Ultrasound attenuation of the calcaneus: A sensitive and specific discriminator of osteopenia in postmenopausal women (original) (raw)
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Clinical Rheumatology, 2007
The association between quantitative ultrasound (QUS) and bone turnover in postmenopausal women of different ages is an area of continuous investigation. The aim of this study was to investigate the relationship of ultrasound parameters [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] to bone mineral density (BMD) and biochemical markers of bone turnover in three age groups of postmenopausal women. One hundred and twenty-three postmenopausal Caucasian women were divided into three groups according to their age: group A, range 44-54 years, mean age (±SD) 48.3±2.3; group B, range 55-65 years, mean age 59.4±2.1; and group C, range 66-77 years, mean age 68.2±3.1. Ultrasound parameters were measured by the DTU-one imaging ultrasonometer in the calcaneus. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, and trochanter. Bone turnover was assessed by serum bone-specific alkaline phosphatase (BAP), urinary excretion of free deoxypyridinoline, N-telopeptides (NTX), and C-telopeptide breakdown products of type I collagen (CTX). QUS and BMD were significantly correlated in all sites, except hip BMD in group A. The most significant correlation was observed between BUA and femoral neck BMD in group C (r=0.626, p<0.01). BUA correlated significantly with BAP, NTX, and CTX (r=−0.434, −0.511, −0.478, respectively; p<0.01), and SOS with BAP and NTX (r=−0.351 and −0.356, respectively; p<0.05) only in group C. In groups A and B, ultrasound parameters did not correlate significantly to biochemical markers. Ultrasound parameters were better correlated to hip BMD and to biochemical markers of bone turnover in elderly postmenopausal women. These ultrasound measurements could be used as a screening test for bone status, either in nonambulatory third aged women or in those living in rural areas where attending medical centers with DEXA equipment and biochemical laboratories is difficult.
Osteoporosis International, 1998
The aim of this cross-sectional study was to use a novel method of data analysis to demonstrate that patients with osteoporosis have significantly lower ultrasound results in the heel after correcting for the effect of bone mineral density (BMD) measured in the spine or hip. Three groups of patients were studied: healthy early postmenopausal women, within 3 years of the
Quantitative ultrasound technique for the assessment of osteoporosis and prediction of fracture risk
Osteoporosis in men and women is increasingly recognised as an important health issue. Bone mineral density (BMD) and bone strength appears to be major determinants of osteoporotic fracture. Measurement of bone strength by ultrasound is found to be a competitive means of measuring osteoporotic fracture risk and provide additional information about bone's structure and composition. In the present work quantitative ultrasound assessment of osteoporosis is carried out in Indian men and women by measuring broadband ultrasound attenuation (BUA) and speed of sound (SOS) through calcaneum bone to provide a clinical measure called the stiffness index (SI). The SI is the sum of the scaled and normalised BUA and SOS values, which is a measure of bone strength and is sensitive to bone structure used to predict the risk of bone fracture due to osteoporosis. Measurement of SI is carried out in 283 men, 108 premenopausal and 85 postmenopausal women. SI results expressed as T-score and Z-score are used to assist the physicians in the diagnosis of osteoporosis. The presence of osteoporosis is defined as T-score lower than-2.5. Observation shows that osteoporosis is predominant in postmenopausal women population who are at greater risk of fracture compared to premenopausal women and men. The effect of age, weight, height and body mass index (BMI) on SI in men and women is analyzed. The SI has negative correlation with age and is found to be a significant factor in both men and women with a high percentage of bone mineral loss in early menopausal women. In univariate analysis body weight and BMI have moderate positive correlation with SI in men and women. Height seems to have no significant effect on SI. There is a rapid loss of bone mineral content leading sudden decrease in SI during the first five years after menopause and it continues to decrease at a lesser rate with increasing age.
Osteoporosis international, 2004
Osteoporotic fracture is considered to result from reduced bone strength and to be related to decreased bone mass and impaired bone architecture. Quantitative ultrasound measurements (QUS) of bone, that may reflect certain architectural aspects of bone, have been shown to be associated with fracture, but it is not clear whether the association is independent of bone mineral density (BMD). This study was designed to examine the contributions of cortical QUS and BMD measurements to the prediction of fracture risk in postmenopausal Caucasian women. Speed of sound (SOS) at the distal radius, tibia, and phalanx (Sunlight Omnisense) and BMD at the lumbar spine and femoral neck (GE Lunar) were measured in 549 women, aged 63.2 ± 12.3 years (mean ± SD; range, 49-88 years), including 77 fracture cases. Lower SOS at the distal radius, tibia, and phalanx, which were correlated with each other, were associated with increased risk of fracture. Independent predictors of fracture risk (in multivariate analysis) were distal radius SOS (OR per SD = 1.8; 95% CI, 1.3-2.4), femoral neck BMD (OR per SD = 1.9; 95% CI, 1.4-2.4), and age (OR per 5 years = 1.2; 95% CI, 1.0-1.5). Approximately 30% of the women had distal radius SOS T-scores <)2.5; however, only 6.6% of women had both BMD and SOS T-scores <)2.5. Among the 77 fracture cases, only 14 (18.2%) had both BMD and QUS T-scores below )2.5. These data in postmenopausal women suggest that speed of sound at the distal radius was associated with fracture risk, independent of BMD and age. The com-bination of QUS and BMD measurements may improve the accuracy of identification of women who will sustain a fracture.
European Journal of Radiology, 2000
Objecti6e: To prospectively study the relationship of quantitative ultrasound of the calcaneus with anthromopometric variables and with bone mineral density (BMD) assessed at the level of the calcaneus as well as at other sites. Method: Osteosonography of the non-dominant calcaneus was performed in 135 menopausal women, using a DTU-one device with parametric imaging. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were assessed. BMD of the calcaneus (BMDcal) was measured using dual energy X-ray absorptiometry (DXA), in a subregion matched with the region of interest for osteosonography. BMD of the lumbar trabecular bone was measured using quantitative computed tomography (BMD QCT) while the non-dominant hip was studied using DXA, which provided the total bone mineral density (BMDhip) and that of the Ward triangle (BMDWard). Results: The Pearson correlation coefficients between BUA, SOS and the various measurements of BMD ranged from 0.305 (SOS versus BMDhip) to 0.717 (BUA versus BMDcal). BMD QCT and BMDWard were found to depend on age, but not on weight or height, while BUA, SOS, BMDcal, BMDhip were unrelated to age, but correlated with weight (SOS, BMDhip) or with weight and height (BUA, BMDcal). In a multiple stepwise regression analysis, age was a significant predictor for BMD QCT, BMD hip and BMDWard; BMD QCT, BMDWard and BMDhip admitted BUA as sole predictor, while BMDcal was significantly related to both BUA and SOS. Conclusion: BUA and SOS of the calcaneus, assessed in 135 menopausal women using a parametric imaging device, reflected BMDcal, measured with DXA at a matched region of interest, and did not decline significantly with age.
Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis
Open Medicine, 2010
Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were...
European Journal of Internal Medicine, 2005
Background: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear. Methods: A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara \, Hologic \ device. Results: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% falsepositive figures, the T-score cut-off for SOS was À 2.45 and À0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined. Conclusions: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.
Calcified Tissue International, 1995
Normative data for qualitative ultrasound (QUS) measurements: speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness were established in 118 healthy women aged 20-86 years and in 42 healthy men aged 22-76 years. The relations between age, weight, height, and QUS were studied. QUS measurements were negatively correlated with age in both sexes. In women, age was accepted as first factor (R 2 = 0.39 for SOS, 0.35 for BUA, and 0.45 for stiffness, P < 0.001); weight was accepted as second factor for BUA (R 2 = 0.44, P < 0.001). In men, age was the only significant parameter (R 2 = 0.41 for SOS, 0.39 for BUA, 0.43 for stiffness, P < 0.001). QUS measurements of the right and the left feet were highly correlated unless unilateral foot pathology such as algodystrophy was present. Significant correlations were found between QUS of the calcaneus and dual X-ray absorptiometry (DXA) of the lumbar spine