Calcaneal Quantitative Ultrasound Measurements Research Articles

Impact of Cola Consumption on Quantitative Ultrasound Parameters in College Age Females

Text: Cola consumption may be a modifiable risk factor for poor bone quality. Young women may be at greater risk for poor bone health because this population consumes the most cola beverages among all women and peak bone mass is established during young adulthood. Research Outcome: To assess the relationship between cola consumption and calcaneal bone outcomes in college-aged women. Methods: Estimated Bone Mineral Density (BMD), Quantitative Ultrasound Index (QUI), Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS) were measured in 18-20 year old Caucasian females (n 37) using calcaneal quantitative ultrasound sonography. Weekly cola consumption was assessed by self-report using a 10-item questionnaire. Results: No difference was seen in estimated BMD (M SD: 0.693 0.148g/cm, 0.672 0.204g/cm; respectively), QUI (121.7 23.4, 114.6 31.6), BUA (91.4 21.0db/MHz, 89.1 29.7db/MHz) or SOS (1598 38m/s, 1592 50m/s) measures between women who consumed 1 cola beverage per week (n 26) and women who did not consume colas (n 11). There were also no differences in estimated BMD (0.741 0.180g/cm, 0.672 0.132g/cm, 0.672 0.204g/cm; respectively), QUI (129.3 28.4, 118.4 20.9, 114.6 31.6), BUA (97.7 24.0db/MHz, 88.7 19.6db/MHz, 89.1 29.7db/ MHz) or SOS (1610 47m/s, 1593 33 m/s, 1592 50 m/s) between high cola consumers ( 7 colas/week; n 8), low cola consumers (1-6 colas/week; n 18) and those who did not consume cola beverages (n 11). BMI was significantly and positively associated with all bone measures in non-cola consumers but did not exhibit the same relationship among cola consumers. Conclusions: Cola consuming and non-cola consuming young Caucasian females did not differ in calcaneal quantitative ultrasound bone measures regardless of level of consumption; however, weight status may influence this association.

Assessment of osteoporotic fracture risk in community settings: a study of post-menopausal women in Australia

The healthcare cost of managing osteoporotic fractures is projected to rise because of the change in population demographics. To reduce the fracture epidemic, strategies are needed to identify those at risk early to allow preventative intervention to be implemented. The aim of this study was to investigate if low-cost community-based assessments, such as calcaneal ultrasound and falls risk assessments, can discriminate a group of elderly women at risk of osteoporotic fracture from those at lower risk. Over the period of 2002-2003, 104 community-dwelling women (mean age 71.3, standard deviation 5.8) were recruited via various modes including advertisements in community newspaper and community centres. These women underwent dual-energy X-ray absorptiometry bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measurements; spinal radiography; and performance-based assessment of strength, mobility and balance. The women were classified into a 'high risk' (osteoporotic) group, based on low BMD (T-score of </= -2.5) and/or a history of a fragility fracture, or a 'low risk' (non-osteoporotic) group. Multiple stepwise logistic regression identified decreased speed of sound (SOS), a QUS variable, and poor mobility [slower performance in the timed 'up and go' (TUG) task], as significant discriminators, adjusted for age [SOS: adjusted odds ratio (OR) = 2.96, 95% confidence interval (CI) = 1.64-5.12, P < 0.001; TUG: adjusted OR = 1.69, 95% CI = 1.04-2.73, P = 0.031]. This result suggests that there may be a potential role for primary healthcare practitioners to use calcaneal QUS and functional mobility assessment (TUG) to screen for post-menopausal women at risk of osteoporotic fracture in community settings.

Functional status and calcaneal quantitative ultrasound measurements among the oldest old people living in rural areas of Korea

The number of very elderly people is increasing worldwide, so that the prevention of fractures and disability in this frail population has become a growing concern. This study evaluated the association between functional status and bone health in the oldest old. The study participants were of a very elderly population comprising 170 rural community dwellers, aged 80–107 years. Quantitative ultrasound (QUS) measurements were performed on both heels. Functional status was assessed by evaluating activities of daily living (ADL) and instrumental activities of daily living (IADL). Data on sociodemographic characteristics and potential risk factors, including medical history, smoking, alcohol intake, exercise, and physical activities were collected by trained interviewers. Generalized multiple linear regression suggested that disability was significantly associated with calcaneal QUS in the oldest old. After adjusting for the effect of potential covariates, such as age, gender, education level, weight, smoking, and physical activity level, the lowest tertile score groups of ADL and IADL were associated with a decrease in stiffness index (SI) T-score of calcaneal QUS. A complete ADL deficit was associated with a low QUS (adjusted β vs. independent group = −1.17, 95% confidence interval = −2.01 to −0.33). Evidence of disability as an associated factor on bone health provides important insight to devise strategies for preventing or delaying further disablement among the elderly.

Quantitative Bone Ultrasound at Phalanges and Calcaneus in Osteoporotic Postmenopausal Women: Influence of Age and Measurement Site

Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmenopausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than −2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group ( p < 0.05). When patients aged <70 y ( n = 43) and patients aged ≥ 70 y ( n = 84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group ( p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one ( p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life. (E-mail: francedt@igea.it)

Discriminatory Ability of Calcaneal Quantitative Ultrasound in the Assessment of Bone Status in Patients With Inflammatory Bowel Disease

A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn’s disease [ n = 94] and ulcerative colitis [ n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1–L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = –0.3, p = 0.002). There was no difference with respect to type of disease (Crohn’s disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures ( n = 28) than in those without fracture in their history ( n = 98) (t-scores: BUA –2.0 vs. –1.3, p = 0.008; SOS –2.1 vs. –1.4, p = 0.02: QUI –2.3 vs. –1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (–1.7 vs. –1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (–1.6 vs. –0.7, p = 0.001). Patients with t-score < –1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff ≤ –1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than –1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff ≤ –1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis. (E-mail: niksa_turk@net.hr)

No associations between OPG gene polymorphisms or serum levels and measures of osteoporosis in elderly Australian women

Bone mass is the single most important risk factor for osteoporotic fractures in the elderly and is mainly influenced by genetic factors accounting for 40–75% of the inter-individual variation. Critical for the bone remodeling process is the balance between the newly discovered members of the tumor necrosis factor ligand and receptor superfamilies, osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand, which mediate the effects of many upstream regulators of bone metabolism. In the present study, we evaluated the impact of sequence variations in the OPG gene on bone mass, bone-related biochemistry including serum OPG and fracture frequency in elderly Australian women. A total of 1101 women were genotyped for 3 different single nucleotide polymorphisms (SNP) within the OPG gene (G1181C, T950C and A163G). The effects of these SNPs and serum OPG on calcaneal quantitative ultrasound measurements, osteodensitometry of the hip and bone-related biochemistry were examined. We found no significant relationship between sequence variations in the OPG gene or serum OPG and bone mass, bone-related biochemistry or fracture frequency. Our findings confirm some recent publications investigating the same SNPs but diverge from others, indicating that generalization of the relationships found in this type of study must be done with caution and signify the importance of determining associations between polymorphisms and osteoporosis in different ethnic groups.

Association of Reduced Physical Activity and Quantitative Ultrasound Measurements: A 6-Year Follow-up Study of Adolescent Girls

Sonographic parameters of the heel were recorded in order to investigate the effects of changes in physical activities among 140 healthy growing peripubertal Caucasian girls. Calcaneal quantitative ultrasound measurements (Hologic Sahara) were recorded at baseline and 2- and 6-year follow-up. Broadband ultrasound attenuation, speed of sound (SOS), and T scores were documented. Altogether, 30 girls reduced their physical activity by >50% and 29 girls by 25-50%, whereas 81 girls continued at the present level or increased it. Age and physical activity together accounted for 16.7% of the variation in calcaneal T scores at baseline and for 16.4% at 2-year follow-up, whereas physical activity alone accounted for 11.3% of the variation at 6-year follow-up. The reduction in mean T scores was significant (from 2.0 to 0.8, P < 0.001) among those having discontinued their physical activity by the 6-year measurement. The changes between three groups were statistically significantly different from each other (P = 0.003). The mean SOS values decreased 16.78 meters per second (95% CI -26.9 to -6.7) among those having discontinued their physical activity between the 2- and 6-year follow-up measurements. The SOS value sensitively reacts to changes in physical activity, and consequently, it will help assess changes in bone quality. Because of such an immediate reaction, SOS is a good-quality measure for the physical condition of bone in young people and a suitable tool for detecting changes in calcaneal bone.

Unique and common genetic effects between bone mineral density and calcaneal quantitative ultrasound measures: the Fels Longitudinal Study

Areal bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measures are correlated, and both traits predict osteoporotic fracture risk independently. However, few studies have examined whether common genetic effects (i.e., pleiotropy) exist between these traits in extended families. In this study, we estimated the additive genetic correlation and random environmental correlation between BMD measured at various skeletal sites and calcaneal QUS measures. Our sample included 537 adults (251 men and 286 women) from 110 families participating in the Fels Longitudinal Study. Total hip, femoral neck, lumbar spine, and total body BMD were measured using dual energy X-ray absorptiometry. Three measures of calcaneal structure--broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI)--were collected from the non-dominant heel using the Sahara sonometer. Applying a variance components-based maximum likelihood method, we estimated the heritability of each trait and estimated the genetic and environmental correlations between the different BMD and QUS measures. Heritability estimates were significant for all measures of BMD and QUS ranging from 0.55 to 0.78. Significant non-zero genetic correlations were found between the different BMD and QUS measures. All genetic correlations were also significantly different from 1. Genetic correlations between total hip BMD and each of the QUS measures were 0.63 with BUA, 0.50 with SOS, and 0.56 with QUI. For femoral neck BMD, genetic correlations were similar to those between total hip BMD and QUS measures. Genetic correlations between BMD of the lumbar spine and QUS measures ranged from 0.34 to 0.38, and those between total body BMD and QUS measures, from 0.51 to 0.54. In contrast, all random environmental correlations were not significantly different from zero. This study demonstrates that BMD and calcaneal QUS measures among healthy men and women are significantly heritable and are, in part, jointly influenced by a common set of underlying genes. Additionally, this study also provides evidence for a unique set of genes that independently influences each individual trait.

Calcaneal Quantitative Ultrasound Measurements in Young Male and Female Professional Dancers

The aim of this study was to assess the bone status of dancers using calcaneal quantitative ultrasound (QUS). Twenty-four male and 26 female dancers (aged 19-36 years) and 100 age- and sex-matched nonathletic controls were included in this study. QUS parameters (broadband ultrasound attenuation [BUA], speed of sound [SOS], quantitative ultrasound index [QUI], and estimated heel bone mineral density [eBMD]) were obtained for both heels in all subjects using a gel-coupled QUS device. Two-way analysis of variance, including the factors of dancing status and gender, revealed significant differences in all QUS parameters between the dancers and the controls (p < 0.001 for all), without a significant interaction with gender status. For each heel (right versus left), the mean QUI, BUA, SOS, and eBMD values of the male and female dancers were 22.0% vs. 20.9% and 16.6% vs. 16.0%; 21.6% vs. 24.1% and 13.2% vs. 14.3%; 2.3% vs. 2.0% and 1.7% vs. 1.7%; and 25.0% vs. 23.9% and 19.0% vs. 18.6% higher than those of the male and female controls, respectively. Analysis of covariance still revealed significant differences between the dancers and the controls after controlling for the influence of body mass index (p < 0.001). Furthermore, the finding that significant bilateral differences in BUA did exist in the controls but not in the dancers demonstrated site-specific effects of exercise on bone, indicating that it is the dance that improved bone properties. Calcaneal QUS, with a strong discriminative ability between those involved in professional dance and normally active individuals, emerges as an attractive technology for exploring the benefits of exercise on bone, which might be a challenge for those in the conditioning field, who need to identify those who need intervention in terms of bone status and promote participation in high-impact physical activity, such as dance, to enhance bone quality.

Calcaneal Osteopenia Is a New Marker for Arterial Stiffness in Chronic Hemodialysis Patients

Background: A high frequency of simultaneous low estimated bone mineral density (BMD) and atherosclerotic vascular disease is found in chronic dialysis patients. The degree of BMD may be closely related to the severity of atherosclerosis in dialysis patients. The purpose of this study was to determine the association of estimated BMD with severity of atherosclerosis using popular economical non-invasive strategies in chronic dialysis patients. Methods: This cross-sectional design study included 58 subjects receiving maintenance hemodialysis (HD) therapy. The mean age was 68 ± 12 years (range 39–93), 22 subjects were female, and 26 subjects (45%) had diabetic nephropathy. The brachial-ankle pulse wave velocity (baPWV) and estimated BMD, using calcaneal quantitative ultrasound measurements of the osteo-sono index (OSI) were measured in all of the subjects. Results: The mean levels of OSI and baPWV were 2.3 ± 0.3 and 21 ± 5 m/s, respectively. Based on single variable regression analysis, the C-reactive protein concentration correlated with baPWV (r = 0.272, p = 0.039), and the serum albumin concentration was inversely correlated with baPWV (r = –0.318, p = 0.015). In addition, OSI had a strong negative correlation with baPWV (r = –0.470, p = 0.0002). To identify the independent factors correlating with baPWV, multivariate regression analysis was performed using confounding variables which had significant association in univariate analysis. OSI and diabetic nephropathy were found to be significant independent parameters. Conclusion: Calcaneal OSI, a surrogate marker for estimated BMD, has a strong ability to predict the severity of arterial stiffness independent of classical risk factors and markers of inflammation and malnutrition.

LRP5 gene polymorphisms predict bone mass and incident fractures in elderly Australian women

Postmenopausal osteoporosis and bone mass are influenced by multiple factors including genetic variation. The importance of LDL receptor-related protein 5 (LRP5) for the regulation of bone mass has recently been established, where loss of function mutations is followed by severe osteoporosis and gain of function is related to increased bone mass. The aim of this study was to evaluate the role of polymorphisms in the LRP5 gene in regulating bone mass and influencing prospective fracture frequency in a well-described, large cohort of normal, ambulatory Australian women. A total of 1301 women were genotyped for seven different single nucleotide polymorphisms (SNPs) within the LRP5 gene of which five were potentially informative. The effects of these gene polymorphisms on calcaneal quantitative ultrasound measurements (QUS), osteodensitometry of the hip and bone-related biochemistry was examined. One SNP located in exon 15 was found to be associated with fracture rate and bone mineral density. Homozygosity for the less frequent allele of c.3357A > G was associated with significant reduction in bone mass at most femoral sites. The subjects with the GG genotype, compared to the AA/AG genotypes showed a significant reduction in BUA and total hip, femoral neck and trochanter BMD (1.5% P = 0.032; 2.7% P = 0.047; 3.6% P = 0.008; 3.1% P = 0.050, respectively). In the 5-year follow-up period, 227 subjects experienced a total of 290 radiologically confirmed fractures. The incident fracture rate was significantly increased in subjects homozygous for the GG polymorphism (RR of fracture = 1.61, 95% CI [1.06–2.45], P = 0.027). After adjusting for total hip BMD, the fracture rate was still increased (RR = 1.67 [1.02–2.78], P = 0.045), indicating factors other than bone mass are of importance for bone strength. In conclusion, genetic variation in LRP5 seems to be of importance for regulation of bone mass and osteoporotic fractures.

Body mass index, calcium intake, and physical activity affect calcaneal ultrasound in healthy Greek males in an age-dependent and parameter-specific manner

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity for the assessment of skeletal status. This study was carried out to examine the effect of anthropometric, dietary, physical activity, and other lifestyle factors on QUS parameters in healthy Greek males of various ages, including children (n=192), adults (n=106), and elderly (n=86) subjects. Calcaneal QUS measurements were performed with the Sahara device (Hologic), which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS) through the os calcis. A composite parameter, the quantitative ultrasound index (QUI), and an estimate of heel bone mineral density (eBMD) were also derived. BUA correlated positively with height, weight, and body mass index, as well as waist and hip circumferences (P<0.001), but this was not the case for SOS. QUI and eBMD were inconsistently related with anthropometric characteristics. Overweight and obese males had significantly higher BUA than normal-weight subjects (P<0.05), but similar SOS, QUI, and eBMD; this held true for all age groups. Boys participating in organized physical activities had significantly higher SOS, QUI, and eBMD than those who did not (P<0.05), although BUA was similar in the two groups; no differences according to organized physical activity were detected in adults and the elderly. On the other hand, adult men devoting at least some time to non-organized physical activities had significantly higher QUS values than their non-exercising peers (P<0.05); no such effects, however, were seen in children and the elderly. Adult men with calcium intakes above 800 mg/day had significantly higher SOS, QUI, and eBMD than those consuming less calcium (P<0.05), and also tended towards higher BUA (P=0.079); no such differences were observed among children and elderly men. The effects of physical activity and calcium intake on heel QUS persisted even after controlling for body size. Overall, body weight was the sole significant positive determinant of BUA (beta=0.373; t=6.589; P<0.001), explaining approximately 14% of the total variance, while age was the sole significant negative determinant of SOS (beta=-0.198; t=-3.321; P=0.001), albeit explaining only less than 4% of the total variance. In conclusion, body size, dietary calcium intake, and physical activity patterns seem to inconsistently and age-dependently influence heel QUS among healthy Greek males in a parameter-specific manner.

Lifestyle factors affecting heel ultrasound in Greek females across different life stages

The use of quantitative ultrasound (QUS) of the bone is rapidly gaining in popularity, and QUS is widely used worldwide for the assessment of skeletal status. Although much has been learned about the influence of various factors on ultrasonic parameters in various populations, similar information at the local level is not available. This study was carried out to examine the effects of anthropometric, dietary, physical activity, reproductive, and other lifestyle factors on QUS parameters in healthy Greek women, including children (n=217), adults (n=235), and elderly (n=369) subjects. Calcaneal QUS measurements were performed with the SAHARA device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS) through the os calcis; a composite parameter, the quantitative ultrasound index (QUI), and an estimate of heel bone mineral density (eBMD) were also derived. All QUS indices were higher in adult women than in girls or elderly women (P<0.05). The latter had a similar BUA to girls, but lower SOS, QUI, and eBMD (P<0.05). Most QUS parameters correlated positively with height, weight, body mass index (BMI), hip circumference, organized physical activity, and activity promoting bone mass, but negatively with the time devoted to sedentary activities and absolute carbohydrate intake (P<0.05). Age of menarche and years since menopause were negatively associated with QUS in the adult and elderly women, respectively (P<0.05). The latter relationship, however, was due to the confounding effect of advancing age. Overweight and obese females had significantly higher BUA and eBMD than normal-weight subjects (P<0.05), but similar SOS and QUI; this held true for all age groups. Likewise, in all ages, individuals spending more than 2 h/week on organized activities had significantly higher QUS indices than those spending less time on exercise (P<0.05). Further, postmenarchial girls had significantly higher age-adjusted BUA, SOS, QUI, and eBMD than premenarchial ones (P<0.05). Similarly, all QUS parameters were significantly higher in adult women with an early onset of menarche (<14 years old) than in those with a late onset (P<0.05), but no effects of menarche were detected among the elderly. No significant effects of calcium intake (which was generally adequate), smoking or alcohol drinking (which were generally low) on QUS indices were observed, in either age group. Available independent variables could explain approximately 16%-24% of the total variance in BUA, SOS, QUI and eBMD. The most important positive predictors of QUS were adulthood, time devoted to organized activities, and weight or BMI, while age and carbohydrate intake per se contributed negatively. In conclusion, age, body size, physical activity, and some aspects of reproductive history and diet appear to variably affect calcaneal QUS indices among otherwise healthy Greek women at different life stages.

Skeletal status assessed by quantitative ultrasound at the calcaneus in females with bronchial asthma on prolonged corticosteroid therapy

Objective: The aim of the study was to assess skeletal status in bronchial asthma female patients after long-term oral corticosteroid (CS) therapy. Methods: Eighty-two female patients (25 with and 57 without fractures; mean age 58.0 ± 7.8 years) were compared with 999 females (821 controls without fractures, mean age 58.6 ± 7.2 years and 178 females with previous osteoporotic fractures, mean age 57.8 ± 7.1 years). Mean age and years since menopause did not differ between patients and controls. The duration of CS therapy was 8.4 ± 7.3 years, and daily mean dose equivalent to prednison was 8.8 ± 3.5 mg. Skeletal status was evaluated by quantitative ultrasound (QUS) measurements at the heel using the Achilles system (Lunar, USA) which measures speed of sound (SOS (m/s)) and Broadband Ultrasound Attenuation (BUA (dB/MHz)). The Achilles software also calculates a stiffness index (SI (%)). The precision expressed using the root mean square coefficient of variation (RMS_CV%) was: 0.26% for SOS, 4.37% for BUA, and 2.13% for SI. Results: Patients (all, with and without fractures) had significantly lower QUS values than controls without fractures and their values did not differ significantly from controls with fractures. Controls with fractures had significantly lower QUS values than controls without fractures. There was no difference between patients with and without fractures. The duration of the therapy did not influence skeletal variables in any group. Receiver operating characteristic curve (ROC) analysis was performed to assess the discriminatory capability of calcaneal QUS for CS-treated patients by calculating the area under the ROC curve (AUC). AUCs were: 0.70 for SOS, 0.68 for BUA and 0.70 for SI. Conclusions: In females with bronchial asthma on prolonged CS therapy, skeletal status is affected but does not differ from controls with fractures therefore CS therapy seems to be a risk factor for osteoporotic fracture. Calcaneal QUS measurements can be a useful tool in the assessment of CS bone-side effects.

Heritability of calcaneal quantitative ultrasound measures in healthy adults from the Fels Longitudinal Study

Quantitative ultrasound (QUS) measurements of bone have been reported to predict osteoporotic fracture risk in postmenopausal women and older men. Although many studies have examined the heritability of bone mineral density (BMD), few studies have estimated the heritability of calcaneal QUS phenotypes. In the present study, we examined the genetic regulation of calcaneal QUS parameters in individuals from nuclear and extended families. The study population includes 260 men and 295 women aged 18–91 years (mean ± SD: 46 ± 16 years) who belong to 111 pedigrees in the Fels Longitudinal Study. Three measures of calcaneal structure were collected from both the right and left heel using the Sahara® bone sonometer. These measures included broadband ultrasound attenuation (BUA), speed of sound (SOS), and the quantitative ultrasound index (QUI). We used a variance components based maximum likelihood method to estimate the heritability of QUS parameters while simultaneously adjusting for covariate effects. Additionally, we used bivariate extensions of these methods to calculate additive genetic and random environmental correlations among QUS measures. All phenotypes demonstrated statistically significant heritabilities ( P < 0.0000001). Heritabilities in the right heel ( h 2 ± SE) were h 2 = 0.59 ± 0.10 for BUA, h 2 = 0.73 ± 0.09 for SOS, and h 2 = 0.72 ± 0.09 for QUI. Similarly, heritabilities for the left heel were h 2 = 0.52 ± 0.10, h 2 = 0.75 ± 0.10, and h 2 = 0.70 ± 0.10, respectively. There was evidence for significant genetic and environmental correlations among these six QUS measures. Combinations of QUS measures in the right and left heel demonstrated genetic correlations of 0.94–0.99 and all were significantly different from one indicating at least a partially unique genetic architecture for each of these measures. This study demonstrates that QUS measures of the calcaneus among healthy men and women are heritable, and there are large shared additive genetic effects among all of the traits examined.

Correlations of calcaneal QUS with pQCT measurements at distal tibia and non-weight-bearing distal radius.

Quantitative ultrasound (QUS) is used for prediction for risks of osteoporotic fractures at various skeletal sites, irrespective of weight-bearing or non-weight-bearing skeletons. In the current study, we investigated the correlation between calcaneal QUS measurements (BUA, VOS, and Soundness) and volumetric trabecular, cortical, and its integral bone mineral density (tBMD, cBMD, and iBMD) using peripheral quantitative computed tomography (pQCT) of the weight-bearing distal tibia and non-weight-bearing distal radius in 198 healthy Chinese women between 40 and 62 years of age. Results showed that BUA, VOS, and Soundness measured by calcaneal QUS were significantly correlated with tBMD, cBMD, and iBMD of both distal tibia and distal radius (r = 0.210-0.447; all P < 0.01). The correlation coefficients of all the individual parameters between calcaneus and distal tibia were correspondingly higher (r = 0.214-0.447; all P < 0.01) than that of distal radius (r = 0.210-0.368; all P < 0.01). QUS Soundness showed the highest correlation (r = 0.447; P < 0.01) with tBMD of distal tibia when comparing with all other parameters between these two measurement devices. Stronger "within-device" correlations (r = 0.640-0.764; all P < 0.01) were found in pQCT measurements between distal tibia and radius. In addition, the largest and significant age-related decline was found in tBMD of the distal radius measured by pQCT and Soundness of the QUS measurement in the postmenopausal group. In conclusion, heel QUS measurement demonstrated slightly better correlation with trabecular bone of the weight-bearing skeleton than that of the non-weight-bearing skeleton measured by pQCT.

Quantitative ultrasound at the calcaneus in corticosteroid-treated male patients with bronchial asthma

The aim of the study was to assess skeletal status in bronchial asthma male patients after long-term corticosteroid (CSt) therapy. A total of 25 men patients (mean age 53.8 ± 11.6 years) were compared with 343 men: 256 control men without fractures (mean age 54.4 ± 13.1 years) and 87 men with previous osteoporotic fractures (mean age 54.7 ± 11.6 years). The mean age and body size did not differ among groups studied. The duration of CSt therapy expressed as median was 6 years (range 1 to 30 years), and a mean dose equivalent to prednisone was 9.3 ± 4.5 mg. Skeletal status was evaluated by quantitative ultrasound (QUS) measurements at the heel using the Achilles system (Lunar), which measures speed of sound (SOS) in m/s and broadband ultrasound (US) attenuation (BUA) in dB/MHz. The Achilles software calculates also a stiffness index (SI) in %. The CV% values were: 2.48% for BUA, 0.33% for SOS and 2.56% for SI. Values of BUA, SOS, SI, T-score and Z-score in patients were significantly lower than in controls and did not differ between patients and men with fractures. The duration of CSt therapy and childhood and current calcium daily intake did not influence skeletal variables measured. ROC analysis was performed to assess the discriminatory capability of calcaneal QUS for fractured and CSt-treated patients by calculating the area under the ROC curve (AUC). AUCs were: 0.74 ± 0.027 and 0.72 ± 0.05 for SOS, 0.71 ± 0.03 and 0.66 ± 0.05 for BUA and 0.74 ± 0.03 and 0.71 ± 0.05 for SI, respectively. Concluding, in male patients with bronchial asthma on prolonged CSt therapy, skeletal status was affected, and calcaneal QUS measurements can be a useful tool in the assessment of skeletal side effects after long-term CSt treatment. (E-mail: bognadr@poczta.onet.pl)

Quantitative ultrasound calcaneus measurements: normative data for the Greek population.

Quantitative ultrasound (QUS) is a peripheral bone densitometry technique that is rapidly gaining in popularity, and is widely used worldwide for the assessment of skeletal status. This, however, generally occurs in the absence of adequate clinical guidelines. As accurate interpretation of the results and correct classification in individual fracture risk assessment are of great value, the present study was carried out to establish a reference database for calcaneal QUS measurements across age group and gender in Greece. A total of 1205 subjects (821 females and 384 males) from three age groups (409 children, 341 adults and 455 elderly) were recruited. QUS measurements were performed at the heel with the Sahara device, which measures broadband ultrasound attenuation (BUA) and speed of sound (SOS), and then combines these variables into a single parameter, the quantitative ultrasound index (QUI). Overall, gender-related differences were more pronounced among the elderly, while age-related differences were more pronounced among females. Elderly men had higher QUS parameters than women of peer age, but no major gender differences were observed in children and adults. In males, only BUA showed a variation with age, being higher in adult and elderly men compared to boys. On the other hand, all QUS parameters varied significantly with age in females, the general trends being mildly positive from childhood to adulthood, when peak levels were observed, and negative thereafter. The results for the Greek population were in the range reported previously for other populations, but some discrepancies were evident, probably resulting from ethno-specific characteristics and different QUS instrumentation. Importantly, using the manufacturer's or the local database as the reference population for computing T-scores led to significantly different classification of subjects into conventional categories of risk. These data could be useful as a guide for comparing the results of individual studies, as well as for the assessment of Greek men and women at risk of fracture.

Cortical and trabecular bone mineral loss from the spine and hip in long-duration spaceflight.

We measured cortical and trabecular bone loss using QCT of the spine and hip in 14 crewmembers making 4- to 6-month flights on the International Space Station. There was no compartment-specific loss of bone in the spine. Cortical bone mineral loss in the hip occurred primarily by endocortical thinning. In an earlier study, areal BMD (aBMD) measurements by DXA showed that cosmonauts making flights of 4- to 12-month duration on the Soviet/Russian MIR spacecraft lost bone at an average rate of 1%/month from the spine and 1.5%/month from the hip. However, because DXA measurements represent the sum of the cortical and trabecular compartments, there is no direct information on how these bone envelopes are affected by spaceflight. To address this, we performed a study of crewmembers (13 males and 1 female; age range, 40-55 years) on long-duration missions (4-6 months) on the International Space Station (ISS). We used DXA to obtain aBMD of the hip and spine and volumetric QCT (vQCT) to assess integral, cortical, and trabecular volumetric BMD (vBMD) in the hip and spine. In the heel, DXA was used to measure aBMD, and quantitative ultrasound (QUS) was used to measure speed of sound (SOS) and broadband ultrasound attenuation (BUA). aBMD was lost at rates of 0.9%/month at the spine (p < 0.001) and 1.4-1.5%/month at the hip (p < 0.001). Spinal integral vBMD was lost at a rate of 0.9%/month (p < 0.001), and trabecular vBMD was lost at 0.7%/month (p < 0.05). In contrast to earlier reports, these changes were generalized across the vertebrae and not focused in the posterior elements. In the hip, integral, cortical, and trabecular vBMD was lost at rates of 1.2-1.5%/month (p < 0.0001), 0.4-0.5%/month (p < 0.01), and 2.2-2.7%/month (p < 0.001), respectively. The cortical bone loss in the hip occurred primarily by cortical thinning. Calcaneal aBMD measurements by DXA showed smaller mean losses (0.4%/month) than hip or spine measurements, with SOS and BUA showing no change. In summary, our results show that ISS crewmembers, on average, experience substantial loss of both trabecular and cortical bone in the hip and somewhat smaller losses in the spine. These results do not support the use of calcaneal aBMD or QUS measurements as surrogate measures to estimate changes in the central skeleton.

Relationship between quantitative ultrasound, anthropometry and sports participation in college aged adults.

The college years are an opportune timepoint of intervention in the primary prevention of osteoporosis. Physical activity is an important modifiable risk factor, yet national surveys reveal that young people are insufficiently active. To determine patterns of physical activity associated with improved skeletal status at this life stage, we assessed the relationship between self-reported physical activity patterns, grip strength, anthropometric measures, and calcaneal quantitative ultrasound (QUS) measures in a study of college students (n=235), the Tufts Longitudinal Health Study (TLHS). Univariate analyses revealed several highly significant relationships between QUS parameters and anthropometry, but only among women, with the highest correlation for skeletal muscle mass. Grip strength was significantly related to broadband attenuation (BUA) and stiffness index (SI) in both men and women. Multiple regression analysis revealed that among the modifiable body composition compartments, muscle mass but not fat mass was significantly associated with higher BUA in men (P<0.05) and women (P<0.001), and higher SI in women (P<0.001). Among our sample of college students, current weight training (P=0.004), and moderate (P=0.003) and vigorous (P<0.001) sports participation were each significantly associated with higher SI. Multiple regression analysis revealed that sports participation (moderate and/or vigorous) was associated with higher SI by 10.22+/-3.93 units (P=0.011) among men and 7.28+/-2.36 units (P=0.002) among women. These data suggest that improved skeletal status in young adulthood may require more specific moderate to vigorous physical activity, such as that achieved with sport, than is currently recommended for overall health.