age in each sex and is therefore the preferred method for ultrasound clinical application.
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Affiliation(s)
- Connor S Blythe
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Mikaela S Reynolds
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura S Gregory
- Clinical Anatomy and Paediatric Imaging Research Laboratory, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Lageweg CMT, van der Putten ME, van Goudoever JB, Feuth T, Gotthardt M, van Heijst AFJ, Christmann V. Evaluation of bone mineralization in former preterm born children: Phalangeal quantitative ultrasound cannot replace dual-energy X-ray absorptiometry. Bone Rep 2018; 8:38-45. [PMID: 29955621 PMCID: PMC6019963 DOI: 10.1016/j.bonr.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/09/2023] Open
Abstract
Background Preterm infants are at risk of impaired bone health in later life. Dual-energy X-ray absorptiometry-scan (DXA) is the gold standard to determine bone mineralization. Phalangeal quantitative ultrasound (pQUS) is an alternative technique that is inexpensive, easy to use and radiation-free. The aim of this study was to investigate whether both techniques reveal equivalent results. Materials and methods Sixty former preterm infants (31 boys; 29 girls) received a DXA and pQUS at age 9 to 10 years. DXA measured bone mineral content (BMC) and bone mineral density (BMD) for total body and lumbar spine (L1-4), while pQUS measured the amplitude dependent speed of sound (AD-SoS) and bone transit time (BTT) at metacarpals II-IV providing continuous values and Z-scores based on age and sex. Four statistical methods evaluated the association between both techniques: Pearson's correlation coefficients, partial correlation coefficients adjusted for gestational age, height and BMI, Bland-Altman analysis and cross tabulation. Results Both techniques showed a statistically significant weak correlation for continuous values as well as Z-scores (0.291–0.462, p < 0.05). Boys had significant and relatively high correlations (0.468–0.585, p < 0.05). In comparison, the correlations for girls were not significant. Correlation coefficients further decreased while calculating the partial correlations. The Bland-Altman plots showed poor agreement. Sensitivity ranged from 33% to 92% and specificity from 16% to 68%. Positive and negative predictive values ranged from 4% to 38% and 82% to 97%, respectively. Conclusions We found statistically significant weak correlations and poor agreement between DXA and pQUS measurements. DXA is not equivalent to pQUS and therefore not replaceable by this technique in former preterm born children at the age of 9 to 10 years. DXA is the golden standard to determine bone mineralization, while Quantitative ultrasound is a radiation-free alternative. Four statistical tests were used to investigate the equivalence of both methods. Comparison of results of 60 preterm born children at age 9 to 10 years found poor agreement between both methods. There was a discrepancy in differentiating the same children with normal or reduced bone mineralization. Quantitative ultrasound cannot replace the DXA scan for determination of bone mineralization in preterm born children.
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Affiliation(s)
- Carmen M T Lageweg
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mayke E van der Putten
- Department of Pediatrics, Subdivision of Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.,Departement of Pediatrics, Emma Children's Hospital - AMC Amsterdam, Amsterdam, The Netherlands
| | - Ton Feuth
- Department for Health Evidence, Radboud Institute for Health Science, Subdivision of Biostatistics, Radboud university medical center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Arno F J van Heijst
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Viola Christmann
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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Delvecchio M, Soldano L, Lonero A, Ventura A, Giordano P, Cavallo L, Grano M, Brunetti G, Faienza MF. Evaluation of impact of steroid replacement treatment on bone health in children with 21-hydroxylase deficiency. Endocrine 2015; 48:995-1000. [PMID: 24981037 DOI: 10.1007/s12020-014-0332-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
There are conflicting data regarding the potential impact of chronic glucocorticoid (GC) therapy on the bone mineral density of patients with congenital adrenal hyperplasia (CAH). Previous studies performed by dual-energy X-ray absorptiometry reported conflicting results. The purpose of this study was to assess the impact of chronic GC replacement treatment in children with classical and non classical CAH due to 21-hydroxylase deficiency (21-OHD) by quantitative ultrasonometry (QUS), an easy, cheap, and radiation-free technique. The study population consisted of nineteen 21-OHD patients (nine males) on lifelong GC treatment. Anthropometric, hormonal, and treatment data were recorded for each patient, and bone quality was assessed by QUS measurements. QUS findings (amplitude-dependent speed of sound and bone transmission time) were normal in 21-OHD patients and did not correlate with duration of treatment, daily, total, and yearly hydrocortisone dose. Furthermore, no significant correlation was found between QUS findings and 17α-hydroxy progesterone, Δ4-androstenedione, and testosterone levels. In conclusion, our results provide reassurance that currently used replacement doses of GC do not have a major impact on bone in patients with CAH. QUS seems to be a reliable tool for screening of bone health in children with 21-OHD.
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Affiliation(s)
- M Delvecchio
- Department of Biomedical Sciences and Human Oncology, Pediatrics Unit, University of Bari 'A. Moro', Piazza G. Cesare, 11, 70124, Bari, Italy
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Krahenbühl T, Gonçalves EM, Costa ET, Barros Filho ADA. [Factors that influence bone mass of healthy children and adolescents measured by quantitative ultrasound at the hand phalanges: a systematic review]. REVISTA PAULISTA DE PEDIATRIA 2014; 32:266-72. [PMID: 25479860 PMCID: PMC4227351 DOI: 10.1590/0103-0582201432319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/05/2014] [Indexed: 11/21/2022]
Abstract
Objective: To analyze the main factors that influence bone mass in children and teenagers
assessed by quantitative ultrasound (QUS) of the phalanges. Data source: A systematic literature review was performed according to the PRISMA method with
searches in databases Pubmed/Medline, SciELO and Bireme for the period 2001-2012,
in English and Portuguese languages, using the keywords: children, teenagers,
adolescent, ultrasound finger phalanges, quantitative ultrasound of phalanges,
phalangeal quantitative ultrasound. Data synthesis: 21 articles were included. Girls had, in QUS, Amplitude Dependent Speed of Sound
(AD-SoS) values higher than boys during pubertal development. The values of the
parameters of QUS of the phalanges and dual-energy X-ray Absorptiometry (DXA)
increased with the increase of the maturational stage. Anthropometric variables
such as age, weight, height, body mass index (BMI), lean mass showed positive
correlations with the values of QUS of the phalanges. Physical activity has also
been shown to be positively associated with increased bone mass. Factors such as
ethnicity, genetics, caloric intake and socioeconomic profile have not yet shown a
conclusive relationship and need a larger number of studies. Conclusions: QUS of the phalanges is a method used to evaluate the progressive acquisition of
bone mass during growth and maturation of individuals in school phase, by
monitoring changes that occur with increasing age and pubertal stage. There were
mainly positive influences variables of sex, maturity, height, weight and BMI,
with similar data when compared to the gold standard method, the DXA.
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5
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Rebocho LM, Cardadeiro G, Zymbal V, Gonçalves EM, Sardinha LB, Baptista F. Measurement properties of radial and tibial speed of sound for screening bone fragility in 10- to 12-year-old boys and girls. J Clin Densitom 2014; 17:528-33. [PMID: 24206868 DOI: 10.1016/j.jocd.2013.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/26/2013] [Accepted: 09/11/2013] [Indexed: 11/20/2022]
Abstract
The objective of this study was to analyze measurement properties of the radial and tibial speed of sound (SoS) evaluated by quantitative ultrasound (QUS) for screening bone fragility. Bone fragility was defined as low whole body less head bone mineral density (WBLH BMD) measured by DXA (first tertile, 95% CI -1.1 to -0.9) and as past fractures evaluated by questionnaire. The sample included 319 nonobese boys and girls, ages 10-12 yr. All bone variables were standardized. The results revealed concordance coefficient correlations between WBLH BMD and radial and tibial SoS of 0.129 and 0.038, respectively. The regression lines between DXA and QUS variables were different from the identity lines. Cross-classification analysis by Kappa statistic showed that only 34% and 36% of the 113 participants categorized in the first tertile of WBLH BMD were also categorized in the first tertile of tibial and radial SoS, correspondingly. Logistic regression with gender and maturity adjustments demonstrates that radial SoS was the single significant variable in predicting OR for identifying participants with past fractures. In conclusion, the radial QUS revealed itself to be a valuable tool for screening bone fragility in youth of 10-12 yr, despite the absence of agreement with DXA WBLH BMD.
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Affiliation(s)
- Lurdes M Rebocho
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Graça Cardadeiro
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Vera Zymbal
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Ezequiel M Gonçalves
- Growth and Body Composition Laboratory, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Luís B Sardinha
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Fátima Baptista
- Exercise and Health Laboratory, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
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Guglielmi G, De Terlizzi F, Nasuto M, Sinibaldi L, Brancati F. Quantitative ultrasound at the phalanges in a cohort of monozygotic twins of different ages. Radiol Med 2014; 120:277-82. [PMID: 25091707 DOI: 10.1007/s11547-014-0440-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of our study was to evaluate bone quality by quantitative ultrasound (QUS) at the phalanges in 129 monozygotic twin couples, outlining the differences between growing subjects and adults. MATERIALS AND METHODS A total of 129 healthy monozygotic twin couples (42 of children under 18 years of age and 87 of adults) were studied by phalangeal QUS, measuring amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT). Anthropometric data were also recorded. RESULTS In children AD-SoS and BTT were positively correlated with age (r = 0.91, r = 0.91), height (r = 0.88, r = 0.90) and weight (r = 0.81, r = 0.87); in adults AD-SoS was negatively related to age (r = -0.36), AD-SoS and BTT were positively related to height (r = 0.37, r = 0.58). Absolute value differences between twins for AD-SoS and BTT were significantly higher in adult twins (25.9 ± 21.9 for AD-SoS and 0.08 ± 0.08 for BTT) than in children (14.5 ± 12.4 for AD-SoS and 0.05 ± 0.04 for BTT). CONCLUSION Differentiation in bone tissue quality in twins increases with age, probably reflecting lifestyle, personal habits, likely acting through epigenetic mechanisms.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy,
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Gonçalves EM, Sewaybricker LE, Baptista F, Silva AM, Carvalho WRG, Santos AO, de Mello MP, Lemos-Marini SHV, Guerra G. Performance of phalangeal quantitative ultrasound parameters in the evaluation of reduced bone mineral density assessed by DX in patients with 21 hydroxylase deficiency. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1414-1419. [PMID: 24726797 DOI: 10.1016/j.ultrasmedbio.2013.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/12/2013] [Accepted: 12/29/2013] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to verify the performance of quantitative ultrasound (QUS) parameters of proximal phalanges in the evaluation of reduced bone mineral density (BMD) in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21 OHD). Seventy patients with 21 OHD (41 females and 29 males), aged between 6-27 y were assessed. The QUS measurements, amplitude-dependent speed of sound (AD-SoS), bone transmission time (BTT), and ultrasound bone profile index (UBPI) were obtained using the BMD Sonic device (IGEA, Carpi, Italy) on the last four proximal phalanges in the non-dominant hand. BMD was determined by dual energy X-ray (DXA) across the total body and lumbar spine (LS). Total body and LS BMD were positively correlated to UBPI, BTT and AD-SoS (correlation coefficients ranged from 0.59-0.72, p < 0.001). In contrast, when comparing patients with normal and low (Z-score < -2) BMD, no differences were found in the QUS parameters. Furthermore, UBPI, BTT and AD-SoS measurements were not effective for diagnosing patients with reduced BMD by receiver operator characteristic curve parameters. Although the AD-SoS, BTT and UBPI showed significant correlations with the data obtained by DXA, they were not effective for diagnosing reduced bone mass in patients with 21 OHD.
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Affiliation(s)
- Ezequiel M Gonçalves
- Growth and Development Lab-Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
| | - Leticia E Sewaybricker
- Growth and Development Lab-Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Pediatric Endocrinology Unit, Pediatrics Department, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil; PhD Student Program in Child and Adolescent Health
| | - Fatima Baptista
- Exercise and Health Laboratory, CIPER, Fac Motricidade Humana, Univ Lisboa, Cruz-Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Fac Motricidade Humana, Univ Lisboa, Cruz-Quebrada, Portugal
| | - Wellington R G Carvalho
- Growth and Development Lab-Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Physical Education Department, Center of Health and Biology Sciences, Federal University of Maranhão, São Luis, MA, Brazil
| | - Allan O Santos
- Nuclear Medicine Division, Clinical Hospital, University of Campinas, Campinas, SP, Brazil
| | - Maricilda P de Mello
- Center of Molecular Biology and Genetic Engineering, University of Campinas, Campinas, SP, Brazil
| | - Sofia H V Lemos-Marini
- Pediatric Endocrinology Unit, Pediatrics Department, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Gil Guerra
- Growth and Development Lab-Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Pediatric Endocrinology Unit, Pediatrics Department, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Chobot AP, Haffke A, Polanska J, Halaba ZP, Deja G, Jarosz-Chobot P, Pluskiewicz W. Quantitative ultrasound bone measurements in pre-pubertal children with type 1 diabetes. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1109-1115. [PMID: 22542259 DOI: 10.1016/j.ultrasmedbio.2012.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 02/08/2012] [Accepted: 02/16/2012] [Indexed: 05/31/2023]
Abstract
This case-control study aimed to assess bone status in children with type 1 diabetes mellitus (T1DM). Fifty-seven pre-pubertal patients (37 boys, aged 7.9 ± 2.5 years, T1DM duration 3.1 ± 1.6 years) and 171 age-matched healthy controls (111 boys) were studied. Quantitative ultrasound (QUS) was used to measure amplitude dependent speed of sound (Ad-SoS) at hand phalanges (expressed as standard deviation score [SDS]). Anthropometric and disease-related data (including mean HbA(1c) from whole T1DM duration [T], last year [Y], examination day [D]) were collected. Mean Ad-SoS SDS in patients -0.13 ± 1.32 (95% confidence interval [CI] -0.48, 0.22) was similar to that of controls. Subgroups discriminated according to HbA(1c) D, Y and T (cut-off 7.0%) did not differ regarding analyzed parameters. In patients, Ad-SoS SDS was comparable for both genders. Multivariable stepwise regression analysis showed significant negative influence of diabetes duration on Ad-SoS SDS. QUS findings in pre-pubertal children with T1DM do not differ from those in healthy children. Disease duration seems to affect negatively Ad-SoS SDS. However, independent prospective studies are needed to elucidate the true associations.
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Affiliation(s)
- Agata P Chobot
- Department of Paediatrics, Clinical Hospital No. 1, Zabrze, Poland.
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9
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Duarte SBL, Carvalho WRGD, Gonçalves EM, Ribeiro RR, Farias ES, Magro DDO, Oliveira LMRD, Guerra-Júnior G. [Preliminary comparison between phalangeal quantitative ultrassonography and bone densitometry for bone mass evaluation in adolescents]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2012; 56:19-24. [PMID: 22460191 DOI: 10.1590/s0004-27302012000100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 12/21/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the association between quantitative ultrasonography at hand phalanges (QUS) and dual energy X-ray absorptiometry (DXA), and between these methods with food intake and history of bone fractures. SUBJECTS AND METHODS After two years of follow up of 270 schoolchildren, 10 of them, who showed bone mass below - 2 SD in QUS, were included in the present study. Laboratory results and DXA data were analyzed. RESULTS Bone mass evaluated by DXA at L1-L4 ranged from -2.8 to -1.1 SDS, and whole body bone mass, from -2.9 to -1.2 SDS. Three children had history of non-pathological bone fractures. Dietary assessment showed low intake of calcium in 10 cases, of phosphorus in 6, and of vitamin D in 8 cases. There were no differences among the cases of bone mass below-2 SD in any of the three used methods. There was no association between history of bone fractures and food intake, and between these evaluations and bone mass. CONCLUSION In this small group of schoolchildren there was an association between the methods QUS and DXA. However, there was no association between bone mass and the history of bone fractures, or calcium, phosphorus and vitamin D intake.
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Affiliation(s)
- Stênio Bruno Leal Duarte
- Laboratório de Crescimento e Composição Corporal, Centro de Investigação em Pediatria, Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brasil
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10
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Impact of metabolic control on bone quality in phenylketonuria and mild hyperphenylalaninemia. J Pediatr Gastroenterol Nutr 2011; 52:345-50. [PMID: 21336059 DOI: 10.1097/mpg.0b013e3182093b32] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES A reduction of bone mineral density of unknown etiology has been reported in phenylketonuria (PKU) by radiological techniques, whereas no data on bone density in mild hyperphenylalaninemia (HPA) are available. We aimed to assess bone condition in PKU and HPA by quantitative ultrasound (QUS), taking into account patients' clinical and biochemical features. PATIENTS AND METHODS Phalangeal QUS has been used for bone assessment in 78 patients affected by PKU (n = 42) or mild HPA (n = 36). For each patient, blood phenylalanine concentrations in the 2 years before the study have been recorded and related to bone assessment. RESULTS Overall normal bone quality has been observed in the whole study group (AD-SoS standard deviation score [SDS] 0.25 ± 1.29; BTT SDS -0.13 ± 1.08). PKU adolescents (age older than 15 years, AD-SoS SDS -0.54 ± 1.33; BTT SDS -0.85 ± 1.21) and patients with poor compliance with treatment (blood phenylalanine >10 mg/dL, AD-SoS SDS -0.47 ± 1.39; BTT SDS -0.97 ± 1.14) showed lower BTT SDS with respect to normal population (P = 0.003 and P < 0.001, respectively). Patients with PKU with good compliance with treatment (blood phenylalanine < 10 mg/dL, AD-SoS SDS 0.65 ± 1.33; BTT SDS 0.15 ± 0.94) and patients with mild HPA (AD-SoS SDS 0.44 ± 1.06 and BTT SDS 0.19 ± 0.85) showed normal bone mineral density and cortical thickness. CONCLUSIONS Good compliance with treatment in PKU during adolescence and adulthood is desirable because diet discontinuation is associated with bone loss. Mild HPA seems not to be complicated by bone damage.
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Cohen M, Lahat E, Bistritzer T, Livne A, Heyman E, Rachmiel M. Evidence-based review of bone strength in children and youth with cerebral palsy. J Child Neurol 2009; 24:959-67. [PMID: 19321458 DOI: 10.1177/0883073809332401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with cerebral palsy have various risk factors for compromised bone health. Evidence concerning their bone fragility is gathering; however, there is no consensus regarding risk factors, indications for evaluation, follow-up, or treatment. We performed an evidence-based review targeted to address the following questions concerning children with cerebral palsy: Is bone strength impaired and what are the risk factors? Are these children at increased risk for bone fractures? What are the relations between bone mineral density and fracture risk? What methods can be used for bone health assessment? How can bone strength be improved? Currently, the most acceptable method for evaluating bone status in children is dual-energy x-ray absorptiometry. Evidence demonstrates reduced bone mass in children with cerebral palsy; yet, no clear association with fractures. Preventive methods are suggested.
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Affiliation(s)
- Michal Cohen
- Maccabi Healthcare Services, Jerusalem & Hashfela District, Israel.
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12
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Christoforidis A, Papadopoulou E, Dimitriadou M, Stilpnopoulou D, Gkogka C, Katzos G, Athanassiou-Metaxa M. Reference values for quantitative ultrasonography (QUS) of radius and tibia in healthy greek pediatric population: clinical correlations. J Clin Densitom 2009; 12:360-8. [PMID: 19577938 DOI: 10.1016/j.jocd.2009.03.097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to provide reference standards for measurements of quantitative ultrasonography (QUS) of radius and tibia in normative Greek pediatric population. Analysis was performed in 1549 healthy subjects (814 girls and 735 boys) with a mean decimal age of 11.41+/-3.52 yr (range: 3.78-18.33 yr). Results showed a gradual increase of absolute values of radial and tibial speed of sound (SOS), with aging and with pubertal progressing, in both girls and boys. Gender comparison showed significantly increased SOS values measured both at radius and at tibia in girls more than 13 yr of age compared with aged-matched boys. Significant but mild correlation was noted between standard deviation scores (SDS) of SOS at radius and at tibia (r = 0.259, p < 0.001). Additionally, tibial SOS SDS were significantly negatively correlated with body mass index (BMI) SDS (r = -0.230, p < 0.001). Finally, subjects that spend more than 3h of daily "screen time" (television and personal computer) showed significantly decreased SOS values measured both at radius and at tibia. On the contrary, no correlation was observed between SOS values and the amount of physical activity reported.
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13
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Quantitative ultrasound in the assessment of skeletal status. Eur Radiol 2009; 19:1837-48. [PMID: 19259681 DOI: 10.1007/s00330-009-1354-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/27/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022]
Abstract
Quantitative ultrasound (QUS) is a non-invasive technique for the investigation of bone tissue in several pathologies and clinical conditions, especially in the field of osteoporosis. The versatility of the technique, its low cost and lack of ionising radiation have led to the diffusion of this method worldwide. Several studies have been conducted in the last years to investigate the potential of QUS in multiple areas with promising results; the technique has been applied in the prediction of osteoporotic fractures, in monitoring therapies, in the investigation of secondary osteoporosis, in paediatrics, neonatology and genetics. Our review article gives an overview of the most relevant developments in the field of quantitative ultrasound, both in clinical and in experimental settings.
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Halaba ZP. Quantitative ultrasound measurements at hand phalanges in children and adolescents: a longitudinal study. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1547-1553. [PMID: 18485570 DOI: 10.1016/j.ultrasmedbio.2008.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 03/01/2008] [Accepted: 03/04/2008] [Indexed: 05/26/2023]
Abstract
The purpose of this longitudinal study was to characterize changes in quantitative ultrasound (QUS) values over a 1-y period in healthy boys and girls aged 7 to 12 y at baseline and assess the relation between the increase in anthropometric parameters and amplitude dependent speed of sound (Ad-SoS). A total of 269 children completed the study (139 girls and 130 boys). Ultrasound measurements were performed with a DBM Sonic 1200 device (IGEA, Carpi, Italy), which measures the Ad-SoS, m/s. Girls had significantly higher QUS values than boys at first and second measurements (p < 0.01 and p < 0.00001, respectively). Both girls and boys experienced statistically significant increases in Ad-SoS and all anthropometric parameters over a 1-y period. When the studied group was divided into age groups by year, the differences in QUS values between genders were significant only for 11 and 12 y groups at baseline (p < 0.02 and p < 0.01, respectively) and second visit (p < 0.00001 and p < 0.001, respectively). Stepwise regression analyses models with Ad-SoS at baseline and after 1 y as dependent variables showed a strong correlation between Ad-SoS and Tanner stage in girls but not in boys. In the entire survey group, only 21.5% of the boys and 41% of the girls experienced increases in Ad-SoS more than least significant change. This article suggests that QUS measurements allow the investigation of longitudinal changes and give reliable information about skeletal status in a manner similar to other methods.
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Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application. Pediatr Res 2008; 63:220-8. [PMID: 18287958 DOI: 10.1203/pdr.0b013e318163a286] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Measurement of bone mineral status may be a useful tool in identifying the children who could be exposed to an increased risk of osteoporosis in adulthood. Dual energy x-ray absorptiometry and peripheral quantitative computed tomography may be used to this purpose, but the exposure to ionizing radiation is a limiting factor for preventive studies in large populations of children. In the last years, quantitative ultrasound (QUS) methods have been developed to assess bone mineral status in some peripheral skeletal sites such as calcaneus, phalanges of the hand, and tibia. QUS techniques are safe, easy to use, radiation-free, and devices are portable, so that they are particularly indicated to assess bone mineral status in children. This review will concentrate on the main methodological principles of ultrasounds and the QUS variables derived from their application to bone tissue, technical differences and performance of QUS methods, factors influencing QUS measurements, normative data and results obtained in children with disturbances of growth or affected by disorders of bone and mineral metabolism, including the assessment of fracture risk, and comparison among QUS, dual energy x-ray absorptiometry, and peripheral quantitative computed tomography methods.
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Abstract
Growing awareness that osteoporosis may have its antecedents in childhood has led to increasing interest in assessing bone mass in children and adolescents. Several noninvasive imaging techniques are currently available to measure properties of the growing skeleton, including bone mass, density, cross-sectional area, and microarchitecture. Dual-energy x-ray absorptiometry (DXA) is the most widely used technique, but it has several major limitations associated with its dependence on two-dimensional projections. Quantitative CT and peripheral quantitative CT allow three-dimensional imaging but are more costly and have higher radiation exposure. Quantitative ultrasound is simple and inexpensive but can measure bone "quality" only at a single peripheral site. MRI techniques for measuring bone are still under development and not yet ready for clinical use. For all of these techniques, clinical interpretation of the bone measures obtained remains a significant challenge. Further research is needed to relate these measures to osteoporosis in the elderly and to short-term and long-term fracture risk.
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Affiliation(s)
- Tishya A L Wren
- Childrens Hospital Los Angeles, Department of Radiology, MS #81, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
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Halaba ZP, Bursa J, Kaplon UK, Pluskiewicz W, Marciniak S, Drzewiecka U. Phalangeal quantitative ultrasound measurements in former pre-term children aged 9-11 years. Br J Radiol 2006; 80:401-5. [PMID: 17068013 DOI: 10.1259/bjr/55460700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to compare phalangeal ultrasound values in 38 former pre-term children, aged 9-11 years, with 50 age-matched term controls. Skeletal status was evaluated using phalangeal quantitative ultrasound measurements (QUS) by DBM Sonic 1200 (IGEA, Carpi, Italy) which measures the amplitude dependent speed of sound (Ad-SoS, m s(-1)). There were no significant differences in values of Ad-SoS, weight and height between patients and controls irrespective of birth weight or prematurity. In conclusion, phalangeal ultrasound measurements performed in prematurely born infants show that at the age of 9-11 years their bone status does not differ from children born at term.
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Affiliation(s)
- Z P Halaba
- Public Clinical Hospital No 1 in Zabrze, Poland.
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Pluskiewicz W, Halaba Z. Quantitative bone analysis in children: current methods and recommendations. J Pediatr 2006; 149:430-1; author reply 431-2. [PMID: 16939774 DOI: 10.1016/j.jpeds.2006.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 03/16/2006] [Indexed: 10/24/2022]
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