Quantitative ultrasound (QUS) at the calcaneus and hand phalanges in Polish healthy postmenopausal women

Characteristics of distal radius speed of sound data in Chinese mainland men and women

Quantitative ultrasound (QUS) assessment of bone health status, as a reliable method, is rapidly gaining popularity. Speed of sound (SOS) is one parameter of skeletal status provided by QUS assessment. The objective of the present study was first to determine the normative distal radius SOS data on healthy Chinese mainland men and women and second to investigate the effects of sex, age, and body size on this parameter. A study cohort consisting of 19,980 healthy Chinese women and 8722 men aged 20-89 yr participated in this investigation. They answered a detailed questionnaire on their healthy condition, and their anthropometric measurements were taken. Their distal radius SOS values were evaluated using the Sunlight ultrasound systems. The distal radius SOS values exhibited a characteristic rise-then-fall pattern with increasing age in both sexes. The peak SOS value occurred at the age of 40-49 both in males and females. Age-related differences were both pronounced among males and females. Pearson correlation and regression analysis showed that age was a major determinant of SOS in both sexes. In females, SOS values had a much stronger correlation with age than male subjects. Body weight was also correlated with SOS but not as well as age. The SOS values of distal radius at present study may be used as normal reference data for Chinese mainland population and will be useful for comparing the results of individual studies and determining diagnostic criteria of osteoporosis by QUS.

Instrumentation for in vivo ultrasonic characterization of bone strength

Although it has been more than 20 years since the first recorded use of a quantitative ultrasound (QUS) technology to predict bone fragility, the field has not yet reached its maturity. QUS has the potential to predict fracture risk in several clinical circumstances and has the advantages of being nonionizing, inexpensive, portable, highly acceptable to patients, and repeatable. However, the wide dissemination of QUS in clinical practice is still limited and suffering from the absence of clinical consensus on how to integrate QUS technologies in bone densitometry armamentarium. Several critical issues need to be addressed to develop the role of QUS within rheumatology. These include issues of technologies adapted to measure the central skeleton, data acquisition, and signal processing procedures to reveal bone properties beyond bone mineral quantity and elucidation of the complex interaction between ultrasound and bone structure. This article reviews the state-of-the art in technological developments applied to assess bone strength in vivo. We describe generic measurement and signal processing methods implemented in clinical ultrasound devices, the devices and their practical use, and performance measures. The article also points out the present limitations, especially those related to the absence of standardization, and the lack of comprehensive theoretical models. We conclude with suggestions of future lines and trends in technology challenges and research areas such as new acquisition modes, advanced signal processing techniques, and modelization.

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 ultrasound at the hand phalanges in patients with acromegaly

The aim of this study was assessment of skeletal status using quantitative ultrasound (QUS) at hand phalanges in patients with acromegaly. A group of 38 patients with acromegaly (27 women and 11 men) with a mean age of 57.21 +/- 9.85 years was compared with a control group of 44 men and 108 women matched for gender, age and body size. Amplitude-dependent speed of sound (Ad-SoS) at hand phalanges had lower values in patients with acromegaly than in controls, both in the entire group and in men and women, respectively. The positive correlation between Ad-SoS and height and the negative one between Ad-SoS and age was found in the entire group of patients with acromegaly. No correlations between Ad-SoS and time from diagnosis or duration of the symptoms were found. Age affected Ad-SoS significantly less in the entire patient group than in controls. Similarly, in women, age and body mass affected Ad-SoS less than in controls. A stepwise multiple regression analysis carried out in the patient group identified age as the only factor significantly influencing negatively the Ad-SoS value (regression equation: Ad-SoS (m/s) = 2124 m/s - 3.26 x age (years) [r2= 0.26, standard error of estimate = 55.1, p < 0.01]). In conclusion, our data demonstrate that, in patients with acromegaly, skeletal status assessed by QUS was affected. This could reflect the worsening of the mechanical properties of bones studied and the increased risk of fractures in other sites of the skeleton. The changes observed were not related to acromegaly-associated hypogonadism. Further studies to assess the role of QUS in acromegaly are necessary and fracture prevalence and risk ought to be established.

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.

Evaluation of skeletal status by quantitative ultrasonometry in postmenopausal women without known risk factors for osteoporosis

The objective of our study was to evaluate bone density in Italian postmenopausal women without clinical risk factors for osteoporosis resident in the Naples area using quantitative ultrasonometry of bone (QUS). Subjects were 1149 Italian postmenopausal women (age: 54.9 +/- 5.0 years (mean +/- standard deviation); range: 45-74 years) resident in the Naples area. Clinical risk factors for osteoporosis resulting in exclusion from the study were family history of osteoporosis, dietary, smoking and alcohol habits, personal history of fractures and/or metabolic diseases. The following QUS parameters were calculated: amplitude-dependent speed of sound (AD-SoS), T-score and Z-score. We found significant inverse correlations between AD-SoS and age (r = - 0.23), time since menopause (r = - 0.25) and body mass index (BMI) (r = - 0.16). The same was observed for T-score. In contrast, Z-score showed a significant positive correlation with age and time since menopause, and a negative correlation with BMI. A T-score suggestive of high risk for osteoporosis (less than -3.2) was found in 1.6% of subjects, while a T-score suggestive of moderate risk for osteoporosis (between -3.2 and -2) was found in 19.3% of patients. In this group of women without clinical risk factors for osteoporosis we found a very low prevalence of QUS results suggesting a high risk for osteoporosis. However, a condition of 'moderate' risk for osteoporosis was present in a remarkable percentage of these women.

Older women track and field athletes have enhanced calcaneal stiffness

Vigorous weight-bearing exercise is recommended to women as a method of osteoporosis prevention. This study examined older women athletes to see if they indeed were less likely to develop osteoporosis than those in the general population, and to investigate which factors could have contributed to these results. One hundred and thirty-nine women 40-88 years old, all competitors in a USA National Masters Track and Field Championships, volunteered for the study. Masters refers to competitors > or =40 years old. Their calcaneal stiffness (SI) was measured by a Lunar Achilles+ ultrasonometer. Subjects were also measured for height and weight, and completed a questionnaire on exercise history, diet, lifestyle factors, medical and menopausal issues, and use of hormone replacement therapy (HRT). The women, mean age 57.3 years, had an overall average SI of 99.5 (T-score = 0.04) which is equivalent to that of a 20-year-old woman and 20.8% higher than expected for women of their age. Their median SI remained not different from expected peak bone SI until the age of 70. For analysis, this cohort of women was divided into two groups: premenopausal and postmenopausal athletes. The SI of both groups was correlated with the earliest age at which they had first participated in sports or exercises that impart moderate to high strain rates to the lower limbs and with current participation in high impact track and field events. Variables correlated with SI in the general population, such as weight, HRT, previous fracture, hysterectomy, and current menopausal status, did not predict SI in this cohort. In conclusion, women competing in Masters track and field at the national level had calcaneal stiffness substantially higher than expected for women of their age in the general population, and their participation in vigorous sports and activities, either currently or at a younger age, was predictive of this association.

Quantitative ultrasound at the phalanxes discriminates osteoporotic women with vertebral but not with hip fracture

Caucasian postmenopausal women with vertebral fracture (38), hip fracture (38) and without fracture (124) were measured by spine and femoral neck bone mineral density (BMD) (Norland XR 36), and two quantitative ultrasound (US) or QUS parameters (Igea DBM sonic 1200): the amplitude-dependent speed of sound (Ad-Sos) and the US bone profile score (UBPS), at the proximal hand phalanxes to investigate the ability of QUS to detect previous fracture. Age, height and weight were not different among groups, but menopausal age was lower with vertebral fracture (p < 0.005). QUS parameters of hip (AdSos = 1806.2 +/- 104.6 m s(-1); UBPS = 0.22 +/- 0.13) or spine fracture (AdSos = 1774.4 +/- 90.0 m s(-1); UBPS = 0.19 +/- 0.10) were not significantly lower than controls (AdSos = 1819.1 +/- 111.9 m s(-1); UBPS = 0.25 +/- 0.17), and BMD of hip (spine: 756.0 +/- 138.9 mg cm(-2); femoral neck: 583.6 +/- 61.8 mg cm(-2)) and vertebral (spine: 727.4 +/- 120.4 mg cm(-2); femoral neck: 592.8 +/- 82.1 mg cm(-2);) fracture was lower than controls (spine: 829.2 +/- 167.6 mg cm(-2); femoral neck 665.0 +/- 108.9 mg cm(-2)) (p < 0.001). Spine and femoral neck BMD significantly separated both types of fractures from controls, but AdSos and UBPS significantly separated only vertebral fractures. Femoral neck BMD has the best receiver operating characteristic (ROC) area for both hip (0.715, SE 0.043) and vertebral (0.693, SE 0.047) fractures, being significantly better (p < 0.01) than that of AdSos (0.503, SE 0.056) and UBPS (0.501, SE 0.057) for hip fractures, but not for vertebral fractures (AdSos 0.604, SE 0.050; UBPS 0.563, SE 0.048). In conclusion, QUS at hand phalanxes predicts vertebral fracture as effectively as BMD, but does not predict hip fracture.

The usefulness of quantitative ultrasound at the hand phalanges in the detection of the different types of nontraumatic fractures

The aim of this retrospective study was to determine whether quantitative ultrasound (QUS) at the hand phalanges has the ability to discriminate between individuals without and with different types of nontraumatic fractures. All women (n = 2466) (age range 38-88 years) not affected by metabolic diseases or under treatment with drugs known to interfere with bone metabolism were divided into controls without fractures (n = 1883) and women with nontraumatic previous fractures (n = 583). Fractures were the result of minimal trauma involving a fall from a standing height or less during normal daily activity. Fractured group was divided into subgroups on the basis of the types of fractures: hip, spine, wrist or other fractures. Skeletal status was assessed using the DBM Sonic 1200 (IGEA, Carpi, Italy) which measures the amplitude-dependent speed of sound, Ad-SoS (m/s) in the distal metaphyses of the proximal phalanges of the second through fifth finger of the dominant hand. Women with hip, spine, wrist or other fractures had significantly lower Ad-SoS values than controls (1814 +/- 60 m/s, 1829 +/- 57 m/s, 1870 +/- 64 m/s, 1893 +/- 66 m/s, respectively, vs. 1943 +/- 73 m/s, p < 0.001). Ad-SoS revealed the following areas under the ROC curve: 0.91 +/- 0.027 for hip fracture, 0.89 +/- 0.019 for spine fracture, 0.77 +/- 0.012 for wrist fracture and 0.70 +/- 0.023 for other fractures. By multiple logistic regression analysis, the probability of having fracture, estimated as odds ratio for each 1 SD reduction in Ad-SoS, was: 3.49 (95% CI, 1.57-7.75) for hip, 3.25 (95% CI, 1.94-5.45) for spine, 2.24 (95% CI, 1.86-2.70) for wrist and 1.81 (95% CI, 1.36-2.40) for other fractures. The present study demonstrates the ability of phalangeal QUS to discriminate between subjects with and without different types of nontraumatic fractures. Phalangeal QUS revealed the best sensitivity and specificity in discriminating hip- and spine-fractured patients from controls.

The aging hand

Hand function decreases with age in both men and women, especially after the age of 65 years. A review is presented of anatomical and physiological changes in the aging hand. The age-related changes in prehension patterns (grip and pinch strength) and hand dexterity in the elderly population are considered. Deterioration in hand function in the elderly population is, to a large degree, secondary to age-related degenerative changes in the musculoskeletal, vascular, and nervous systems. Deterioration of hand function in elderly adults is a combination of local structural changes (joints, muscle, tendon, bone, nerve and receptors, blood supply, skin, and fingernails) and more distant changes in neural control. These age-related changes are often accompanied by underlying pathological conditions (osteoporosis, osteoarthritis, rheumatic arthritis, and Parkinson's disease) that are common in the elderly population. Assessment of hand function and prehension patterns is needed in order to determine specific treatment approaches.

Ability of ultrasound bone profile score (UBPS) to discriminate between fractured and not fractured osteoporotic women

In this study, we evaluated the ability of different quantitative ultrasound (QUS) parameters (speed of sound, SOS, coefficient of variation, CV, = 0.34% and broadband ultrasound (US) attenuation, BUA, CV = 3.25% measured at the heel by an Hologic Sahara unit; Ad-Sos and ultrasound bone profile score (UBPS) at the proximal phalanges by an Igea DBM Sonic 1200 unit, Ad-Sos CV = 0.57%) to detect differences between osteoporotic patients with vertebral fractures and osteoporotic patients without fractures. We examined 87 women with primary osteoporosis: 53 women with femoral neck bone mineral density (BMD) T scores less than -2.5 SD and no vertebral fractures and 34 women with one or more vertebral fractures, regardless of T score values. Considering all the patients together, the correlations between QUS parameters and BMD resulted in statistical significance (p < 0.05) only for BUA and femoral neck BMD. Lumbar and femoral neck BMD did not statistically differ between the two groups, while UBPS, which is a quality control of measurement and is correlated with bone quality, was significantly higher in women without fractures than those with fractures; the other QUS parameters were not statistically different. Our data indicate that, among QUS parameters, only UBPS is able to detect differences among osteoporotic patients with and without vertebral fractures.

Stiffness index of the calcaneus measured by quantitative ultrasound and menopause among Japanese women: The Hizen-Oshima Study

Quantitative ultrasound (QUS) is a recently developed technique for evaluating fracture risk that can assess both bone mass and architecture. Although numerous studies have shown that menopause is associated with accelerated loss of bone mineral density, there are only a few studies on the association of QUS parameter (stiffness index) with menopausal status, especially among Japanese population. We examined age-specific changes in stiffness index, and relation with age, body mass index (BMI) and menopausal status among 506 community-dwelling Japanese women aged 40-89 years. Mean age at menopause (standard deviation) among 459 women with natural menopause was 49.4 (4.0) years. Stiffness index significantly decreased with increasing age. Stiffness index among 80-89 years age group was 40% lower, compared with that of 40-49 years age group. The greatest decline among adjacent ten-year age groups in stiffness index (15%) was found between 40-49 and 50-59 years of age. Multiple regression analysis showed that menopause related with decreased stiffness index, independent of age and BMI. Our findings indicate that menopause influences loss of bone mass and induces deterioration of bone trabecular microstructure.