The Use of Calcaneal Ultrasound Evaluation of Bone Mineral Density in Cognitively Impaired Seniors

Abstract

Low bone mineral density (BMD) is a major risk factor for osteoporotic fracture. The gold standard measurement of BMD, central dual-energy x-ray absorptiometry (DXA), requires transportation to a radiologic facility, patient agility and cooperation. For those with severe cognitive impairment, this is not realistic; hence, central BMD is seldom measured. The objectives were to evaluate the use of calcaneal BMD measurement (by qualitative ultrasound), the prevalence of osteoporosis diagnosis (based on calcaneal BMD), and treatment in individuals with severe cognitive impairment.This is a point prevalence descriptive study. Calcaneal BMD was measured using a Sahara sonometer (Hologic). Cognition (Mini Mental Status Examination), mobility (Berg balance scale, timed up-and-go), and chart audit were also undertaken.This study was conducted at four dementia long-term care facilities (122 beds) in Edmonton, Alberta, Canada.Forty long-term care residents participated in this study with an average MMSE of 10 (range, 0-25).One hundred percent of study subjects cooperated with calcaneal ultrasound measurement.Based on calcaneal BMD measurement using recommended cutoffs, 92.5% were at high risk for osteoporosis or osteopenia and 5% were at moderate risk. One participant (2.5%) had a normal calcaneal BMD measurement. Calcium supplementation occurred in 32% of the high-risk group, 50% of the moderate-risk group, and 100% of the normal group. One (2.5%) participant was on hormone replacement therapy, and 12% were taking etidronate.Calcaneal ultrasound measurement could be a useful tool to assess BMD in cognitively impaired nursing home residents.