Influence of density, elasticity, and structure on ultrasound transmission through trabecular bone cylinders

Effects of prenatal single and mixed bisphenol exposure on bone mineral density in preschool children: A population-based prospective cohort study

Exposure to bisphenols can affect bone mineral density (BMD) in animals and humans. However, the effects of maternal exposure to bisphenols during pregnancy on bone health in preschool children remain unknown. We aimed to assess the effects of prenatal exposure to single and multiple bisphenols on bone health in preschool children. A total of 230 mother-child pairs were included in this study. Generalized linear regression, restricted cubic spline (RCS), principal component analysis (PCA), and Bayesian kernel machine regression (BKMR) were utilized to assess the relationship between bisphenol levels and bone health in preschool children. Each natural log (Ln) unit increase in tetrabromobisphenol A was related to a 0.007 m/s (95 % CI: -0.015, 0.000) decrease in Ln-transformed speed of sound (SOS) among girls. Decreased BMD Z scores in preschool children were found only in the high bisphenol S exposure group (β = -0.568; 95 % CI: -1.087, -0.050) in boys. The risk of low BMD (BMDL) was significantly higher in the middle-exposure group (OR = 4.695; 95 % CI: 1.143, 24.381) and high-exposure group of BPS (OR = 6.165, 95 % CI: 1.445, 33.789) compared with the low-exposure group in boys. In girls, the risk of BMDL decreased with increasing bisphenol A concentration (OR = 0.413, 95 % CI: 0.215, 0.721). RCS analysis revealed a U-shaped nonlinear correlation between BPB concentration and BMDL in girls (P-overall = 0.011, P-nonlinear = 0.009). In PCA, a U-shaped dose-response relationship was found between PC2 and the risk of BMDL (P-overall = 0.048, P-nonlinear = 0.032), and a significant association was only noted in girls when stratified by sex. The BKMR model revealed a horizontal S-shaped curve relationship between bisphenol mixtures and BMDL in girls. The results indicated that prenatal exposure to single and mixed bisphenols can affect BMD in preschool children, exerting nonmonotonic and child sex-specific effects.

Quantitative Ultrasound Examination (QUS) of the Calcaneus in Long-Term Martial Arts Training on the Example of Long-Time Practitioners of Okinawa Kobudo/Karate Shorin-Ryu

Quantitative research of bone tissue related to physical activity (PA) and sport has a preventive dimension. Increasing the parameters of bone tissue strength, especially reaching the maximum value of peak bone strength in childhood, adolescence, and early adulthood due to practicing sports can contribute to maintaining bone health throughout life. Practicing martial arts (tai chi, traditional karate, judo, and boxing) can effectively improve the quality of bone and reduce the risk of falls and fractures. The study aimed to evaluate the calcaneus bones among Okinawa Kobudo/Karate Shorin-Ryu practitioners using the quantitative ultrasound method as an indicator for assessing bone fracture risk. Forty-four adult martial arts practitioners with a mean age of 36.4 participated in this study. Quantitative ultrasound (QUS) with a portable Bone Ultrasonometer was used in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (SI) were measured. Subjects were assigned to two groups of black and color belts, according to the advancement in Kobudo/karate practice. The measurements of the SI, BUA, SOS, T-score, and Z-score were significantly higher in subjects from the advanced, long-term practice (black belts) (p < 0.05). The long-term martial arts training in traditional karate and Kobudo significantly impacts the parameters of the calcaneus quantitative ultrasound measurements. Significantly higher bone density was observed among the black belt holders. Long-term practice subjects achieved results far beyond the norm for their age groups. Further studies using non-invasive methods of bone quantification are needed to determine the specific conditions for preventing osteoporosis through physical activity, sports, and martial arts, particularly the duration of the activity, the magnitude of loads, and other related factors.

Bone Mineral Density Screening System Using CMOS-Sensor X-ray Detector

This research concerns a design and construction of a bone mineral density (BMD) and bone mineral content (BMC) measurement system based on dual energy X-ray absorptiometry (DEXA). An indirect X-ray detector is designed by optical coupling CMOS sensor with image on the intensifying screen. A dedicated microcontroller X-ray apparatus is used as an X-ray source to capture two energy level X-ray of middle phalanges bone of middle finger. The captured image is processed based on modified Beer-Lambert law to compute bone mineral density. Bone mineral content is also computed by determining the area of the phalanges bone using active contour. The designed bone mineral density (BMD) and bone mineral content (BMC) measurement system is low-cost and hence can be distributed at district hospital for screening purposes of Osteoporosis of the elderly. Compared with BMD measured from commercial model, BMD measurement of our system acquires linear relation with R2 equals 0.969. The mean square error between the normalized BMD value and that of the commercial model is 0.0000981.

Mechanisms of Interaction of Ultrasound With Cancellous Bone: A Review

Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of attenuation and sound speed in cancellous bone. This review discusses fundamental mechanisms underlying the interaction between ultrasound and cancellous bone. Because of its two-phase structure (mineralized trabecular network embedded in soft tissue-marrow), its anisotropy, and its inhomogeneity, cancellous bone is more difficult to characterize than most soft tissues. Experimental data for the dependencies of attenuation, sound speed, dispersion, and scattering on ultrasound frequency, bone mineral density, composition, microstructure, and mechanical properties are presented. The relative roles of absorption, scattering, and phase cancellation in determining attenuation measurements in vitro and in vivo are delineated. Common speed of sound metrics, which entail measurements of transit times of pulse leading edges (to avoid multipath interference), are greatly influenced by attenuation, dispersion, and system properties, including center frequency and bandwidth. However, a theoretical model has been shown to be effective for correction for these confounding factors in vitro and in vivo. Theoretical and phantom models are presented to elucidate why cancellous bone exhibits negative dispersion, unlike soft tissue, which exhibits positive dispersion. Signal processing methods are presented for separating "fast" and "slow" waves (predicted by poroelasticity theory and supported in cancellous bone) even when the two waves overlap in time and frequency domains. Models to explain dependencies of scattering on frequency and mean trabecular thickness are presented and compared with measurements. Anisotropy, the effect of the fluid filler medium (marrow in vivo or water in vitro), phantoms, computational modeling of ultrasound propagation, acoustic microscopy, and nonlinear properties in cancellous bone are also discussed.

A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk

The prevalence of osteoporosis in Asian countries is growing. An effective screening method will enable patients at risk for osteoporosis to receive early diagnosis and treatment, and avoid overcrowding the limited dual-energy x-ray absorptiometry (DXA) machines available in Asian countries. Many simple osteoporosis screening algorithms have been developed but they are not validated for use in Asian populations. osteoporosis self-assessment tools for Asians (OSTA), established using a multinational Asian cohort, is the first screening algorithm that caters for the Asian populations. It considers only body weight and age in the algorithm. It shows consistently high performance and sensitivity in identifying postmenopausal women at risk for osteoporosis in many Asian countries. Its usage has been expanded for identifying osteoporosis in men, as well as determining fracture risk for both sexes. However, the performance of OSTA is influenced by age, sex, ethnicity and site of BMD measurement to define osteoporosis. Its usage is also limited in individuals without apparent risk factors. These limitations should be noted by physicians considering the use of OSTA in clinical setting. As a conclusion, OSTA is a cost-effective measure for osteoporosis screening in primary healthcare setting.

Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia

Background

Osteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia.

Methods

A cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices.

Results

The prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05).

Conclusion

A significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.

Lessons from the Bone Chapter of the Malaysian Aging Men Study

Male osteoporosis in Malaysia is a largely neglected problem. Therefore, a bone health study in men using quantitative ultrasonometry was launched as part of the Malaysian Aging Men Study in 2009–2012. This review aimed to summarize the findings of the aforementioned bone health study. The study examined the bone health of Chinese and Malaysian men aged 20 years and above living in Kuala Lumpur using a quantitative ultrasound device. Participants answered a questionnaire on their demographic details and physical activity status. Body anthropometry of the participants was measured and their blood collected for biochemical analysis. Results showed that a significant proportion of the Malaysian Chinese and Malay men had suboptimal bone health indicated by calcaneal speed of sound and vitamin D status. Age-related decline of the calcaneal speed of sound in these men was gradual and biphasic without ethnic difference. Body anthropometry such as height, weight, body mass index, and body fat percentage contributed to the variation of the calcaneal speed of sound in Malaysian men. Age-related changes in testosterone, insulin-like growth factor 1, and thyroid stimulating hormone also influenced the calcaneal speed of sound in these men. This study serves as a reminder that male osteoporosis in Malaysia should be an issue of concern. It is also a basis for a more comprehensive study on bone health in men in the future.

Longitudinal assessment of bone loss using quantitative ultrasound in a blood-induced arthritis rabbit model

INTRODUCTION

Osteoporosis is common in haemophilic arthropathy. Quantitative ultrasound (QUS) can be a suitable alternative for dual-energy x-ray absorptiometry for diagnosing osteoporosis in haemophiliacs due to its lack of ionizing radiation, and ease to use.

AIM

We investigated the intra- and inter-operator reliability of QUS, its responsiveness to bone growth, its ability to differentiate bone adjacent to blood-injected vs. control joints, and the effect of soft tissues on the speed of sound (SOS) QUS values in a juvenile white New Zealand rabbit model of blood-induced arthritis.

METHODS

Eight of 16 rabbits were injected with autologous blood (0.1 mL kg(-1) ) 8 times over a 17-week period, the remaining eight rabbits served as controls. SOS was measured at baseline, weeks 8 and 17 in vivo and after the bones were excised on week 17.

RESULTS

Intra- and inter-operator coefficients of variation for QUS data were <5% and intraclass correlation coefficients were >60% for 22/27 (81.5%) of bones assessed. The level of interval increase in SOS values from baseline to week 17 was significantly different in tibiae of injected, contralateral to injected and non-injected knee groups by anova (P = 0.01). In vivo (mean ± SD, 4147.17 ± 96.27 m s(-1) ) and postmortem (4457.85 ± 104.00 m s(-1) ) measurements on week 17 differed (P < 0.01) indicating an effect of soft tissues on SOS.

CONCLUSION

In conclusion, QUS' acceptable reliability, its responsiveness to growth-related changes and its ability to discriminate injected and non-injected joints make this technique a plausible candidate as a diagnostic tool for osteoporosis in the paediatric haemophilic population if these results are confirmed upon animal-human translation.

Calcaneal quantitative ultrasound as a determinant of bone health status: what properties of bone does it reflect?

Quantitative ultrasound (QUS) has emerged as a convenient and popular screening tool for osteoporosis. This review aimed to provide basic information on the principle of QUS measurement and discuss the properties of bone reflected by QUS indices. QUS employed high frequency sound waves generated by the device to determine bone health status in humans. In vitro studies showed that QUS indices were significantly associated with bone mineral density (BMD), bone microarchitecture and mechanical parameters. In humans, QUS indices were found to be associated with BMD as well. In addition, QUS could discriminate subjects with and without fracture history and predict risk for future fracture. In conclusion, QUS is able to reflect bone quality and should be used in the screening of osteoporosis, especially in developing countries where dual-X-ray absorptiometry devices are less accessible to the general population.

Cortical thickness and medullary canal dimensions of the bone phalanx are predicted by quantitative ultrasound parameters

The aim of the study was to investigate the relationship between quantitative ultrasound (QUS) parameters extracted from the analysis of the ultrasound (US) signal and the geometric properties of the bones. One hundred and one subjects in the age range of 20-7 4yr (mean: 52+/-12 yr) have been measured by QUS at the phalanges for the evaluation of amplitude-dependent speed of sound (AD-SoS), bone transmission time (BTT), US peak amplitude (UPA), signal dynamic (SDY), slope, energy, and fast wave amplitude (FWA). Hand radiograph, lumbar spine dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), and femoral neck DXA forearm peripheral QCT were performed on all patients. BTT is related to cortical thickness (CTh) (r=0.62, p<0.0001), and FWA is related to medullary canal thickness (r=-0.64, p<0.0001). Other parameters are related to both medullary canal thickness (AD-SoS: r=-0.21; UPA: r=-0.53; SDY: r=-0.56; slope: r=-0.64; energy: r=-0.44, p<0.05) and CTh (AD-SoS: r=0.54, p<0.0001; UPA: r=0.51; SDY: r=0.38; slope: r=0.32; energy: r=0.56, p<0.001). Linear multivariate models indicate that BTT, UPA, and energy measured at the phalanges carry independent information on CTh of the bone, whereas FWA, SDY, and slope are related only to medullary canal thickness.

Genetic architecture of hand quantitative ultrasound measures: a population-based study in a Sardinian genetic isolate

It is now recognized that quantitative ultrasound (QUS) measures may predict osteoporotic fracture risk independently of bone mineral density. Although many studies have examined genetic and environmental components of bone mineral density and calcaneal QUS measures, few of them were addressed to phalangeal QUS phenotypes, and none to graphic trace parameters. This study aims to evaluate the relative contribution of genetics in the expression of phalangeal QUS traits in the adult healthy population of a Sardinian genetic isolate. Our sample includes 6056 men and women aged 30-103 years, from 43 extended pedigrees recruited in 10 villages of Ogliastra region in occasion of a large epidemiologic survey. Amplitude-dependent speed of sound (AD-SoS), fast wave amplitude (FWA), signal dynamic (SDy), bone transmission time (BTT) and ultrasound bone profile index (UBPI) were obtained from the non-dominant hand using the IGEA DBM Sonic Bone Profiler. These phenotypes were first regressed on age, anthropometric and bioimpedance measures, serum calcium, phosphorus and alkaline phosphatase, alcohol and caffeine consumption, smoking status, exercise and also months since menopause and estrogens use in women. Adjusted QUS parameters were then analyzed by univariate and bivariate variance component models to obtain heritability estimates and genetic and environmental correlations. QUS parameters were correlated to age, anthropometric and bioimpedance measures, serum phosphorus, alkaline phosphatase and to reproductive history and menopause in women. All phenotypes demonstrated substantial heritabilities ranging from 0.29+/-0.03 for SDy to 0.55+/-0.03 for FWA. Proportion of variance due to all covariates ranged from 36% for SDy to 59% for BTT. Many significant genetic and environmental correlations were found between the different QUS measures. In this study, genetic factors appear to play a relevant role in determining hand QUS measures even when taking into account various important environmental factors. Furthermore, the modest genetic correlations may imply the existence of partially unique sets of genes affecting different QUS traits, thus suggesting that QUS parameters measure different properties of bone tissue.

Modelling Young's modulus for porous bones with microstructural variation and anisotropy

A structural model with three compositional phases and two levels of hierarchical organization is proposed for predicting Young's modulus of porous bones with microstructural variations and anisotropy based on their geometric similarity to metal foams. It has been shown that the proposed single model provides predictions of Young's modulus with high accuracy up to +/-30% for cortical and cancellous bones compared with measured data from the literature. In addition, the conversion of the solid bone shape from "Plate-like" to "Rod-like" at a porosity of 70% or higher (BV/TV 30% or lower)-verified by observations-can be predicted using the proposed model.