Calcaneal Ultrasound Measurements Research Articles

Anthropometric Dimensions and Bone Quality in International Male Beach Handball Players: Junior vs. Senior Comparison.

Background: Beach handball is a recent team sport characterized by defensive and offensive actions on a sand surface. Scientific evidence has shown that body composition is fundamental in sports performance. The main objective of this study was to know the body composition, anthropometric characteristics, and bone mineral density of elite beach handball players. Furthermore, another purpose was to analyze the differences between categories (junior and senior) and playing position. Methods: A descriptive, cross-sectional study of 36 male players (18 juniors and 18 seniors) of the Spanish National Beach Handball Team was conducted. Full profile anthropometry and calcaneal ultrasound measurements were used. Results: Significant differences between categories (p < 0.05) were found in: height, body mass, arm span, BMI, muscle mass, fat mass, bone mass, skinfolds, and body perimeters. The somatotype changes depending on the playing position. Bone mineral density of the players was adequate. No significant differences were found by playing position. Conclusions: Senior players had a better body composition due to the presence of less fat mass than junior players. This study provides reference values of elite junior and senior beach handball players and by playing positions. This data is useful for the identification of talents and players who should be trained to improve their body composition.

A novel bone sonometer for estimation of calcaneal bone mineral density

This study evaluated a new clinical ultrasound device, the QRT 250, in terms of its ability to estimate BMD at the calcaneus. The QRT 250 rests on the floor and permits real-time evaluation of calcaneal BMD. The QRT 250 utilizes a novel heel positioning system that relies on an individual's foot size to locate a specific region-of interest (ROI) in the calcaneus. This feature of the device was designed to account for the relatively high degree of BMD heterogeneity associated with the calcaneus. The device measures in thru-transmission a net time delay (NTD) parameter. NTD has been shown to be highly correlated with bone mass in simulations, in vitro, and in other clinical studies. A linear regression of the NTD is used to provide an estimate of calcaneal BMD that would be measured by DXA. A clinical IRB-approved study was carried out in which 145 adults were measured at the calcaneus using ultrasound and DXA (Lunar GE PIXI; WI, USA). In addition, thirty (30) subjects were each ultrasonically measured two (2) times and the short term precision was evaluated. A linear regression showed that BMDUS = 0.12 · NTD—0.11 and that the linear correlation between BMDDXA and BMDUS was 0.89 (P<0.001). We found that calcaneal ultrasound measurements yield results that are very closely associated with those from DXA. In the short-term precision study, we found that the mean percent precision was 1.37%. In summary, the QRT 250 can be used to identify bone loss in osteoporosis and ultimately to reduce the incidence of fragility fractures.

The influence of dairy consumption and physical activity on ultrasound bone measurements in Flemish children

The study's aim was to analyse whether children's bone status, assessed by calcaneal ultrasound measurements, is influenced by dairy consumption and objectively measured physical activity (PA). Moreover, the interaction between dairy consumption and PA on bone mass was studied. Participants of this cross-sectional study were 306 Flemish children (6-12years). Body composition was measured with air displacement plethysmography (BodPod), dairy consumption with a Food Frequency Questionnaire, PA with an accelerometer (only in 234 of the 306 children) and bone mass with quantitative ultrasound, quantifying speed of sound (SOS), broadband ultrasound attenuation (BUA) and Stiffness Index (SI). Regression analyses were used to study the associations between dairy consumption, PA, SOS, BUA and SI. Total dairy consumption and non-cheese dairy consumption were positively associated with SOS and SI, but no significant association could be demonstrated with BUA. In contrast, milk consumption, disregarding other dairy products, had no significant effect on calcaneal bone measurements. PA [vigorous PA, moderate to vigorous physical activity (MVPA) and counts per minute] was positively associated and sedentary time was negatively associated with BUA and SI, but no significant influence on SOS could be detected. Dairy consumption and PA (sedentary time and MVPA) did not show any interaction influencing bone measurements. In conclusion, even at young age, PA and dairy consumption positively influence bone mass. Promoting PA and dairy consumption in young children may, therefore, maximize peak bone mass, an important protective factor against osteoporosis later in life.

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

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.

Ultrasound bone measurements in pre-adolescent girls: interaction between ethnicity and lifestyle factors.

We obtained calcaneal ultrasound measurements in 198 girls between 7.5 and 11.7 y of age, representing ethnic groups (black [n = 80], white [n = 41], mixed ancestral origin [n = 77]) in South Africa. Anthropometry was assessed. Demographics, physical activity, habitual dietary calcium intake and pubertal development were quantified by questionnaires. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the left calcaneus were measured. Girls in Tanner breast stage 5 and/or those menstruating were excluded from analysis. Black girls were lighter than white girls (31.4 +/- 7.8 vs 34.8 +/- 7.5 kg; p < 0.05), and shorter than girls of mixed ancestral origin (1.29 +/- 0.08 vs 1.34 +/- 0.07 m; p < 0.001) and white girls (1.35 +/- 0.07 m; p < 0.001), after adjusting for age. Reported calcium intake scores were higher in black than white girls (21.6 +/- 11.1 vs 16.1 +/- 8.4; p < 0.01). Total peak bone strain score (TPBSS) was higher in white compared to black girls (6.8 +/- 4.8 vs 5.0 +/- 4.7; p < 0.05), while walking energy expenditure (MET h/wk) was higher in black girls compared to the other groups (p < 0.001). BUA and SOS were higher in the black girls (59.6 +/- 13.7 dB/MHz; 1575.1 +/- 22.6 m/s; p < 0.001) and girls of mixed ancestral origin (59.0 +/- 12.5 dB/MHz; 1567.8 +/- 26.1 m/s; p < 0.01) than in the white girls (50.4 +/- 8.7 dB/MHz; 1552.1 +/- 19.5 m/s). Co-varying for age and weight did not affect these results. Walking energy expenditure (r = 0.20) and calcium score (r = 0.17) were correlated (p < 0.05) with SOS for the whole group. Ultrasound parameters were lower in the white compared to the black girls, who consumed more calcium on average, but who were lighter, shorter and performed less impact activity. This suggests that interactions between ethnicity and lifestyle factors determine bone quality in premenarcheal girls.

Identification of risk factors for future fracture in patients following distal forearm fracture.

The challenge for healthcare systems around the world is delivering timely preventative strategies to subjects most likely to develop fragility fractures. The success or failure of national campaigns will be determined at local level, and many studies to date have found under-utilization of osteoporosis treatment strategies due to reduced public and healthcare professional awareness. An important link between the at-risk patients and their appropriate therapy is their identification and assessment. In the context of a medium sized secondary care provider, this study examined the efficiency of a nurse-led service for assessing women following distal forearm fracture, looking for additional risk factors for future fracture and also looking at uptake of the assessment programme among the target population. Two hundred and two women, median (range) age 69 (50-91) years presented with distal forearm fracture over a 9-month period. Fifty-four subjects did not participate in the study: they were significantly older than those who did ( P<0.002). One hundred and forty-eight subjects underwent assessment of falls risk, future hip fracture risk and calcaneal ultrasound attenuation measurement: 107 attended for assessment at the hospital and 41 required a health professional to visit at their place of residence-the latter group were significantly older ( P<0.0002). Of 148 subjects assessed, 76 (51%) had one or more risk factors for a fall: these subjects were significantly older ( P<0.0002) and more likely to have required a home visit ( P<0.002). Twenty-seven (18%) were considered at risk of a future hip fracture: again they were older and more likely to have required a home visit ( P<0.0005). Ninety-one subjects (61%) had a calcaneal ultrasound attenuation T-score below -2.0, and were referred for bone densitometry: again, they were older ( P<0.0002) and more likely to have required a home visit ( P<0.05). Bone densitometry demonstrated osteoporosis in 47 (52%) of those with low attenuation, osteopenia in 31 and normal bone density in 13. Of 76 subjects deemed to be at risk of falls, 31 (41%) had osteoporosis demonstrated on bone densitometry and of those at risk of future hip fracture, 12 (44%) had osteoporosis. Only nine (22%) subjects who received home visits had no risk factors for falls or hip fracture and normal bone density, compared to 45 (42%) of those who attended hospital. This study has demonstrated that the efficiency of a program to assess additional risk of future fracture in a population who have already fractured may be influenced by where the assessment is delivered: it may be that the patients at greatest risk did not avail of the service.

Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia.

Patients with congenital adrenal hyperplasia attributable to 21-hydroxylase deficiency are treated with glucocorticoids. Glucocorticoid administration, even in substitution doses, may cause decreased bone mineral density (BMD) and obesity. The purpose of this study was to determine BMD, lean mass, and fat mass in young adult male (M, n = 15) and female (F, n = 15) patients with 21-hydroxylase deficiency, who had been treated with currently recommended low doses of glucocorticoids. Measurements were performed with dual-x-ray absorptiometry. In addition, calcaneal ultrasound measurements were performed (broadband ultrasound attenuation and speed of sound). Results were compared with those in age- and sex-matched controls; to adjust for height, lean and fat mass were divided by (height)(2). M and F patients [M, 21.7 +/- 2.4; F, 20.6 +/- 2.9 yr old (mean +/- SD)] were shorter than the controls (M, P < 0.001; F, P < 0.003) and their body mass indices were higher [M patients (25.0 +/- 3.6) vs. controls (22.3 +/- 1.9 kg/m(2)) (P < 0.02); F patients (25.5 +/- 4.5) vs. controls (21.9 +/- 2.3 kg/m(2)) (P < 0.02)]. BMD values (lumbar spine L1-L4, femoral neck, and total body) were not different from controls. Calcaneal ultrasound measurements showed that M patients had higher speed of sound values [M patients (1564 +/- 38) vs. controls (1529 +/- 29 m/sec) (P < 0.01)]. Lean mass in M and F patients was not different from controls when adjusted for height. Fat mass was higher in M and F patients when adjusted for height [M patients 5.6 +/- 2.9 vs. controls 2.7 median (1.7-7.0 min-max) kg/m(2) (P < 0.04); F patients 8.7 +/- 2.8 vs. controls 5.8 (4.3-10.7) kg/m(2) (P < 0.02)]. Relative fat mass (fat mass as a percentage of the total body mass) was higher in patients, compared with controls [M patients 22.0 +/- 9.1 vs. controls 12.8 (8.5-27.0)% (P < 0.04); F patients 34.1 +/- 5.0 vs. controls 29.0 +/- 5.1% (P < 0.02)]; this resulted from increased fat mass, not from decreased lean mass. Fat distribution over the body was not different in patients and controls. No significant correlations were found between cumulative glucocorticoid doses in the last 0.5, 2, or 5 yr or mean salivary morning levels of 17-hydroxyprogesterone and androstenedione in the last 5 yr on one hand and bone parameters, lean mass, or fat mass on the other hand. We conclude that, at prevailing low-dose glucocorticoid regimens, young adult patients with 21-hydroxylase deficiency have normal BMD. Their lean mass is in accordance with height, but fat mass is increased, with a normal distribution over the body. This results in a higher fat percentage of the total body and a higher body mass index than in healthy peers. Because overweight and increased fat mass are associated with the metabolic syndrome and increased cardiovascular risk, weight management should have appropriate attention in the follow-up of congenital adrenal hyperplasia patients, to prevent overweight-associated morbidity.

Calcaneal ultrasound measurements and pubertal maturation in girls

Calcaneal ultrasound measurements and pubertal maturation in girls

Mapping of quantitative ultrasound of the calcaneus bone to chromosome 1 by genome-wide linkage analysis.

Quantitative ultrasound (QUS) may predict the risk of fracture independent of bone density. The aim of this study was to identify, using quantitative trait linkage analysis, chromosomal regions that might contain genes influencing variation in calcaneal ultrasound measures in a set of families from the general population. A genome-wide autosomal scan was conducted in 324 Caucasian families (1270 measured individuals) from the Framingham Osteoporosis Study, using a set of 401 Marshfield microsatellite markers with a 10 cM average density map. QUS measurements included broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI). These phenotypes were regressed on age, age(2), body mass index, height, alcohol and caffeine consumption, smoking status, physical activity, and estrogen use in females, in each sex and generation separately. Adjusted QUS phenotypes demonstrated a strong heritability ranging from 0.45 (SOS) to 0.52 (BUA). By two-point variance components genome screening, phenotype-specific regions of possible linkage were identified on chromosomal regions 1p36.3 and 5p15.2. The maximum LOD score attained was 2.74 for BUA with D1S468 (4 cM) and 2.69 for SOS with D5S817 (23 cM). QUI, a linear combination of the SOS and BUA, showed linkage with both markers (LOD = 2.1 with D1S468 and LOD = 2.2 with D5S817). Results of two-point analysis were confirmed by multipoint linkage analysis only for BUA, with LOD = 2.4 at D1S468, but not for SOS or QUI. The results for QUS, adjusted for femoral and lumbar spinal bone mineral density, in addition to the above covariates, were virtually the same. In conclusion, our results suggest that there may be genetic determinants for BUA on 1p36.3. These results should encourage further investigations of the genetic source of QUS variability and candidate polymorphisms in this region.

The impact of low-saturated fat, low cholesterol diet on bone properties measured using calcaneal ultrasound in prepubertal children.

To analyze the effects of low-saturated fat, low-cholesterol diet on bone in healthy children, calcaneal ultrasound measurements were obtained in 139 subjects (71 girls, 68 boys; mean age 8 years, SD 0.5), who were recruited from the STRIP (Special Turku Coronary Risk Factor Intervention Project) trial. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and quantitative ultrasound index (QUI) values were determined at the dominant heel using a Hologic Sahara scanner. Values were compared with anthropometry and mean, energy-adjusted dietary intakes (absolute intake/1000 kcal) of fat, carbohydrates, protein, cholesterol, calcium, fiber, and the polyunsaturated to saturated fatty acid ratio derived from 4-day food diaries kept once a year between the ages of 2-7 years. The intakes were also analyzed separately at each time point. The BUA, SOS, and QUI values of the intervention children (n = 90) and the control children (n = 49) were similar. No gender differences were found. BUA correlated with age (r = 0.26, P<0.01), height (r = 0.19, P<0.05), and weight (r = 0.22, P<0.05). QUI correlated with mean intake of fat (r = 0.19, P<0.05) and carbohydrate (r = -0.22, P<0.05), SOS with mean intake of cholesterol (r = 0.18, P<0.05), and BUA with mean intake of carbohydrate (r = -0.22, P<0.05). The intakes of fat and cholesterol were lower (P<0.001) and intakes of protein and carbohydrates higher (P<0.01) in the intervention children, but the intakes of calcium were similar. The differences in the dietary intakes persisted throughout the study period. We conclude that dietary counseling aimed at reducing risk of atherosclerosis in later life does not decrease dietary intake of calcium or diminish the calcaneal ultrasound values in the intervention of children in this study. However, since this study is cross-sectional and only one measurement of bone is used, further studies are needed to draw further conclusions about the influence of dietary counseling on bone health.

Genetic variation in bone mineral density and calcaneal ultrasound: a study of the influence of menopause using female twins.

The aim of the study was to determine whether the genetic variance in bone mineral density (BMD) and calcaneal ultrasound differs in pre- and postmenopausal women and to establish whether the genes operating before the menopause are the same as those after the menopause. Twins aged 18-75 years were recruited from the St Thomas' UK Adult Twin Registry. Quantitative model fitting techniques were used to test for differences in genetic influences in pre- and postmenopausal twins of several BMD sites and calcaneal ultrasound measures accounting for age. BMD and heel ultrasound variables were measured in 2490 female twins: 360 monozygotic pairs and 885 dizygotic pairs. The heritability in the group overall ranged from 19% to 76%. A significant increase in total variance was seen for most BMD sites after the menopause. The proportion of total variance explained by genetic influence was higher premenopausally at all sites except the femoral neck. For example, the genetic proportion of total variance for spine BMD was 88% premenopausally and 77% postmenopausally. In contrast there was no significant difference in total variance of ultrasound measures with menopause. There was no indication that traits are influenced by different genes before and after menopause. This study demonstrates that genetic and environmental influences differ significantly in pre- and postmenopausal groups for BMD, but not for calcaneal ultrasound. The total variance in BMD is greater postmenopausally, but there is evidence that the same genes are involved. These data stress the importance of accounting for menopause-gene interactions in the genetic analysis of data on osteoporosis.

Evidence of association and linkage disequilibrium between a novel polymorphism in the transforming growth factor beta 1 gene and hip bone mineral density: a study of female twins.

Bone mineral density (BMD) in later life is a major determinant of osteoporotic fracture risk and has been shown to be under strong genetic influence. Transforming growth factor beta 1 (TGF-beta 1) is an important regulatory cytokine, is found in high concentrations in the bone matrix, and is a plausible candidate for the genetic regulation of BMD. This study investigated whether a novel polymorphism within the TGF-beta 1 gene is associated with BMD in a large normal female population of 1706 dizygotic (DZ) twins (age range 18-76 yr). A C--->T [corrected] polymorphism was identified in intron 5, the T [corrected] allele having a frequency of 0.25. Subjects homozygous for the presence of the TGF-beta 1 T [corrected] allele had a 4% reduction in femoral neck BMD compared with the other two genotype groups (P<0.025). No effect was seen at the lumbar spine or ultradistal radius, or with calcaneal ultrasound measurements. Results were unaffected after adjustment for potential confounders. These findings were predominantly seen in pre-menopausal subjects, suggesting that this locus has an effect on the attainment of peak BMD. In pre-menopausal women, subjects who were homozygous for the T [corrected] allele had a 5-fold excess risk of having osteoporosis at the femoral neck compared with the other genotype groups. A within-pair analysis using the sibling transmission disequilibrium test confirmed these findings in pre-menopausal women and supported the candidacy of the TGF-beta 1 locus in the genetic regulation of hip BMD. These results indicate that allelic variation at the TGF-beta 1 gene contributes to the development of osteoporosis at the hip. The study also highlights the power of candidate gene analysis in twins, in whom loci having modest effects on disease risk can be identified.

Calcaneal ultrasound measurements are determined by age and physical activity. Studies in two Swedish random population samples.

To present reference values and correlations with body composition, blood variables and lifestyle factors. Two random population samples from Göteborg, Sweden, one comprising 184 men and 455 women aged 25-64 years (MONICA) and the other 860 women aged 55-82 years (BEDA) were studied. Calcaneal ultrasound measurement (LUNAR Achilles) and bioimpedance were measured. Smoking habits, coffee consumption, physical activity, psychological stress, education and marital status, as well as blood lipids, blood pressure, and fractures were studied. Broadband ultrasound attenuation and stiffness were higher in men than in women (P < 0. 001), but speed of sound did not differ between sexes. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age (P < 0.001). In both sexes speed of sound, broadband ultrasound attenuation and stiffness correlated positively to body size variables, and negatively with smoking in women after adjustment for age. Speed of sound, broadband ultrasound attenuation and stiffness were positively related to physical activity in both sexes, and these relationships were the only ones that remained in multivariate analyses in addition to age (negative). Osteoporotic fractures increased with age. Speed of sound, broadband ultrasound attenuation and stiffness were lower amongst women with osteoporotic fractures. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age and increased with physical activity, but body weight and height were not correlated in multivariate analyses. Osteoporotic fractures increased with age and were associated with lower calcaneal ultrasound values.

Screening calcaneal ultrasound and risk factors for osteoporosis among lesbians and heterosexual women.

We compared calcaneal ultrasound measurements (speed of sound [SOS], broadband ultrasound attenuation [BUA], and stiffness index [SI]) of lesbian and heterosexual women to examine the medical and lifestyle risk factors for osteoporosis in each group. This was an exploratory, community-based, cross-sectional study. Subjects were mailed food frequency, health, and physical activity questionnaires. Weight, height, and calcaneal ultrasound measurements were taken at one office visit. In communities in southern and eastern Maine, 71 lesbians and 77 heterosexual women between the ages of 30 and 50 with regular menses and in good general health were the subjects. Statistical analysis used t-tests and chi-square tests to evaluate differences between study groups. Linear regression models were used to evaluate risk factors for low calcaneal ultrasound measurements. There were no differences between the lesbian and heterosexual women in age, body mass index (BMI), exercise, calcium intake, alcohol use, or calcaneal ultrasound measurements. There was a positive association between BUA and both BMI and alcohol consumption (p < 0.01). Antidepressant use significantly reduced SOS and SI (p < 0.05). There were no differences in calcaneal ultrasound measurements between lesbian and heterosexual women. BMI was strongly and positively associated with BUA. Antidepressant use in both populations was associated with a significant reduction in calcaneal bone mass. Studies are needed to define the relationship of depression and its treatment to bone mineral density and the future risk of osteoporosis.

Influence of handedness on calcaneal ultrasound: implications for assessment of osteoporosis and study design.

Calcaneal ultrasound has been increasingly studied for its potential in the assessment of osteoporotic fracture risk. The accuracy of such an assessment is, in part, dependent on the reproducibility of the measurement. This study examines the impact of handedness on ultrasound measurements [broadband ultrasound attenuation (BUA) and velocity of sound (VOS)] in the calcaneus. Two hundred and sixty-four subjects (57 men and 297 women) aged 51.1 +/- 13.6 years (mean +/- SD) were studied. For each subject, calcaneal ultrasound measurements were performed on both heels with a McCue CUBA ultrasound densitometer. Right-handed dominance (94.7%) was determined by structured interview. In men, BUA measurements were significantly higher on the dominant side: mean difference 4.1 +/- 1.5 dB/MHz (mean +/- SD; p = 0.009), equivalent to 4.2 +/- 1.5% and more than 4 times the average rate of annual change in BUA. The difference between sides was greater in young (< 50 years) than old men (> 50 years). Among the women, the difference was not statistically significant (0.7 +/- 0.9 dB/MHz; p = 0.4); however, it was significant in younger women (20-30 years) (99 +/- 4 vs 90 +/- 4 dB/MHz, p = 0.01). By contrast VOS did not differ between sides in either men or women irrespective of age. Within-subject standard deviation of BUA was 9.8 dB/MHz for men and 8.6 dB/ MHz for women and the component due to right and left difference was 8.4 dB/MHz for men and 6.9 dB/MHz for women. This variability of BUA between right and left heels could increase the false-positive rate by up to 28% for a cut-off of 2 SD below the mean. These data indicate that variation between left and right heel measurements of BUA is higher than that of random error measurements, particularly in men and younger, presumably more physically active subjects. Although VOS measurements were not side dependent, in the smaller number of studies examining VOS and fracture risk, VOS appears to have a weaker predictive power than BUA. Clinical and epidemiological studies involving calcaneal BUA measurements should standardize the side measured to either the dominant or non-dominant heel, to reduce within-subject variation and increase their power.