Ultrasound bone velocity on proximal phalanges in premenopausal, perimenopausal, and postmenopausal healthy women

Diabetes and Obesity as Independent Risk Factors for Osteoporosis: Updated Results from the ROIS/EMEROS Registry in a Population of Five Thousand Post-Menopausal Women Living in a Region Characterized by Heavy Environmental Pressure

Objectives: We aimed to analyze bone mineralization and the effect of different risk factors for osteoporosis in postmenopausal women. Methods: We found 4909 postmenopausal subjects within ≥10,000 records from the ROIS/EMEROS (Ionian and Salento Osteoporosis Registry/Euro Mediterranean Registry of Osteoporosis) registry, a population study carried out in an area characterized by heavy environmental pressure between Brindisi and Taranto from 2009 to 2016. All subjects were assessed via phalangeal quantitative ultrasound (QUS) to evaluate their bone mineralization (assessed via amplitude dependent speed of sound (AD-SoS)) and the association between demineralization and the presence of other conditions or risk factors. Results: Mean age was 64 ± 9.5 years and mean body mass index (BMI) was 28.7 ± 3.5 kg/m². Pearson correlation analyses revealed a negative association between bone mineralization (AD-SoS) and BMI (p < 0.001). By using multivariate logistic regression analysis, we observed significant values of odds ratios (ORs) of osteoporosis (adjusted for age, physical activity, and the use of drugs known to increase the risk of fractures) in subjects with diabetes and obesity: 1.39 (confidence interval (CI): 1.05-1.83) and 1.46 (CI: 1.20-1.78), respectively. A statistically significant linear trend of higher ORs of osteoporosis was found for increasing values of BMI. Conclusions: Our study confirmed the high impact of obesity and type 1 and type 2 diabetes on osteoporosis.

Effect of beer drinking on ultrasound bone mass in women

OBJECTIVE

To study the effect of beer consumption on bone mass in a group of healthy women, by using phalangeal bone ultrasound to evaluate the amplitude-dependent speed of sound.

METHODS

This was a cross-sectional study of 1697 healthy women (mean age 48.4 y, body mass index (BMI) 19.0-32.0 kg/m(2)), recruited in a clinical convenience sample and screened for the existence of disease and/or medication that would affect calcium metabolism. Of this total, 710 were premenopausal, 176 were perimenopausal, and 811 were postmenopausal. The women recruited completed a questionnaire that contained detailed sections on current cigarette, alcohol, caffeine, and nutrient consumption. In terms of current alcohol intake, the subjects were classified as moderate drinkers, light drinkers, and nondrinkers. Drinkers were also analyzed according to the kind of alcohol consumed: wine or beer.

RESULTS

Quantitative bone ultrasound values were greater in the beer drinkers compared with the no beer and/or wine drinkers. Taking the amplitude-dependent speed of sound as a dependent variable, and age, BMI, gonadal status, intake of beer and wine, and number of cigarettes per day as independent variables, we found age (beta = -1.52), BMI (beta = -3.86), gonadal status (beta = -27.47), and beer intake (beta = 1.06) to be significant.

CONCLUSION

The greater bone density found in women beer drinkers might be a result of the phytoestrogen content of this alcoholic drink; this requires further investigation.

Quantitative bone ultrasound at phalanges and calcaneus in osteoporotic postmenopausal women: influence of age and measurement site

Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmenopausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than -2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group (p < 0.05). When patients aged <70 y (n = 43) and patients aged > or = 70 y (n = 84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group (p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one (p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life.

Quantitative ultrasound at the hand phalanges in 2850 females aged 7 to 77 yr: a cross-sectional study

In the study, skeletal status was evaluated in 2850 females aged 7 to 77 yr using quantitative ultrasound (QUS amplitude-dependent speed of sound [Ad-SoS]). Ad-SoS ranged from 1923 +/- 30 to 1876 +/- 81 m/s, and the peak value (2121 m/s) was achieved in 19-yr-old females. Ad-SoS increased significantly between subgroups aged 11 and 12 yr, 12 and 13 yr, 13 and 14 yr, 14 and 15 yr, and 15 and 16 yr. After the age of 19 yr the only significant drop was noted between age groups 47 and 48 yr. Ad-SoS was regressed on age, weight, and height for age ranges 7 to 11 yr.(before an increase in Ad-SoS), 12 to 19 yr (from the onset of the increase to the peak value), and older than 19 yr to menopause. In females after menopause, years since menopause (YSM) were taken into consideration. In the two youngest groups Ad-SoS was affected positively by age, and in the two next groups, age had a negative influence on Ad-SoS, whereas weight had a negative and height a positive influence in all groups. YSM did not influence the Ad-SoS value. It was concluded that QUS measurements at the hand phalanges are a useful tool in assessment of skeletal status in the female population.

Different diagnostic techniques for the assessment of cortical bone on osteoporotic animals

The aim of this study was to assess the capability of ultrasonography and densitometry to predict the mechanical competence of cortical bone in healthy and osteopenic rats, respectively. Thirty 10-month-old Sprague-Dawley retired breeder female rats were used and randomized into three groups of 10 animals each. A group underwent bilateral ovariectomy by dorsal approach (Ovx), another group underwent a simulated ovariectomy (Sham-Ovx), and the last group served as a sham-aged control group (Control). Sixteen weeks after surgery, the animals were euthanized and the femurs of each rat excised for ultrasonographic and densitometric measurements, and mechanical analyses. The Ovx Group had a significantly decreased amplitude dependent speed of sound (AD-SoS-about 7-8%) when compared to the other groups (p<0.0005). For Ovx animals compared with Sham-Ovx and Control rats, significant decreases in densitometric data were observed (6-13%), as well as significant decreases in femoral Max. Load (about 18%) and flexural rigidity (about 30%). The best correlation (R2=0.55, p<0.0005) found was between SoS and femoral shaft bone mineral density (SBMD). The regression coefficient R2 increased when power-law fits were used, particularly from 0.34 (p<0.001) to 0.36 (p<0.0005) in the correlation between SoS and Max. Load and from 0.21 (p<0.05) to 0.25 (p<0.01) in the correlation between SBMD and Max. Load. The ability of QUS or DXA to accurately predict the actual mechanical characteristics of bone, and in particular bone elasticity, remained relatively poor and the improvement of the power-law model did not describe exhaustively the relationships between the variables tested. The DXA and QUS capability to discriminate between ovariectomized and non-ovariectomized rats did not improve when tested together.

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.

Reference curve of bone ultrasound measurements in proximal phalanges in normal Spanish women

There are clear discrepancies in how the different measurements of phalangeal bone ultrasound, such as the amplitude-dependent speed of bone ultrasound (Ad-SoS), correlate with age, given their dependence on gonadal status and other anthropometric variables. In order to contribute to clarifying these discrepancies, we evaluated the phalangeal Ad-SoS in healthy women-295 postmenopausal, 59 perimenopausal, and 270 premenopausal. Phalanges (II-V) of the nondominant hand were measured and the mean Ad-SoS was computed. There were significant differences between groups (p < 0.0001 in all cases), with the perimenopausal group presenting the intermediate values. For the overall group of women, the Ad-SoS was significantly and negatively correlated with age, weight, and body mass index (BMI), and positively correlated with height (p < 0.0001 in all cases). By gonadal status group, the premenopausal women showed the three significant negative correlations of Ad-SoS with age, weight, and BMI (each, p < 0.0001), the perimenopausal group only with BMI (p < 0.007), and the postmenopausal group with age and BMI (p < 0.0061 to p < 0.0001) and also with years since menopause (p < 0.0001). The premenopausal decline in AD-SoS requires further longitudinal studies, although in our experience it may depend on dietary habits and/or a diminished quality, though not quantity, of bone in this period of a woman's fertile life.

Effects of caffeine, vitamin D, and other nutrients on quantitative phalangeal bone ultrasound in postmenopausal women

OBJECTIVE

We investigated the controversial effects of coffee and other nutrients on bone mass.

METHODS

In a study of 93 healthy postmenopausal women (mean +/- standard deviation: 57.3 +/- 7.1 y old and 8.9 +/- 7.5 y since menopause) selected on the basis of not having changed their eating habits since premenopause, not smoking, not exercising, not receiving hormone-replacement therapy, and having a weight in the range of 70% to 130% of their ideal weights, amplitude-dependent speed of sound (Ad-SOS) was determined by quantitative bone ultrasound, and a prospective 7-d diet survey evaluated the intake of caffeine and nutrients involved in calcium metabolism. Women were stratified according to their caffeine, calcium, and vitamin D intakes and ratios of calcium to phosphorus and to protein. Ad-SOS differed only with vitamin D intake and was greater in the group taking at leasst 400 IU/d (P < 0.0001).

RESULTS

In simple and multiple regression analyses, the only significant variable that affected Ad-SOS and nutrient intake was vitamin D (P < 0.0001). Phalangeal bone Ad-SOS was influenced only by the intake of vitamin D, not of caffeine or other nutrients.

CONCLUSIONS

This lack of effect of caffeine and protein may be related to good nutritional intake or the low levels of caffeine consumed.

Do ultrasound measurements reflect bone microarchitecture rather than bone mass?: An in vitro study of the rat femur with the use of ultrasound, densitometry, and histomorphometry

RATIONALE AND OBJECTIVES

In an experimental study in 40 rat femurs, the authors correlated the amplitude-dependent speed of bone ultrasound (Ad-SOS) with the bone mineral content and density and with the bone trabecular connectivity: trabecular bone volume, trabecular number, trabecular thickness, and trabecular separation to evaluate and compare the usefulness of the Ad-SOS to determine bone quantity and/or quality.

METHODS

Bone mineral content and density were determined with dual-energy x-ray absorptiometry. Trabecular connectivity was determined with histomorphometric techniques.

RESULTS

There was a strong correlation between the Ad-SOS and the other parameters studied, with a particularly high positive correlation with trabecular bone volume and trabecular thickness, and an inverse correlation with trabecular separation. The correlation was weaker with the bone mineral content and bone mineral density and with the trabecular number. For the trabecular separation, the correlation was significant in all cases, but it was negative.

CONCLUSIONS

Bone ultrasound, in this case Ad-SOS, defines the quality of the bone in terms of trabecular architecture rather than bone density; however, this conclusion is valid only for the rat femur model that the authors used.

Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power. The Phalangeal Osteosonogrammetry Study Group

Phalangeal osteosonogrammetry was introduced as a method for bone tissue investigation in 1992. It is based on the measure of the velocity of ultrasound (amplitude-dependent speed of sound [AD-SoS]) and on the interpretation of the characteristics of the ultrasound signal. In this study we have collected a database of 10,115 subjects to evaluate the performance of AD-SoS and to develop a parameter that is able to quantify the signal characteristics: ultrasound bone profile index (UBPI). The database only includes females of which 4.5% had documented vertebral osteoporotic fractures, 16% lumbar spine dual X-ray absorptiometry (DXA), and 6% hip DXA. The analysis of the ultrasound signal has shown that with aging the UBPI, first wave amplitude (FWA), and signal dynamics (SDy) follow a trend that is different from the one observed for AD-SoS; that is, there is no increase during childhood. In the whole population, the risk of fracture per SD decrease for AD-SOS was odds ratio (OR) 1.71 (CI, 1.58-1.84). The AD-SoS in fractured subjects was significantly lower than in a group of age-matched nonfractured subjects (p < 0.0001). In a small cohort of hip-fractured patients UBPI proved to be lower than in a control age-matched group (p < 0.0001). When the World Health Organization (WHO) working group criteria were applied to this population to identify the T score value for osteoporosis, for AD-SoS we found a T score of -3.2 and for UBPI we found a T score of -3.14. Sixty-six percent of vertebral fractures were below the AD-SoS -3.2 T score and 62% were below UBPI -3.14. We observed the highest incidence of fractures (63.6%) among subjects with AD-SoS who had both DXA T score values below the threshold. We conclude from this study that ultrasound investigation at the hand phalanges is a valid methodology for osteoporosis assessment. It has been possible to quantify signal changes by means of UBPI, a parameter that will improve the possibility of investigating bone structure.

Impact of weight in obese subjects on bone speed of sound

RATIONALE AND OBJECTIVES

The authors determined the effect of obesity on measurements of amplitude-dependent speed of bone ultrasound (Ad-SOS [m/sec]) and compared them to the total body bone mineral content (TBBMC/g).

METHODS

A total of 25 women were studied (mean age 41.8 +/- 10.2 years). In all the subjects, body mass index (BMI) exceeded 30 kg/m2 (range, 31.12-47.47 kg/m2); mean body weight was 104 +/- 17 kg. Ad-SOS was measured at the proximal phalanges and TBBMC in whole body with dual-energy x-ray absorptiometry.

RESULTS

Correlation study (Fisher's r to z) showed that Ad-SOS correlated negatively with weight (r = -0.85, P < 0.0001) and with TBBMC (r = -0.71, P < 0.0001). The correlation between TBBMC and weight was r = 0.76, P < 0.0001. Body fat percentage correlated partially with TBBMC (r = 0.40, P < 0.05) and negatively with Ad-SOS (r = -0.75, P < 0.0001). When the correlation test was adjusted for weight (partial correlation), the correlation between Ad-SOS and TBBMC was not significant (r = -0.21, P = NS), and the correlation between Ad-SOS and weight continued to be inversely significant (r = -0.67, P < 0.0001).

CONCLUSIONS

The results showed a clearly negative effect of weight on Ad-SOS measurements and indicated the limitations of this technique when employed in overweight and obese patients. Broad-band ultrasound attenuation and speed of sound, two commonly measured variables in bone ultrasound studies, may be differently affected by soft tissue.

Reproducibility of phalanx osteosonography and relation with forearm peripheral quantitative computed tomography: single finger versus average measurement on the last four fingers

The aim of this study was to evaluate the in vivo short-term reproducibility of amplitude-dependent speed of sound (AD-SOS) measured at the proximal phalanx, using an Igea DBM Sonic 1200 device, as well as its relationship with bone mineral density of the ultradistal radius, assessed using peripheral quantitative computed tomography (pQCT). In particular, the authors wished to evaluate whether average measurements on the last four fingers, as recommended by the manufacturer, yielded or not more information than measurements on one single finger. For the precision study, the authors carried out phalanx osteosonography ten times once every other day in ten healthy young women. To compare with pQCT of the radius, 37 women referred for screening of osteoporosis (mean age 60 years) were studied. AD-SOS was reported for each finger separately, as well as an average; pQCT (XCT 960 Stratec) yielded trabecular (BMDt); cortical (BMDc); and total (BMDtot) bone mineral densities, as well as the cortical area (Ac). The reproducibility of AD-SOS was significantly higher for the middle finger (mean coefficient of variation (CV) 1.1%) and the index than for the ring and small (mean CV 2.7%) finger. The middle finger consistently showed the best correlations with pQCT variables; the relationships involving BMDc (r = 0.54), BMDtot (r = 0.62) and Ac (r = 0.61) were stronger than that with BMDt (r = 0.34). The authors conclude that phalanx AD-SOS is moderately correlated with BMD of the ultradistal radius--at least when it includes the cortical component--and that reporting AD-SOS for the middle finger--instead of an average value--improves the reproducibility and possibly the relevance of phalanx osteosonography.

Reproducibility and diagnostic sensitivity of ultrasonometry of the phalanges to assess osteoporosis

OBJECTIVE

The present study was designed to assess the reproducibility and the diagnostic sensitivity of the amplitude-dependent speed of sound (SoS) at the distal metaphysis of the proximal phalanges.

METHOD

Fourteen presumably healthy volunteers were repeatedly measured every 6 weeks for approximately 6 months in order to assess the reproducibility of the SoS of the phalanges. We recruited 91 post-menopausal women, aged 55-75 years, who were divided in three groups according to their lumbar bone mineral density (BMD) and the existence of prevalent vertebral fractures. The objective was to evaluate the diagnostic sensitivity of SoS measurements. We used DBM Sonic 1200 equipment, and assessed the velocity at which US cross the phalanx in a lateral-medial direction. In post-menopausal women, BMD was measured by dual energy X-ray absorptiometry (DXA) at the level of the lumbar spine, the total zone of the non-dominant hip and the femoral neck zone of the non-dominant hip.

RESULTS

The precision of the SoS measurements was 0.71+/-0.05% (mean+/-S.E.M) whereas the reproducibility was 0.95+/-0.06%. Subjects with low BMD or prevalent fractures had significantly lower values of SoS (P < 0.001) than the controls. ROC curve analysis applied to the study population confirmed that SoS was able to discriminate between the controls and osteoporotic subjects (area under the ROC curves were 0.82 (low bone mineral density) and 0.85 (prevalent fractures), respectively). Hip BMD was found to be the most significant variable when comparing the controls and the low density patients by stepwise discrimination and SoS significantly improved the discrimination between the groups when added to the hip BMD. The hip BMD was again the most discriminant variable when applying the same techniques to controls and patients with prevalent fractures, followed by SoS and lumbar BMD. A cut-off value of 1881 m/s is defined for SoS by logistic discrimination and likelihood ratio function. With this value, the sensitivity and the specificity for SoS used in the diagnosis of established osteoporosis were, 81.5% and 79.3%, respectively. Sensitivity and specificity were significantly improved when combining ultrasonometry and densitometry.

CONCLUSION

Measurement of ultrasound velocity at the phalanges appears to be a precise and reproducible technique. SoS discriminates between normal post-menopausal women and patients with either low lumbar BMD or prevalent fractures to the same extent as BMD measurements.

Ultrasonographic bone velocity in pregnancy: a longitudinal study

OBJECTIVE

Longitudinal changes in bone mass were evaluated with use of ultrasonography and bone remodeling markers in 40 normal pregnant women in relation to their calcium intake.

STUDY DESIGN

The study took place at the University of Alcalá Hospital in Madrid. Biochemical markers of bone remodeling and ultrasonographic bone propagation velocity in the proximal phalanxes of fingers 2 to 5 were measured in all three trimesters of pregnancy. Wilcoxon, unpaired and paired t tests, and analysis of variance were used.

RESULTS

Ultrasonographic bone propagation velocity (meters per second) was lower in the second and third trimesters of pregnancy (p < 0.0001) compared with the respective preceding trimesters and in the third trimester in the overall group of pregnant women. Tartrate-resistant acid phosphatase and alkaline phosphatase levels increased significantly (p < 0.0001) in parallel with the ultrasonographic bone propagation velocity decrease.

CONCLUSIONS

Gestation was accompanied by a reduction in ultrasonographic bone propagation velocity that was greater in women with low calcium intake.