Can the effects of exercise on bone quality be detected using the CUBA clinical ultrasound system?

Discrepancy in bone mineral densities at different skeletal sites in hip osteoarthritis patients

OBJECTIVE: Increased femoral neck bone mineral density (BMD) in a hip with osteoarthritis (OA) has been previously reported, however, it is possible that increased BMD at sites other than the hip joint is influenced by the disease process of OA. Therefore, we measured BMD at locations different from the hip joint and determined whether higher BMD was also observed at these different skeletal sites in hip OA patients. METHODS: We measured BMD in 68 women (average age 61.0 years) scheduled to undergo total hip arthroplasty for end-stage OA and 100 healthy women (average age 60.9 years) as age-matched controls. BMD at the lumbar spine, radius, and calcaneus was measured by dual-energy X-ray absorptiometry (DXA). Moreover, we measured speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index of the calcaneus by quantitative ultrasonography (QUS). RESULTS: BMD obtained by DXA at the lumbar spine and radius was significantly higher in hip OA patients than in controls. However, at the calcaneus, no significant differences were observed between the groups in BMD obtained by DXA. SOS, BUA, and stiffness index obtained by QUS were significantly lower in the OA group than in controls. CONCLUSION: Higher BMDs of the spine and radius suggest that the incidence of osteoporosis is inversely associated with the incidence of OA. However, it remains unclear whether lack of difference in BMD and lower SOS, BUA, and stiffness index of the calcaneus in the OA group was secondary to the effect walking disturbance resulting from hip pain. Our data suggest that hip OA patients have higher BMD than healthy women, and that inactivity or immobilization caused by hip OA may reduce BMD in the lower limb.

Assessment of the bone density of nomadic Fulani Herdsmen in northern Nigeria using calcaneal ultrasonography

CONTEXT

Osteoporosis is characterized by decreased bone density and increased bone fragility. Genetics, diet, and physical activity are established determinants of bone density. The seminomadic Fulani of northern Nigeria trek long distances on foot daily to graze and water their animals, and have access to calcium-rich dairy products.

OBJECTIVE

We sought to determine whether the high level of physical activity and presumed calcium-rich diet of the Fulani would promote a higher bone density, compared with their relatively inactive counterparts in the general population.

DESIGN

Cross-sectional study.

SETTING

Three Fulani settlements (Toro, Tilden Fulani, and Magaman Gumau) within 5 to 15 kilometers of Jos Metropolis on the Jos Plateau in northern Nigeria.

PATIENTS

We assessed the calcaneal characteristics of a consecutive sample of 51 active seminomadic Fulani men using the Lunar Achilles+ ultrasonometer.

MAIN OUTCOME MEASURES

Calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and SI T-scores.

RESULTS

The mean age of the herdsmen was 26 +/- 9 years (range, 16 to 49), and the mean BMI was 19.9 +/- 2.3 kg/m(2). The mean BUA was 124 +/- 13 dB/MHz (95% CI, 120 to 128), the mean SOS was 1572 +/- 33 m/s (95% CI, 1563 to 1581), the mean SI was 102 +/- 17 (95% CI, 97 to 107], and the mean SI T-score was -0.74 +/- 0.97 (95% CI, -0.47 to 1.01]. The mean SI was 1 T-score unit below that of an age-matched cohort in the general population.

CONCLUSION

Fulani herdsmen have a theoretically increased risk for bone fracture in a background of low BMI and potentially high calcium intake.

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

BACKGROUND

Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading.

METHODS

We recruited 102 male athletes: these included football (n = 68), running (n = 15), handball (n = 7), taekwando (n = 6), cycling (n = 2), judo (1), badminton (1) and high jump (1). Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer.

RESULTS

The mean age of athletes was 25 +/- 6 years. The means of BMI and energy expenditure were 21.9 +/- 2.0 kg/m2 and 35.0 +/- 13.7 kcal/kg/day, respectively. Footballers were younger (p < 0.001) and heavier (p < 0.001) than runners. Football was a significant determinant of BUA independent of age, BMI and energy expenditure (p = 0.001). Football was also a significant determinant of SOS independent of age, height, weight and BMI (p < 0.001). The mean SI was 127 +/- 16 and the median T-score was 0.82 (-1.88, 3.35). The mean SI of footballers (130 +/- 15), runners (130 +/- 12) and other sportsmen (115 +/- 18) differed significantly (p = 0.001). Multivariate analyses revealed that football (p < 0.001) and running (p < 0.001) were significant determinants of SI independent of age and BMI. Footballers when compared with other sportsmen had a higher mean SI independent of age and BMI (p < 0.001). Age was not correlated with SI. The median T-score of footballers, 0.94 (-1.0, 3.35) was higher than that of other sportsmen.

CONCLUSION

Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.

Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound

OBJECTIVE

This study was designed to investigate bone properties using heel quantitative ultrasound (QUS) in young adults participating in various sports.

METHODS

A cross sectional study was performed on Chinese male students (n = 55), aged 18-22 years. Subjects with previous fractures or suffering from any diseases known to affect bone metabolism or taking any medication with such an effect, were not included. The subjects were categorised according to their main sporting activities, including soccer (n = 15) (a high impact, weight bearing exercise), dancing (n = 10) (a low impact, weight bearing exercise), and swimming (n = 15) (non-weight bearing exercise). A sedentary group acted as controls (n = 15). A reproducibility study of the velocity of sound (VOS) and the broadband ultrasound attenuation (BUA) measurement was performed and analysed using the intraclass correlation coefficient (ICC).

RESULTS

There was good intra-investigator and inter-investigator agreement (ICC > or = 0.8; p < 0.05) in the measurement of BUA and VOS. No significant differences in BUA and VOS (p > 0.05) were found between the dominant and non-dominant heel. Soccer players (137 +/- 4.3 dB/MHz; 1575 +/- 56 m/s; 544.1 +/- 48.4) and dancers (134.6 +/- 3.7 dB/MHz; 1538 +/- 46 m/s; 503.0 +/- 37.0) had significantly higher BUA, VOS, and stiffness index (SI) scores (p < 0.05), respectively, than swimmers (124.1 +/- 5.1 dB/MHz; 1495 +/- 42 m/s; 423.3 +/- 46.9) and the sedentary control group (119.9 +/- 6.1 dB/MHz; 1452 +/- 41 m/s; 369.9 +/- 46.4). A trend of a significant linear increase with the weight bearing and high impact exercise was revealed in all QUS parameters (p < 0.05).

CONCLUSION

This cross sectional study indicated that regular participation in weight bearing exercise in young people might be beneficial for accruing peak bone mass and optimising bone structure.

Quantitative heel ultrasound variables in powerlifters and controls

OBJECTIVE

To compare by cross sectional study the quantitative heel ultrasound (QUS) variables broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in male powerlifters and controls.

METHODS

Twenty four powerlifters and 21 sedentary male controls were recruited to the study. All the powerlifters were members of the British Drug Free Powerlifting Association and actively competing at the time of the study. A questionnaire was completed by all those entered into the study. This included a history of smoking and an estimation of daily intake of alcohol and calcium. For the powerlifters, the number of years spent training and time spent training each week was also recorded. The QUS variables of all powerlifters and controls were measured using a Cubaclinical II (McCue) ultrasound scanner.

RESULTS

The powerlifters had been training for a mean (SEM) of 10.6 (1.6) years and they trained for 6.5 (0.4) hours a week. The powerlifters were non-significantly older and had a significantly higher body mass index (BMI) than the controls. Calcium intake and consumption of alcohol and tobacco were similar in the two groups. The mean BUA in the powerlifters was a significant 9.5% (95% confidence interval 0.7 to 18.3%) higher than the controls (105 v 96 dB/MHZ) and 15.6% (95% confidence interval 6.8 to 24.4%) higher after adjustment using analysis of covariance for age, BMI, and alcohol and tobacco consumption (108 v 93 dB/MHZ). The mean VOS was similar in the two groups, but after adjustment it was significantly higher in the powerlifters (1671 v 1651 m/s, p<0.01).

CONCLUSIONS

The study shows the ability of heel ultrasound to discriminate between QUS variables in powerlifters and controls. The results indicate that the QUS variables BUA and VOS are significantly higher for powerlifters than for controls.