Assessment of a new quantitative ultrasound calcaneus measurement: precision and discrimination of hip fractures in elderly women compared with dual X-ray absorptiometry

The incidence of osteoporotic hip fracture increases in postmenopausal women with low hip bone mineral density (BMD). Dual X-ray absorptiometry (DXA) is the most commonly used technique for the assessment of bone status and provides good measurement precision. However, DXA affords little information about bone architecture. Quantitative ultrasound (QUS) systems have been developed to evaluate bone status for assessment of fracture risk. Our study was designed to assess a new QUS system from Hologic, the Sahara; to compare it with a previous model, the Walker-Sonix UBA 575+; and to investigate whether it is able to discriminate between women with and without fracture. Using both ultrasound devices, the measurements were performed at the heels of 33 postmenopausal women who had recently sustained hip fracture. A control group of 35 age-matched postmenopausal women was recruited for comparison. The total, neck and trochanter femoral BMD values were assessed using DXA for both groups. QUS and DXA measurements were significantly lower in fractured patients (p < 0.005) than in the control group. The short-term, mid-term and standardized short-term precisions were used to evaluate the reproducibility of the two QUS systems. The Sahara showed a better standardized coefficient of variation for broadband ultrasound attenuation (BUA) than did the UBA 575+ (p < 0.001). The correlation of BUA and speed of sound (SOS) between the two QUS devices was highly significant, with an r value of 0.92 for BUA and 0.91 for SOS. However, the correlation between DXA and ultrasound parameters ranged from 0.28 to 0.44. We found that ultrasound measurements at the heel were significant discriminators of hip fractures with odds ratios (OR) ranging from 2.7 to 3.2. Even after adjusting the logistic regressions for total, neck or trochanter femoral BMD, QUS variables were still significant independent discriminators of hip fracture. The areas under the ROC curves of each ultrasound parameter ranged from 0.75 to 0.78, and compared very well with femoral neck BMD (p > 0.05). In conclusion, our study indicated that the calcaneal QUS variables, as measured by the Sahara system can discriminate hip fracture patients equally as well as hip DXA.

Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimination

Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). The short-term and mid-term precisions of these devices were also determined. Thirty-five women (mean age 74.5+/-7.9 years) who had sustained a hip fracture within the past 3 years, and 35 age-matched controls (75.8+/-5.6 years) were recruited. Ultrasound measurements were acquired using six ultrasound devices: three gel-coupled and three water-coupled devices. Bone mineral density was measured at the hip using DXA. Discrimination of fracture patients versus controls was assessed using logistic regression analysis (expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA). The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson correlation coefficients between different devices was highly significant (SOS, r = 0.79-0.93; BUA, r = 0.71-0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r = 0.30-0.55; BUA, r = 0.35-0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r = 0.48-0.57 for BMD and r = 0.18-0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1-2.8) and BUA (2.4-3.4) were comparable to those for femoral BMD (2.6-3.5), as were the area under the curve (SOS, 0.65-0.71; BUA, 0.62-0.71; BMD, 0.65-0.74) from ROC analysis. Within the limitation of the sample size all devices show similar diagnostic sensitivity.

An evaluation of a new gel-coupled ultrasound device for the quantitative assessment of bone

Quantitative ultrasound (QUS) is now being accepted as a tool in the assessment of bone status. Most QUS devices measure broadband ultrasound attenuation (BUA) and speed of sound (SOS). A newly introduced device, the Acoustic Osteo-Screener (AOS-100), measures both SOS and an attenuation related parameter called the transmission index (TI) and provides a derived parameter called osteo sono-assessment index (OSI). The purpose of this study was to examine the reproducibility of this new device, compare the results with the UBA 575+ and evaluate the effect of using two platforms to compensate for different foot sizes on the measured values. 83 subjects aged 21-89 years, who gave informed consent, were recruited. Subjects were assigned to three different groups determined by age and health status. The short-term measurement precision (expressed as root mean square coefficient of variation) of SOS (0.13-0.16%) and TI (1.18-1.96%) was similar to and better than that obtained for the UBA 575+. Significant negative correlations were found between the differences in SOS measured with the two platforms (adaptors to adjust the position of the foot relative to the foot plate) and foot length (p < 0.0001). This implies that small feet are more influenced by the differences of measured location. All QUS parameters measured with the small platform were found to be significantly smaller than those with the large platform (p < 0.0001). The mean percentage differences were 0.6% in SOS, 2.8% in TI and 4.3% in OSI with the large foot platform giving larger value results. Proper use of the platforms resulted in more reproducible SOS and TI. This study demonstrated that the newly developed AOS-100 parameters TI and OSI were highly reproducible. This study also demonstrated that the use of an inappropriate platform can cause discrepancies in QUS readings and poor reproducibility.

Lymphoblastoid interferon-alpha downregulates parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor expression in human osteoblastic cells (Saos-2)

Interferon-alpha (IFN-alpha) is a pleiotropic cytokine that modulates the cellular functions of both osteoblastic and osteoclastic lineages. It remains unclear whether IFN-alpha regulates the expression of parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor, which is a major target molecule regulating skeletal metabolism. In this study, we examined the effect of IFN-alpha on the expression of PTH/PTHrP receptor in human osteoblastic cells (Saos-2). IFN-alpha inhibited the expression of PTH/PTHrP receptor gene in both a time- and dose-dependent manner. The mRNA level was decreased to 61.1% of that of the untreated control by 48 h treatment with 6000 U/mL of IFN-alpha. IFN-alpha also decreased cAMP response to PTH(1-34) in a dose-dependent manner and significantly depressed expression of the receptor protein. However, IFN-alpha did not exert any effect on other osteoblastic markers, such as alkaline phosphatase (ALP) activity, cAMP response to prostaglandin E2 (PGE2), and secretion of bone gla-protein (BGP) and bone sialoprotein (BSP). Finally, IFN-alpha decreased PTH/PTHrP receptor mRNA to 60.7% that of control in the presence of actinomycin D. These data suggest that IFN-alpha downregulates the expression of PTH/PTHrP receptor and its signaling without affecting other osteoblastic markers, and that IFN-alpha regulates its gene expression mainly by decreasing the stability of its mRNA.