Calcaneal Broadband Ultrasound Attenuation Research Articles

Prediction of Dominant Skeletal Mass with Different Tests of Lower Limb Dominance

The site-specific effects of bone loading are evident when observing the effect of upper limb dominance on bone mass. For instance, studies of the upper extremity bones of tennis players have revealed greater bone mineral density (BMD) of the dominant arm. However, bone strength is commonly examined in the lower limbs, where the determination of lower limb dominance is not as straightforward as for the upper limbs. Clinicians and researchers often expressly scan the non-dominant limb. PURPOSE: To compare the ability of a selection of questionnaires and physical tests to predict lower limb dominance in terms of bone strength in adults. METHODS: We recruited 40 healthy men and women (20 M; 20 F) aged 18 to 30 years inclusive. Participants completed the Waterloo Footedness Questionnaire (WFQ) and answered a series of dominance-related questions. Several physical challenges were also performed, including a hop distance test, step recovery test, and tests for cerebral lateralization. Bilateral calcaneal broadband ultrasound attenuation (BUA) (QUS-2, Quidel, USA) and femoral neck (FN) BMD (XR-36, Norland, USA) were measured from all subjects. RESULTS: The WFQ, task-related side dominance questions and the step recovery test showed significant negative relationships for both FN and calcaneal mass (r = −0.35-−0.47, p < 0.03). The relationships between measures of dominance were high for some (e.g. step recovery test vs task-related side dominance questions and self-determined dominant foot vs WFQ; r = 0.64-0.75, p = 0.001), but non-significant for others (e.g. dominant hop distance test vs step recovery test and WFQ vs dominant hop distance). Regression analysis revealed that none of the tests could predict the strongest heel, whereas the step recovery test predicted 22% of the variance in determination of dominant FN BMD. Addition of task-related side dominance questions and the WFQ enhanced prediction to 44% of the variance in FN dominance determination. CONCLUSIONS: Self-determined functional side dominance is not a good predictor of skeletal strength dominance. In fact, analysis suggests that functional side dominance is inversely related to skeletal side dominance.

The BPAQ: a bone-specific physical activity assessment instrument

A newly developed bone-specific physical activity questionnaire (BPAQ) was compared with other common measures of physical activity for its ability to predict parameters of bone strength in healthy, young adults. The BPAQ predicted indices of bone strength at clinically relevant sites in both men and women, while other measures did not. Only certain types of physical activity (PA) are notably osteogenic. Most methods to quantify levels of PA fail to account for bone relevant loading. Our aim was to examine the ability of several methods of PA assessment and a new bone-specific measure to predict parameters of bone strength in healthy adults. We recruited 40 men and women (mean age 24.5). Subjects completed the modifiable activity questionnaire, Bouchard 3-day activity record, a recently published bone loading history questionnaire (BLHQ), and wore a pedometer for 14 days. We also administered our bone-specific physical activity questionnaire (BPAQ). Calcaneal broadband ultrasound attenuation (BUA) (QUS-2, Quidel) and densitometric measures (XR-36, Norland) were examined. Multiple regression and correlation analyses were performed on the data. The current activity component of BPAQ was a significant predictor of variance in femoral neck bone mineral density (BMD), lumbar spine BMD, and whole body BMD (R(2) = 0.36-0.68, p < 0.01) for men, while the past activity component of BPAQ predicted calcaneal BUA (R(2) = 0.48, p = 0.001) for women. The BPAQ predicted indices of bone strength at skeletal sites at risk of osteoporotic fracture while other PA measurement tools did not.

Lower calcaneal bone mineral density and broadband ultrasonic attenuation, but not speed of sound, in South Asian than white European women

Background: Quantitative ultrasound (QUS) measures of bone predict fracture risk in older white women. South Asian women have low bone mineral density (BMD), perhaps related to smaller body size or vitamin D insufficiency, but it is unknown whether this is accompanied by lower QUS.Aim: The study compared QUS, BMD and vitamin D status between South Asian and white European women.Subjects and methods: Participants were 47 postmenopausal women (23 white European, 24 South Asian) aged 55–65 years. BMD was measured at the calcaneus and radius by dual X-ray absorptiometry. The QUS measurements were broadband ultrasound attenuation (BUA) at the calcaneus and speed of sound (SOS) at the calcaneus, radius and tibia. Serum 25-hydroxy vitamin D was determined in late summer.Results: South Asian women had significantly lower serum 25-hydroxyvitamin D than white Europeans (13.0 ± 5.1 versus 30.3 ± 7.1 ng mL–1; p < 0.001). Calcaneal BMD and BUA were 14% and 10% lower (p = 0.016 and 0.045), respectively, in South Asian women. Radial BMD, and SOS at all sites, did not differ significantly between groups.Conclusion: In this study, postmenopausal South Asian women living in the UK had a high prevalence of vitamin D insufficiency and lower calcaneal BMD than white European women, consistent with previous findings. Differences were detected in calcaneal BUA but not SOS. Further research is needed to evaluate fracture risk and its detection in South Asian women.

Monitoring Bone Growth Using Quantitative Ultrasound in Comparison with DXA and pQCT

Quantitative ultrasound (QUS) is a safe, inexpensive, and nonradiation method for bone density assessment. QUS correlates with, and predicts fragility fractures comparable to, dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) in postmenopausal women. However, its validity in monitoring bone growth in children is not well understood. Two hundred and fifty-eight 10–13 yr pubertal girls and 9 37–43 yr adults without diseases or history of medications known to affect bone metabolism were included in the 2-yr prospective study. Calcaneal broadband ultrasound attenuation (cBUA) was assessed using QUS-2 (Quidel, Santa Clara, CA), speed of sound of tibial shaft (tSOS) using Omnisense (Sunlight Technologies, Israel), apparent volumetric BMD (vBMD) of tibial shaft using peripheral quantitative computed tomography (pQCT; XCT2000, Stratec), and femoral neck (FN) and lumbar spine 2–4 (LS) areal BMD (aBMD) using DXA (Prodigy, GE). Over the 2 yr in girls, FN and LS aBMD showed the largest increases (17 ± 8% and 20 ± 8%, respectively), followed by tibial vBMD and cBUA (10 ± 5% and 9 ± 9%, respectively). There was no apparent change in tSOS (2 ± 3%). The increase in FN and LS aBMD attenuated 48% and 40%, respectively, after adjustment of the change in body size. The change of cBUA correlated significantly with change in tibial vBMD and FN and LS aBMD ( r = 0.24–0.40). At the matched location, tSOS correlated only with cortical vBMD, not with cortical thickness, apparent vBMD, or bone size. The long-term reproducibility, assessed using the concordance correlation coefficient of young adults' pre-post measurements, was substantially lower in tSOS than cBUA, tibial vBMD, FN, and LS aBMD (0.65 vs 0.97, 0.95, 0.98, and 0.96; p < 0.05). The transverse transmission method-derived calcaneal BUA, but not the axial transmission method-derived SOS, is comparable to DXA and pQCT for monitoring bone densitometric change in pubertal girls. The role of QUS in fracture-risk prediction in children and adolescents needs further investigation.

Association of vitamin D receptor polymorphism with calcaneal broadband ultrasound attenuation in Korean postmenopausal women with low calcium intake

This study investigated the associations among vitamin D receptor (VDR) BsmI polymorphism, calcium intake and bone strength as indicated by the broadband ultrasound attenuation (BUA) measured by calcaneal quantitative ultrasound at the left calcaneus in community-dwelling subjects with a low calcium intake. The VDR BsmI polymorphism was analysed in 335 women older than 65 years residing in rural Asan, Korea. Calcium intake was assessed with a 2 d, 24 h recall method. The distribution of genotypes was similar to that reported in other Asian populations (92 % bb, 7 % Bb and 1 % BB). The calcaneal BUA was significantly higher (P = 0.013) in the bb genotype than in the Bb or BB genotype (Bb and BB genotypes were combined due to the small number of BB subjects) in a multiple regression model after adjusting for age, body weight, height, physical activity and nutritional factors. BUA was not significantly affected by the calcium intake regardless of the genotype, cross-sectionally. The energy-adjusted average calcium intake of this population was 439.6 mg/d (432.5 mg/d for bb and 522.3 mg/d for Bb or BB), and 96 % of the subjects had dietary intakes that were less than the recommended Dietary Reference Intake for Koreans (which for calcium is 800 mg/d for women older than 65 years). In summary, the BUA in older Korean women with a low calcium intake was significantly influenced by the VDR genotype but not by the calcium intake, cross-sectionally.

The Effect of Phase Cancellation on Estimates of Calcaneal Broadband Ultrasound Attenuation in Vivo

Broadband ultrasonic attenuation (BUA) is a clinically-accepted measurement for prediction of osteoporotic fracture risk. Typical clinical BUA measurements are performed with phase-sensitive receivers and, therefore, can be affected by phase cancellation. In order to separate the effects of conventional attenuation (absorption plus scattering) from phase cancellation, BUA was measured on phantoms with acrylic wedge phase aberrators and on 73 women using both phase sensitive (PS) and phase insensitive (PI) reception. A clinical bone sonometer with a two-dimensional (2-D) receiver array was used. PI BUA measurements on phantoms with acrylic wedge phase aberrators were found to be far more resistant to phase cancellation than PS BUA measurements. In data from 73 women, means and standard deviations for BUA measurements were 81.4 +/- 21.4 dB/MHz (PS) and 67.2 +/- 9.7 dB/MHz (PI). The magnitude of the discrepancy between PS BUA and PI BUA tended to increase with bone mineral density (BMD).

More acidic dietary acid-base load is associated with reduced calcaneal broadband ultrasound attenuation in women but not in men: results from the EPIC-Norfolk cohort study

Background:Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone density.Objective:We investigated the relation between a measure of dietary acid-base load, potential renal acid load (PRAL), and calcaneal broadband ultrasound attenuation (BUA) after adjustment for confounders and also compared the results with different estimates of acid-base load.Design:A cross-sectional study was conducted in 14 563 men and women aged 42–82 y living in Norfolk, United Kingdom, in which measures of calcaneal BUA and dietary PRAL were estimated by using the European Prospective Investigation into Cancer and Nutrition Norfolk (EPIC-Norfolk) food-frequency questionnaire.Results:A more acidic dietary intake (high PRAL) was significantly associated with lower calcaneal BUA in women but not in men; there was a difference of ≈2% in BUA between the highest and lowest quintiles of PRAL, independent of age, body mass index, smoking habit, physical activity, diagnosed osteoporosis, and history of fracture, and (in women) hormone replacement therapy. No relation was observed between history of fracture or incident fracture and PRAL. Those with the greatest PRAL had higher intakes of meat, fish, eggs, and cereal and cereal products and lower intakes of fruit and vegetables, tea, and coffee.Conclusion:PRAL was inversely associated with bone ultrasound measures in women, but the magnitude of the association was relatively small compared with other known risk factors. Further longitudinal studies are required to establish whether, in the long term, these small effects are important in overall fracture risk in populations.

Potential Benefits of Marathon Training on Bone Health as Assessed by Calcaneal Broadband Ultrasound Attenuation

The purpose of this study was to determine calcaneal broadband ultrasound attenuation (BUA) of marathon race participants and compare this information with previously obtained normative data. BUA was assessed using the McCue CUBA clinical device in 217 male and 184 female runners, aged 20–93 yr, participating in the 2004 Flora London Marathon. The normative data included 267 men and 334 women, aged 20–80 yr. A significantly higher mean BUA ( p < 0.001) was observed for all the men (91.2 dB/MHz, standard deviation [SD] 18.2 dB/MHz) in the study compared to the women (81.6 dB/MHz, SD 17.0 dB/MHz) and for the marathon runners compared to the nonrunners ( p < 0.001) among men (97.2 dB/MHz, SD 17.6 dB/MHz and 87.7 dB/MHz, SD 17.6 dB/MHz, respectively) and women (89.2 dB/MHz, SD 14.2 dB/MHz and 77.4 dB/MHz, SD 17.0 dB/MHz, respectively). A significant decline in BUA with age was observed in all males and females, with the males starting from a higher baseline and with the rate of decline significantly ameliorated by marathon training (from −0.35 to −0.25 dB/MHz per year in men and −0.51 to −0.15 dB/MHz per year in women). This study provides observational evidence in support of the potential benefits of weight-bearing exercise, such as marathon training and running, on BUA of the calcaneus, an index of bone mineral density.

Reduced Peripheral Nerve Function Is Related to Lower Hip BMD and Calcaneal QUS in Older White and Black Adults: The Health, Aging, and Body Composition Study

Bone tissue is innervated, and peripheral nerve function may impact BMD. Older black and white men and women (N = 2200) in the Health, Aging, and Body Composition Study with worse sensory and motor peripheral nerve function had lower hip BMD and calcaneal BUA independent of lean mass, strength, physical ability, and diabetes. Poor peripheral nerve function may directly affect bone. Bone tissue is innervated, yet little is known about the impact of nerve function on BMD. Poor peripheral nerve function may contribute to lower BMD and higher fracture risk, particularly in those with diabetic neuropathy. The Health, Aging, and Body Composition (Health ABC) Study included annual exams in white and black men and women 70-79 years of age recruited from Pittsburgh and Memphis. Nerve function in legs/feet was assessed by 1.4- and 10-g monofilament detection, vibration threshold, and peroneal motor nerve conduction velocity (NCV) and amplitude (CMAP). Total hip BMD, heel broadband ultrasound attenuation (BUA), and total fat and lean mass were measured 1 year later (QDR 4500A, Sahara QUS; Hologic). Participants (N = 2200) were 48% men and 37% black. Poor nerve function (lower monofilament detection, higher vibration threshold, lower CMAP, lower NCV) was associated with 1.4-5.7% lower BUA and significant for all but NCV, adjusted for demographics, diabetes, body composition, and physical ability. Results were similar for adjusted hip BMD, with 1.0-2.9% lower BMD, significant for monofilament and CMAP testing. When considering the components of BMD, total hip area was 1.8-4.9% higher in those with the worst nerve function, although BMC showed little difference. Lower monofilament detection and CMAP were independently associated with lower heel BUA (p < 0.01), and monofilament detection was associated with lower hip BMD (p < 0.05) in regression additionally adjusted for lifestyle factors, bone-active medications, and diabetes-related complications. Poor peripheral nerve function may directly related to lower BMD, likely through an increase in bone area in older adults, independent of lean mass, strength, physical ability, and diabetes. Whether those with impaired nerve function are at higher risk for fracture independent of falls needs to be studied.

A Pilot Study of Heel Ultrasound to Screen for Low Bone Mass in Children With Leukemia

The optimal method to assess pediatric bone mass remains controversial. Dual x-ray absorptiometry (DXA) is commonly used but quantitative ultrasound is less expensive, free of ionizing radiation, and predicts fractures as well as DXA does, in adults. Broadband ultrasound attenuation (BUA) was determined using a portable calcaneal ultrasonometer and, compared with DXA derived areal bone mineral density (BMD) values in 42 young patients (ages 4.5 to 20.3 y) with leukemia. Reduced BMD was defined as a DXA z score of <-1. Mean z scores for lumbar spine BMD were significantly lower than zero (-0.77+/-1.23 SD, P=0.0004). Mean z scores for whole body BMD were also significantly lower than different from 0 (-0.34+/-1.04 SD, P=0.05). Calcaneal BUA was highly correlated with DXA measurement of lumbar, whole body, and femoral neck BMD. BUA was significantly associated with the probability of having a reduced lumbar BMD z score (P=0.03) and having a reduced whole body z score of (P=0.03). Area under the receiver operator characteristic curves for model including BUA predicting reduced bone density by DXA were 0.77 and 0.86 for lumbar and whole body z score cutoffs, respectively. Our data suggest that calcaneal BUA may serve as a reliable screening tool to detect reduced bone mass in pediatric patients with leukemia.

Screening for low bone mass with quantitative ultrasonography in a community without dual-energy X-ray absorptiometry: population-based survey

BackgroundDual-energy x-ray absorptiometry (DXA) is the criterion standard to identify low bone mineral density (BMD), but access to axial DXA may be limited or cost prohibitive. We screened for low bone mass with quantitative ultrasonography (QUS) in a community without DXA, analyzed its reliability and obtained reference values and estimated the prevalence of low QUS values.MethodsWe enrolled 6493 residents of Kinmen, Taiwan, and a reference group (96 men and 70 women aged 20–29 years) for this cross-sectional, community-based study. All participants completed a questionnaire and underwent ultrasonographic measurements. Reliability and validity of QUS measurements were evaluated. Broadband ultrasound attenuation (BUA) values were obtained and statistically analyzed by age, sex and weight. Annual loss of BUA was determined. Trends in the prevalence of QUS scores were evaluated.ResultsTwo QUS were used and had a correlation coefficient of 0.90 (p < 0.001). Calcaneal BUA was significantly correlated with BMD in the femoral neck (r = 0.67, p < 0.001) and BMD of the total lumbar spine (r = 0.59, p < 0.001). BUAs in the reference group were 92.72 ± 13.36 and 87.90 ± 10.68 dB/MHz for men and women, respectively. Estimated annual losses of calcaneal BUA were 0.83% per year for women, 0.27% per year for men, and 0.51% per year for the total population. The prevalence of severely low QUS values (T-score = -2.5) tended to increase with aging in both sexes (p < 0.001). Across age strata, moderately low QUS values (-2.5 < T-score < -1.0) were 31.6–41.0% in men and 23.7–38.1% in women; a significant trend with age was observed in men (p < 0.001).ConclusionAge-related decreases in calcaneal ultrasonometry, which reflected the prevalence of low bone mass, were more obvious in women than in men.

Middle-Aged Premenopausal Women With Type 1 Diabetes Have Lower Bone Mineral Density and Calcaneal Quantitative Ultrasound Than Nondiabetic Women

To determine whether middle-aged premenopausal women with type 1 diabetes had more self-reported fractures and lower bone mineral density (BMD) compared with nondiabetic women. Participants were premenopausal women aged 35-55 years with type 1 diabetes (n = 67; 32.2 +/- 5.3 years duration) and without diabetes (n = 237). Total hip, femoral neck, whole-body, and spine BMD were measured by dual X-ray absorptiometry. Calcaneal broadband ultrasound attenuation (BUA) was assessed with quantitative ultrasound. Women with type 1 diabetes were more likely to report a fracture after age 20 years compared with nondiabetic women (33.3 vs. 22.6%; age-adjusted odds ratio 1.89 [95% CI 1.02-3.49]). Type 1 diabetes was associated with lower total hip BMD (0.890 vs. 0.961 g/cm2; P < 0.001), femoral neck BMD (0.797 vs. 0.847 g/cm2; P = 0.001), whole-body BMD (1.132 vs. 1.165 g/cm2; P < 0.01), and lower calcaneal BUA (71.6 vs. 84.9 dB/MHz; P < 0.001) after multivariate adjustment. BMD was 3-8% lower in type 1 diabetic compared with control women and calcaneal BUA was 15% lower. Spine BMD and biomarkers of bone remodeling were not significantly different between groups. In the type 1 diabetic women, reduced monofilament detection and blindness were both associated with lower BMD. Lower BMD in premenopausal women with type 1 diabetes may substantially increase their risk of developing osteoporosis after menopause. Type 1 diabetic women should be targeted for osteoporosis screening and possible fracture prevention as they transition through menopause.

Osteoprotegerin serum levels in children with type 1 diabetes: a potential modulating role in bone status

Children and adolescents with type 1 (insulin-dependent) diabetes mellitus (T1DM) show several impairment of bone metabolism and structure, resulting in a higher risk of decreased bone mass and its related complications later in life. Alterations of the nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) system have been implicated in several metabolic bone diseases characterized by increased osteoclast differentiation and activation and enhanced bone resorption. We aimed to assess OPG levels and to investigate the possible relation between OPG levels, bone status and glycemic control in a group of prepubertal children with T1DM without microvascular complications. Twenty-six prepubertal T1DM children (median age 9.9 years, range 4.1-13.1 years) were studied. In all patients, serum OPG, hemoglobin (Hb)A1c, parathyroid hormone (PTH) and 25-dihy-droxyvitamin D (25-D) levels were evaluated. Bone quality was determined by measuring the attenuation of ultrasound waves by bone (broadband ultrasound attenuation (BUA)) at the calcaneal site. The data were compared with those of a group of 45 age-, sex-and body-size-matched healthy children. Children with T1DM showed a reduced Z-score BUA in comparison with the control group (Student's t-test, P < 0.0001). Plasma OPG levels were significantly higher in diabetic children than in controls (Student's t-test, P < 0.0001). In T1DM children, Z-score BUA values displayed a significant correlation with OPG (Student's t-test, r = -0.62; P = 0.001), and HbA1c (r = -0.59; P = 0.007). OPG levels were significantly correlated with HbA1c (r = 0.56; P = 0.008). In a multiple regression analysis including age, duration of diabetes, physical activity, calcium intake, mean HbA1c and Z-score BUA, only HbA1c significantly predicted serum OPG levels (beta 0.67; P = 0.003). Prepubertal children with T1DM have a significant increase of OPG levels. OPG serum concentrations are correlated to calcaneal BUA and HbA1c values. OPG could be a new marker of reduced bone mass in children with T1DM.

Association of radiological hand osteoarthritis with bone mineral mass: a population study

A number of previous studies have reported an inverse relationship between osteoarthritis and osteoporosis. However, the association has remained controversial because osteoarthritis in hand joints seems to associate differently from osteoarthritis in weight-bearing joints with bone mineral mass. We studied osteoarthritis in distal interphalangeal (DIP) joints and osteoarthritis in the base of the thumb (CMC-1) for their cross-sectional associations with metacarpal cortical bone mineral mass, and for their prediction of calcaneal broadband ultrasound attenuation. A population sample of 8000 Finns aged 30 yr and over was invited to a comprehensive health examination in 1978-1980; 90% complied. Hand radiographs were taken from 3568 participants to diagnose osteoarthritis in various hand joints, and to determine two indicators of cortical bone mineral mass, the combined cortical thickness (CCT) and the metacarpal index (MCI). Calcaneal broadband ultrasound attenuation was measured 20 yr later in 340 of these participants with the Sahara sonometer. In the cross-sectional setting, osteoarthritis in the DIP joints and osteoarthritis in the base of the thumb (CMC-1) were significantly associated with low CCT and low MCI. These associations were proportional to the radiological severity of osteoarthritis. In the follow-up setting, symmetrical DIP osteoarthritis adjusted for age, sex, body mass index, smoking, education, workload and MCI significantly predicted low values of broadband ultrasound attenuation. Our results indicate a direct relation of both radiological DIP osteoarthritis and CMC-1 osteoarthritis with low cortical bone mineral mass, in proportion to the severity of osteoarthritis. The presence of symmetrical DIP osteoarthritis, a possible indicator of generalized osteoarthritis, suggests an increased risk of osteoporosis over time.

Vitamin D receptor polymorphisms, bone ultrasound and mineral density in post-menopausal women

Bone structure, geometry and mineral content represent complex traits with a significant heritable component. However, the specific contributing genes have not been unambiguously identified. The aim of the present cross-sectional study was to analyse an association between heel ultrasound measurements, partly reflecting bone quality, and VDR (Vitamin D receptor) gene polymorphisms in post-menopausal women, and to assess whether these associations differ from those of bone density or not. BUA (broadband ultrasound attenuation, dB/MHz) at the right heel and BMD (bone mineral density, g/cm2) at the lumbar spine and hip were measured in 114 post-menopausal women of Caucasian origin (62.4 +/- 9.8 years). All probands were genotyped for common VDR polymorphisms--FokI, BsmI, Apal and TaqI--by restriction analysis of the PCR product. ANCOVA revealed significant associations between calcaneal BUA adjusted for BMI (body mass index) and YSM (years since menopause), and BsmI, Apal and TaqI genotypes in the VDR gene (p < 0.02; p < 0.0003; p < 0.02 ANCOVA, respectively). BMI- and YSM-adjusted BMD was significantly associated with Fokl genotypes in the VDR gene (p < 0.028 at lumbar spine, p < 0.007 at hip). The present data show that post-menopausal BMD and BUA are determined by different polymorphisms within the VDR gene. Non-coding polymorphisms in the 3' end of the VDR gene (BsmI, Apal, TaqI) are related to heel ultrasound while the FokI polymorphism in exon 2, located at the opposite site of the VDR gene, is associated with BMD measurements. Further studies are required to determine whether different polymorphic markers within a single gene independently determine various components of post-menopausal bone.

Association of oestrogen receptor α gene polymorphisms with postmenopausal bone loss, bone mass, and quantitative ultrasound properties of bone

Background: The gene encoding oestrogen receptor α (ESR1) appears to regulate bone mineral density (BMD) and other determinants of osteoporotic fracture risk. Objective: To investigate the relation between common polymorphisms...

Influence of Aquatic and Weight-Bearing Exercises on Quantitative Ultrasound Variables in Postmenopausal Women

In this prospective, controlled study, the effects of weight bearing and aquatic exercises on the calcaneal ultrasonic scores of postmenopausal sedentary women was investigated. A total of 62 postmenopausal sedentary women (mean age, 54.1 +/- 7 yrs) with broadband ultrasound attenuation (BUA) T-score variables less than -1 were admitted to Ataturk Balneotherapy and Rehabilitation Center and randomized into aquatic exercise (n = 21), weight-bearing exercise (n = 21), and control (n = 20) groups. The subjects were told to perform the aerobic exercises according to the Borg scale. Quantitative ultrasound variables, BUA, and speed of ultrasound were evaluated after the 6-mo training study. Calcaneal BUA increased in aquatic exercise and weight-bearing exercise groups by 3.1% and 4.2% (P < 0.05, P < 0.05) respectively. There was a decrease in BUA by 1.3% in the control group (P > 0.05). Speed of ultrasound did not change in the aquatic exercise, weight-bearing exercise, or the control groups. There were no statistically significant differences between the exercise groups for BUA and speed of ultrasound. The percentage changes in the aquatic exercise and weight-bearing exercise groups were statistically significant when compared with the control group for BUA (P < 0.01, P < 0.01) and speed of ultrasound (P < 0.05, P < 0.05). Although weight-bearing physical activity is known to be superior to non-weight-bearing activity to increase the bone mass, our present evidence shows that aquatic and weight-bearing exercises both can increase calcaneal BUA.

Correlation of quantitative ultrasound parameters of the calcaneus with bone density of the spine and hip in women with prevalent hypovitaminosis D.

Quantitative ultrasound (QUS) of the calcaneus correlates modestly with axial dual-energy X-ray absorptiometry (DXA). Because bone mineral density (BMD) might be influenced by vitamin D status, we assessed the correlation between both techniques in 56 Arabian women, a population with high prevalence of hypovitaminosis D. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and estimated BMD of the right calcaneus were determined by QUS. Spine and right hip BMD were measured by DXA scan. The serum 25-hydroxyvitamin D (25OHD) level was measured by radioimmunoassay. The correlations of QUS parameters (estimated calcaneal BMD, BUA, and SOS) with spine and hip BMD were modest (r = 0.50, r = 0.53, r = 0.41 for the spine and r = 0.54, r = 0.56, and r = 0.46 for the hip, respectively; p < 0.01 for all comparisons), but stronger in postmenopausal women. All postmenopausal women with low estimated calcaneal BMD (T-score pound -1) had a T-score pound -1 by DXA of the spine or hip. Of the 21 premenopausal women with spine or hip T-score pound -1 who had 25OHD measurements, 20 (95.2%) had levels below 50 nmol/L and 12 (57%) had levels below 30 nmol/L. The subgroup with 25OHD < 30 nmol/L had significantly lower spine (p < 0.01) and hip BMD (p < 0.05) than the subgroup with 25OHD >/= 30 nmol/L. QUS parameters were not significantly different between the two subgroups. The QUS and DXA correlated modestly well in women with prevalent hypovitaminosis D. QUS could be used in postmenopausal women with hypovitaminosis D to identify those at risk for osteoporotic fracture.

Adolescent dairy consumption and physical activity associated with bone mass

Background. This study identifies key modifiable factors influencing Asian and White adolescent bone development. Cross-sectional analysis of baseline data of cohort. Methods. Three hundred and twenty-three girls were examined from age-eligible girls at Kaiser Permanente Oahu in Hawaii. Girls' age, ethnicity, Tanner stage, 3-day diet record, level of physical activity, anthropometry, and calcaneal bone status were obtained by questionnaire and measurement, respectively. Lunar Achilles calcaneal was used to measure calcaneal bone mass. Multiple regression was used for analysis of factors influencing bone mass. Results. The mean age of adolescents was 11.6 ± 1.5 years. Girls were generally ethnically mixed; the mean Asian ethnic proportion was 48% while White ethnic proportion was 43% and other ethnic proportion was 10%. Multiple regression explained 40.8% and 25.6% of the variation in calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS), respectively, in a model where age, weight, biacromial breadth, Tanner pubic hair stage, Asian ethnicity, dairy intake, and physical activity positively influenced bone mass. Conclusions. Tanner pubic hair stage, ethnicity, and biacromial breadth had the greatest influence on SOS; while physical activity, body weight, and dairy product intake had the greatest influence on BUA.

Evaluation of an Osteoporosis Self-Referral Program to Enhance Management Outcomes

Abstract Osteoporosis is a common but undertreated condition. While bone density is known to predict fracture risk, there is currently no economical way of measuring general population risk. This study examined whether an economical screening technique could improve diagnosis and lead to appropriate outcomes in the management of osteoporosis. A self-referral program was established to provide women with information about osteoporosis and an individualized risk assignment. A high-risk designation was provided for postmenopausal women below the lower tertile of a calcaneal broadband ultrasound attenuation (BUA) (≤ 58 db/MHz) or those with a SCORE value ≥ 6. A telephone survey was conducted 6 mo after program registration to evaluate osteoporosis management outcomes. Of 271 women surveyed, 181 (67%) were postmenopausal and thus potential candidates for estrogen replacement, and 21% and 63% were assigned a high-risk profile by either calcaneal ultrasound or SCORE, respectively. Women at higher risk were significantly more likely to discuss osteoporosis with their family physician ( p < 0.001), and to undergo further testing with dual X-ray absorptiometry measurement ( p < 0.005). Utilization of estrogen replacement by postmenopausal women at time of survey was significantly increased compared to registration ( p = 0.01). The self-referral program positively impacted decisions women made about preventing osteoporosis, particularly if they considered themselves at higher risk.