Amplitude-dependent Speed Of Sound Values Research Articles

Ultrasound bone mass in patients undergoing chronic therapy with oral anticoagulants

The purpose of this study was to assess the effects of chronic oral anticoagulant (OAC) treatment on bone mass using quantitative ultrasound (QUS) techniques. A total of 120 patients (47 women and 73 men) undergoing treatment with OAC and 57 healthy subjects (27 women and 30 men) participated in this study. Bone status was assessed using QUS devices that measure the amplitude-dependent speed of sound (Ad-SoS) in phalanges and the broadband ultrasound attenuation (BUA) in the calcaneus. Men undergoing OAC treatment had lower Ad-SoS, Z-score, T-score, and BUA values (all p < 0.005) and higher levels of undercarboxylated osteocalcin (u-OC) and tartrate-resistant acid phosphatase (TRAP) (both p < 0.0001) than controls. Women receiving OAC treatment had lower BUA values (p < 0.005) and total osteocalcin (OC) levels (p < 0.0001) and higher levels of u-OC and TRAP (both p < 0.0001) than controls. There was a statistically significant negative correlation between u-OC levels and Ad-SoS values in both men (r = -0.432, p = 0.0328) and women (r = -0.332, p = 0.0269) undergoing OAC treatment. In conclusion, patients undergoing OAC treatment had a loss of trabecular and cortical bone mass, possibly due to a decrease in the γ-carboxylation of osteocalcin resulting from the vitamin K antagonism of these drugs.

Ultrasound bone mass in schizophrenic patients on antipsychotic therapy

To determine bone mass using quantitative phalangeal bone ultrasound in institutionalized schizophrenic patients under chronic treatment with antipsychotic drugs. A total of 73 patients with schizophrenia (25 women, mean age 59.84 +/- 17.01 years; 48 men, mean age 61.89 +/- 12.95 years) and 73 healthy subjects (25 women, mean age 60.37 +/- 17.16 years; 48 men, mean age 61.24 +/- 13.09 years) participated in the study. Bone status was assessed using an ultrasound device that measures the amplitude-dependent speed of sound (Ad-SoS) in metres per second. Measurements were made on the phalanges (II-V) of the non-dominant hand, and the mean value was computed. The schizophrenic women had higher levels of prolactin (PRL), parathyroid hormone (PTH), alkaline phosphatase (AlPh), and tartrate-resistant acid phosphatase (TRAP) (all p < 0.0001), and lower 25-hydroxyvitamin D(25(OH)D3) levels (p < 0.0001) and Ad-SoS values (p < 0.05) than controls. Ad-SoS was higher in schizophrenic men (p < 0.05). Schizophrenic women in treatment with antipsychotic drugs had a loss of phalangeal bone mass that was associated with the levels of vitamin D or PTH, and increased bone turnover.

The influence of gluten free diet on quantitative ultrasound of proximal phalanxes in children and adolescents with type 1 diabetes mellitus and celiac disease

A reduced bone mineral density has been reported in patients with untreated celiac disease (CD) as well as in patients with poorly controlled type 1 diabetes mellitus (T1DM). The aim of this study was to evaluate the bone mineral status by phalangeal quantitative ultrasound in 52 children and adolescents with both diseases (mean age 13.3 ± 4.9 years). As a control group 50 patients with T1DM and no CD (age 12.2 ± 4.0 years) were studied. The following bone parameters, amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were considered and expressed as z score. Compliance to gluten free diet and long term glycemic control (mean of four determinations of HbA1c in the last year) were also assessed. The lowest mean AD-SoS z score values were found in patients with T1DM and CD, who reported transgressions to gluten free diet and exhibited positivity for serum anti-tissue transglutaminase antibodies (tTG) and/or endomysial antibodies (EmA), compared with patients with occasional transgressions but negative for anti-tTG and/or -EmA, patients strictly adherent to the diet, and patients who suffered only from diabetes (ANOVA p = 0.021). No difference was found between patients with diabetes alone and patients with both diseases strictly adherent to gluten free diet. Prevalence of osteopenia ( z AD-SoS values < − 2 SD) was higher in patients with T1DM and CD and poor compliance to the diet (45.5%) compared with patients with T1DM (8%) or patients with both diseases strictly compliant to diet (12.9%) ( p = 0.015). A negative correlation between Ad-SoS z score and HbA 1c ( r − 0.236, p = 0.036) was found when patients with T1DM and patients with T1DM and CD, who strictly adhere to the diet, were pooled. In conclusion the quality of bone as assessed by phalangeal ultrasound in patients with T1DM and CD, who strictly adhere to gluten free diet, is similar to that found in T1DM patients. A higher prevalence of osteopenia is present in patients with both diseases who reported habitual transgressions to gluten free diet. The gluten free diet, as well as the optimization of glycemic control, plays an important role in preventing the osteopenic status caused by the clustering of these two chronic diseases.

Bone Metabolism Changes During Anti‐TNF‐α Therapy in Patients with Active Rheumatoid Arthritis

Osteoporosis (OP) occurs more frequently in patients with rheumatoid arthritis (RA) than in healthy individuals. Specific treatments of RA may increase susceptibility to OP, but at the same time decrease inflammatory activity, which is associated with accelerated bone loss. Treatment with TNF-alpha blockers might influence bone metabolism and prevent structural bone damage in RA, in particular at the periarticular level. Our aim was to assess the influence of anti-TNF-alpha therapy on bone metabolism in RA patients. To that end we evaluated a group of 30 RA patients [mean age 50.6 +/- 6.8 years; median disease duration 82 +/- 38 months; median disease activity score (DAS-28) 5.8 +/- 1.2: 70% of whom were positive for the rheumatoid factor IgM (>40 IU/mL)]. Patients were treated with stable therapy of prednisone (7.5 mg/day) and methotrexate (MTX = 10 mg/week). Eleven of these RA patients further received etanercept (25 mg, twice/weekly) and 10 infliximab (3 mg/kg on 0, 2, 6, and every 8 weeks thereafter). A control group included 10 RA patients with stable therapy (prednisone and MTX) and without anti-TNF-alpha therapy. All the patients fulfilled the ACR criteria for the diagnosis of adult RA and were treated for 6 months. Quantitative ultrasound (QUS) bone densitometry was performed at the metaphyses of the proximal phalanges of both hands with a DBM Sonic 1200 QUS device (IGEA, Carpi, Italy). Amplitude-dependent speed of sound (AD-SoS) was evaluated at base line and at 3 and 6 months. Bone mineral density (BMD) of the hip and lumbar spine (L1-L4) was determined by a densitometer (GE Lunar Prodigy, USA) at base line at after 6 months. Soluble bone turnover markers [osteocalcin (BGP) and deoxypyridinoline/creatinine (Dpd/Cr) ratio] were measured in all patients at the same times, using enzyme-linked immunosorbent assay tests. All data were compared using Wilcoxon signed rank test. Results were as follows: AD-SoS values were found increased by 1.3% after 6 months of treatment in the RA patients treated with anti-TNF-alpha therapy. On the contrary, the Ad-SoS levels decreased by 4.6% during the same period in the untreated RA group. BMD increased by 0.2% at lumbar spine and 0.1% at the hip in TNF-alpha-blocker-treated patients and decreased by 0.8% and 0.6% (at lumbar spine and at the hip, respectively) in RA patients without anti-TNF-alpha therapy. However, BMD variations were not significant. In RA patients treated with TNF-alpha blockers, BGP levels were found significantly increased (14.8 +/- 3.8 mg/mL vs. 22.4 +/- 4.2 mg/mL; P < 0.01) and Dpd/Cr levels were found significantly decreased (8.2 +/- 2.1 nM vs. 4.6 +/- 1.8 nM; P < 0.01) at 6 months when compared to base line values. On the contrary, there were no significant differences in the untreated RA patients concerning these latter parameters (BGP = 12.2 +/- 3.1 mg/mL vs. 10.8 +/- 2.8 mg/mL and Dpd/Cr = 8.9 +/- 2.4 nM vs. 10.2 +/- 1.8 nM, respectively). In conclusion, during 6 months of treatment of RA patients with TNF blockers, bone formation seems increased while bone resorption seems decreased. The reduced rate of OP appears to be supported by the same mechanisms involved in the decreased bone joint resorption during anti-TNF-alpha therapy, that is, the marked decrease of the proinflammatory (i.e., TNF-alpha) cytokine effects on bone metabolism.

Quantitative ultrasound in the assessment of skeletal status in children and adolescents

The aim of this study was to provide normative data for quantitative ultrasound (US) through the phalanges and to evaluate the influence of age and body size on Ad-SoS (amplitude-dependent speed-of-sound). Measurements were performed in 1020 healthy Polish children ages 7 to 19 years, using a DBM Sonic 1200 (IGEA, Carpi, Italy). The Ad-SoS increased with age in all studied subjects; in girls from 1926 to 2124 m/s and in boys from 1916 to 2114 m/s. The statistically significant increases in Ad-SoS values were noted between the ages of 10 and 16 years in girls and 13 and 18 years in boys. Correlations and regressions between Ad-SoS and age and body were dependent on the phases of growth. In stepwise multiple linear regression of Ad-SoS on age and body size, the following equations were obtained: in girls, Ad-SoS (m/s) = 1843 + 18 × age (years) + 2.3 × weight (kg) − 9.4 × body mass index (BMI) (kg/m 2) , r = 0.85, standard error of estimate (SEE) = 42; and, in boys, Ad-SoS (m/s) = 2443 + 14 × age (years) − 3.7 × height (cm) + 8.4 × weight (kg) − 24.8 × BMI (kg/m 2) , r = 0.83, SEE = 45. In conclusion, the study showed the ability of US measurements at hand phalanges to monitor the skeletal maturation during childhood and adolescence. (E-mail: zhalaba@poczta.onet.pl)

Ultrasound bone mass in paraplegic patients.

A cross-sectional study. To clarify the existing controversy with regard to whether paraplegic patients suffer a loss of bone mass in the upper limbs. Madrid, Spain. We evaluated bone mass by phalangeal ultrasonography in 35 male patients with paraplegia (mean age 49+/-12 years), and 25(OH)D3 and PTH to exclude the presence of osteomalacia and secondary hyperparathyroidism. Spasticity was evaluated according to the Ashworth scale. Patients were compared with a control group of 35 healthy male subjects (mean age 48+/-13 years). The patients had lower 25(OH)D3 levels and amplitude-dependent speed of sound (Ad-SOS) than controls (both P<0.001), and higher PTH levels (P<0.05). There was a statistically significant negative association between PTH and 25(OH)D3 levels (r=-0.52, P<0.0001, CI -0.73 to -0.22) and between 25(OH)D3 and injury duration (r=0.34, P<0.05, CI -0.60 to -0.01). There was no correlation between Ad-SOS values, levels of PTH or 25(OH)D3, and the injury duration. No significant difference in Ad-SOS values was found in patients grouped according to low-to-normal 25(OH)D3 level or according to normal-to-high PTH level. There were no differences in relation to muscle tone. Only alkaline phosphatase and tartrate-resistant acid phosphatase levels were higher in patients than in controls (both P<0.001). Paraplegic patients had a loss of phalangeal bone mass that was unrelated to the levels of vitamin D or PTH, or to muscle tone, so it seems to be related to increased bone resorption rather than to deficient bone formation.

Behavior of phalangeal bone ultrasound in normal women with relation to gonadal status and body mass index.

The behavior of phalangeal bone ultrasound was studied, measured by amplitude-dependent speed of sound (Ad-SOS) in meters per second, in 324 normal women (mean age 48.9 +/- 13.7 years) classified by gonadal status (premenopausal, perimenopausal and postmenopausal) and body mass index (BMI, thin, normal, overweight and obese). Ad-SOS differed significantly with gonadal status and BMI (p<0.0001 for all). In the overall group of women, Ad-SOS correlated negatively with age (r=-0.84, p<0.0001), weight (r=-0.16, p<0.005), BMI (r=-0.27, p<0.0001), and tartrate-resistant acid phosphatase concentration (TRAP) (r=-0.35, p<0.0001). The negative correlation remained significant in the groups separated by gonadal status, but to a lesser extent. After adjusting for confounding variables such as age and weight, Ad-SOS was dependent on age (but not on weight or BMI) in the overall group of women and in the gonadal status groups. In conclusion, Ad-SOS values differed significantly with gonadal status and BMI, and correlated negatively with TRAP. The plot of Ad-SOS against age differed significantly with gonadal status as well as BMI.

Ultrasound measurement of proximal phalanges in a normal Polish female population.

In this cross-sectional study 954 Polish healthy women aged 30-80 years were evaluated (mean age 50.8 +/- 8.9 years). Among them were 460 premenopausal (mean age 44.4 +/- 5.5 years) and 494 postmenopausal women (mean age 56.8 +/- 7.2 years). Women suffering from diseases known to affect bone metabolism and/or treated with drugs that affect bone tissue were excluded. All women were volunteers from six towns in the south of Poland, who underwent bone measurements for screening purposes. Bone status was assessed using an ultrasound device (DBM Sonic 1200, Igea, Italy) that measures amplitude-dependent speed of sound (AD-SoS) in metres per second. Phalanges (II-V) of the non-dominant hand were measured and an average value was computed. In vivo short-term precision was 0.49% for intraobserver, and 0.42% for interobserver measurements. Mean AD-SoS values were: in the whole group, 1974.6 +/- 90.7 m/s; in premenopausal women, 2032.1 +/- 50.0 m/s; and in postmenopausal women, 1921.0 +/- 87.3 m/s (p < 0.0001). The mean decrease in AD-SoS value in the studied population was 6.1 m/s per year. Simple linear regression analysis showed significant, negative correlations between age and AD-SoS: in the whole group r = -0.70 (p < 0.0001); in pre- and postmenopausal women, r = -0.29 (p < 0.0001) and r = -0.58 (p < 0.0001), respectively. Years since menopause (YSM) showed a significant influence on AD-SoS: linear correlation in the whole group resulted in a value of r = -0.59 (p < 0.0001) and in the group of postmenopausal women in a value of r = -0.57 (p < 0.0001). AD-SoS decreased in the first 8 YSM by 5.1% (0.63%/year) and in the next 15 YSM by 5.44% (0.36%/year). In postmenopausal women mean AD-SoS was regressed simultaneously on age and YSM, resulting in AD-SoS = 2181.0 - 4.031 x Age - 3.911 x YSM. In conclusion, ultrasound measurements of proximal phalanges were found to enable detection of age- and YSM-related skeletal changes in a Polish healthy female population. Results obtained in this study showed a premenopausal decrease in the ultrasound parameter (not observed by other authors) and an AD-SoS value lower than those in French, Italian and Spanish populations. The premenopausal decline in AD-SoS, the most important observation, requires further longitudinal investigations to determine factors affecting the skeleton before menopause.