Calcaneal Ultrasound Parameters Research Articles

A Comparison of Bone-Targeted Exercise Strategies to Reduce Fracture Risk in Middle-Aged and Older Men with Osteopenia and Osteoporosis: LIFTMOR-M Semi-Randomized Controlled Trial.

The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial examined efficacy and safety of two novel exercise programs in older men with low BMD. Men with low hip and/or LS BMD were randomized to high-intensity progressive resistance and impact training (HiRIT) or machine-based isometric axial compression (IAC) and compared to a nonrandomized matched control (CON). Outcomes included: hip and LS BMD; calcaneal ultrasound parameters; anthropometry; body composition; function (timed up-and-go [TUG], five-times sit-to-stand [FTSTS]); back extensor strength (BES); leg extensor strength (LES); compliance and adverse events. Ninety-three men (67.1 ± 7.5 years; 82.1 ± 11.6 kg; 175.2 ± 6.7 cm; FN T-score -1.6 ± 0.6) were randomized to HiRIT (n = 34) or IAC (n = 33), or allocated to CON (n = 26). HiRIT improved trochanteric BMD (2.8 ± 0.8%; -0.1 ± 0.9%, p = .024), LS BMD (4.1 ± 0.7%; 0.9 ± 0.8%, p = .003), BUA (2.2 ± 0.7%; -0.8 ± 0.9%, p = .009), stiffness index (1.6 ± 0.9%; -2.0 ± 1.1%, p = .011), lean mass (1.5 ± 0.8%; -2.4 ± 0.9%, p = .002), TUG, FTSTS, BES, and LES (p < .05) compared with CON. IAC improved lean mass (0.8 ± 0.8%; -2.4 ± 0.9%, p = .013) and FTSTS (-4.5 ± 1.6%; 7.5 ± 2.0%, p < .001) compared with CON. HiRIT improved LS BMD (4.1 ± 0.7%; 2.0 ± 0.7%, p = .039), stiffness index (1.6 ± 0.9%; -1.3 ± 0.9%, p = .025), and FTSTS (-10.7 ± 1.6%; -4.5 ± 1.7%, p = .010) compared with IAC. Exercise compliance was high (HiRIT 77.8 ± 16.6%; IAC 78.5 ± 14.8%, p = .872). There were five minor adverse events (HiRIT, 2; IAC, 3). HiRIT was well-tolerated and improved bone, function and fracture risk more than CON or IAC. © 2020 American Society for Bone and Mineral Research.

The ESR1 (6q25) Locus Is Associated with Calcaneal Ultrasound Parameters and Radial Volumetric Bone Mineral Density in European Men

PurposeGenome-wide association studies (GWAS) have identified 6q25, which incorporates the oestrogen receptor α gene (ESR1), as a quantitative trait locus for areal bone mineral density (BMDa) of the hip and lumbar spine. The aim of this study was to determine the influence of this locus on other bone health outcomes; calcaneal ultrasound (QUS) parameters, radial peripheral quantitative computed tomography (pQCT) parameters and markers of bone turnover in a population sample of European men.MethodsEight single nucleotide polymorphisms (SNP) in the 6q25 locus were genotyped in men aged 40–79 years from 7 European countries, participating in the European Male Ageing Study (EMAS). The associations between SNPs and measured bone parameters were tested under an additive genetic model adjusting for centre using linear regression.Results2468 men, mean (SD) aged 59.9 (11.1) years had QUS measurements performed and bone turnover marker levels measured. A subset of 628 men had DXA and pQCT measurements. Multiple independent SNPs showed significant associations with BMD using all three measurement techniques. Most notably, rs1999805 was associated with a 0.10 SD (95%CI 0.05, 0.16; p = 0.0001) lower estimated BMD at the calcaneus, a 0.14 SD (95%CI 0.05, 0.24; p = 0.004) lower total hip BMDa, a 0.12 SD (95%CI 0.02, 0.23; p = 0.026) lower lumbar spine BMDa and a 0.18 SD (95%CI 0.06, 0.29; p = 0.003) lower trabecular BMD at the distal radius for each copy of the minor allele. There was no association with serum levels of bone turnover markers and a single SNP which was associated with cortical density was also associated with cortical BMC and thickness.ConclusionsOur data replicate previous associations found between SNPs in the 6q25 locus and BMDa at the hip and extend these data to include associations with calcaneal ultrasound parameters and radial volumetric BMD.

Influence of insulin-like growth factor binding protein (IGFBP)-1 and IGFBP-3 on bone health: results from the European Male Ageing Study.

The aim of this study was to determine the influence of insulin-like growth factor binding protein (IGFBP)-1, IGFBP-3, and IGF-I on calcaneal ultrasound parameters in middle-aged and elderly European men. Men aged 40-79 years were recruited from population registers for participation in the European Male Ageing Study (EMAS). Subjects were invited by letter to complete a postal questionnaire and to attend for an interviewer-assisted questionnaire, quantitative ultrasound (QUS) of the calcaneus, and a fasting blood sample from which serum levels of IGFBP-1, IGFBP-3, IGF-I, estradiol (E(2)), and SHBG were assayed. The questionnaires included the Physical Activity Scale for the Elderly (PASE) and questions about smoking and alcohol consumption. Estimated bone mineral density (eBMD) was derived as a function of the QUS parameters speed of sound and broadband ultrasound attenuation. Height and weight were measured in all subjects. 3057 men, mean age 59.7 years (standard deviation 11.0) were included in the analysis. After adjusting for age, center, and BMI, higher levels of IGFBP-1 were associated with lower eBMD. Higher levels of both IGFBP-3 and IGF-I were associated with higher eBMD. After further adjustment for PASE score, current smoking, alcohol consumption, free E(2), and SHBG, IGFBP-3 and IGF-I, though not IGFBP-1, remained significantly associated with eBMD. IGFBP-1 was associated with bone health, though the effect could be explained by other factors. IGFBP-3 and IGF-I were independent determinants of bone health in middle-aged and elderly European men.

A validation of the first genome-wide association study of calcaneus ultrasound parameters in the European Male Ageing Study

BackgroundA number of single nucleotide polymorphisms (SNPs) have been associated with broadband ultrasound attenuation (BUA) and speed of sound (SOS) as measured by quantitative ultrasound (QUS) at the calcaneus in the Framingham 100K genome-wide association study (GWAS) but have not been validated in independent studies. The aim of this analysis was to determine if these SNPs are associated with QUS measurements assessed in a large independent population of European middle-aged and elderly men. The association between these SNPs and bone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DXA) was also tested.MethodsMen aged 40-79 years (N = 2960) were recruited from population registers in seven European centres for participation in an observational study of male ageing, the European Male Ageing Study (EMAS). QUS at the calcaneus was measured in all subjects and blood was taken for genetic analysis. Lumbar spine (LS), femoral neck (FN) and total hip (TH) BMD were measured by DXA in a subsample of 620 men in two centres. SNPs associated with BUA or SOS in the Framingham study with p < 10-4 were selected and genotyped using SEQUENOM technology. Linear regression was used to test for the association between SNPs and standardised (SD) bone outcomes under an additive genetic model adjusting for centre. The same direction of effect and p < 0.05 indicated replication.ResultsThirty-four of 38 selected SNPs were successfully genotyped in 2377 men. Suggestive evidence of replication was observed for a single SNP, rs3754032, which was associated with a higher SOS (β(SD) = 0.07, p = 0.032) but not BUA (β(SD) = 0.02, p = 0.505) and is located in the 3'UTR of WDR77 (WD repeat domain 77) also known as androgen receptor cofactor p44. A single SNP, rs238358, was associated with BMD at the LS (β(SD) = -0.22, p = 0.014), FN (β(SD) = -0.31,p = 0.001) and TH (β(SD) = -0.36, p = 0.002) in a locus previously associated with LS BMD in large-scale GWAS, incorporating AKAP11 and RANKL.ConclusionsWe found suggestive evidence of association between a single SNP located in the 3'UTR of WDR77 with calcaneal ultrasound parameters. The majority of SNPs, associated with QUS parameters in the Framingham Study, were not replicated in an independent population sample of European men.

Associations of Daily Walking Steps with Calcaneal Ultrasound Parameters and a Bone Resorption Marker in Elderly Japanese Women

Quantitative ultrasound (QUS) parameters of the calcaneus and bone resorption markers predict osteoporotic fractures. High levels of physical activity have positive effects on bone health. The purpose of this cross-sectional study was to investigate the effects of daily walking activity (number of steps taken), as an outcome of physical activity, on QUS parameters of the calcaneus and urinary deoxypyridinoline (DPD) in elderly Japanese women. The subjects were 113 postmenopausal women aged 60-85 years. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (Stiffness) of the calcaneus were measured with A-1000 (GE-Lunar, USA). Spot urine samples were collected between 09:00 and 10:00, and the levels of urinary DPD were measured. The subjects were instructed to wear a pedometer during waking hours for 7 consecutive days. In univariate analyses, steps/day significantly decreased with aging (r=-0.306, p<0.001). Steps/day showed significant positive correlations with SOS (r=0.252, p<0.01) and Stiffness (r=0.258, p<0.01). There was a significant decrease in DPD with steps/day (r=-0.262, p<0.01). These effects of walking on QUS parameters and DPD remained significant after adjustment for confounding factors by multiple regression analyses. We conclude that high levels of walking activity may be effective in both maintaining the levels of QUS parameters and reducing bone resorption, and hence preserve bone health in elderly women.

Maternal and early life influences on calcaneal ultrasound parameters and metacarpal morphometry in 7- to 9-year-old children

We investigated the relationship between maternal and early life influences, calcaneal ultrasound parameters, and metacarpal morphometry in 7- to 9-year-old children (n = 109) of mixed ancestral origin from a working class community. Their mothers had participated in a nutrition and pregnancy study at the time of the birth. Demographic and maternal data were collected. Anthropometry was assessed. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the children and a subsample of the mothers (n = 94), using calcaneal ultrasound. Hand radiographs were used to measure metacarpal morphometry. There was no relationship between the ultrasound parameters, birthweight, current weight, or height. The ponderal index was correlated with BUA (r = 0.25; P = 0.036). BUA was lower in children whose mothers smoked during pregnancy compared to children whose mothers did not smoke (P = 0.054). Children whose mothers consumed alcohol during pregnancy had a lower Barnett-Nordin metacarpal index compared to children whose mothers did not consume alcohol (P < 0.05), after covarying for sex, age, gestational age, weight, and height of the child. Children's BUA was negatively correlated with housing density (r = -0.23; P = 0.021). In this study, we found an association between maternal and early life influences on calcaneal ultrasound parameters and metacarpal morphometry in prepubertal children, an association that was also influenced by sociodemographic and environmental factors.

The ability of quantitative ultrasound at the calcaneus to identify postmenopausal women with different types of nontraumatic fractures

The aim of the cross-sectional study was to determine if ultrasound (US) measurements of the calcaneus have the ability to predict the risk for fractures and to discriminate between postmenopausal women with and without different types of nontraumatic fractures. All women ( n = 1129, age range 40 to 87 years) were divided into group 1, created by 656 women with 956 nontraumatic past fractures, and group 2, consisting of 473 women without fractures. Group 1 was divided into subgroups: with hip fractures, with vertebral (nonhip) fractures, with wrist (nonhip and nonspine) fractures and with other (nonhip, nonspine and nonwrist) fractures. The speed of sound (SOS; m/s) and broadband ultrasound attenuation (BUA; dB/MHz) were measured with the Achilles system (Lunar), which also calculates stiffness index (SI; %). US values were significantly lower in group 1 (1481.4 ± 20.2 m/s, 98.7 ± 9.4 dB/MHz, 61.1 ± 11.0%; p < 0.000001) and in subgroups ( p < 0.000001), and these women had a higher mean age and longer postmenopausal period than women without fractures (1508.2 ± 26.5 m/s, 107.7 ± 9.9 dB/MHz, 74.2 ± 13.0%). Women with hip fractures had the lowest US values (1464.6 ± 18.6 m/s, 89.9 ± 8.7 dB/MHz, 50.6 ± 10.5%), women with vertebral fractures had intermediate values (1473.6 ± 17.4 m/s, 94.8 ± 8.9 dB/MHz, 56.4 ± 10.0%), and women with wrist (1484.3 ± 19.8 m/s, 99.9 ± 9.3 dB/MHz, 62.7 ± 10.7%) and other fractures (1483.3 ± 21.0 m/s, 100.4 ± 8.6 dB/MHz, 62.7 ± 10.6%) had the highest values. The US values differed significantly between subgroups with fractures ( p < 0.05), with no significant differences between women with wrist and other fractures. ROC analysis showed SOS to have the best sensitivity and specificity in detecting fracture cases. All US parameters revealed the greatest areas under the ROC curve (AUCs) for hip fracture (0.92 to 0.93) in comparison to smaller AUCs for vertebral fractures (ranging from 0.84 to 0.87), and the smallest AUCs for wrist and other fractures (ranging from 0.72 to 0.77 and 0.72 to 0.78, respectively). Generally, the SOS measurement presented greater odds ratio (OR) than BUA and SI: 4.1 (3.09 to 5.43) for any fracture, 11.66 (3.09 to 43.96) for hip fracture, 6.51 (3.61 to 11.73) for vertebral fracture, 3.32 (2.41 to 4.58) for wrist fracture and 4.2 (2.7 to 6.54) for other fracture. The present study demonstrates the ability of calcaneal QUS to discriminate between healthy individuals and subjects with different types of nontraumatic fractures. Calcaneal US parameters show the best sensitivity and specificity in discriminating the hip fracture patients from the controls. Generally, the SOS parameter is a better discriminator than SI and BUA and estimates the highest OR for fractures. (E-mail: bognadr@poczta.onet.pl)

Mechanical strength of the thoracolumbar spine in the elderly: prediction from in situ dual-energy X-ray absorptiometry, quantitative computed tomography (QCT), upper and lower limb peripheral QCT, and quantitative ultrasound

The objective of this study was to compare the ability of clinically available densitometric measurement techniques for evaluating vertebral strength in elderly individuals. Measurements were related to experimentally determined failure strength in the thoracic and lumbar spine. In 127 specimens (82 women and 45 men, age 80 ± 10 years), dual-energy X-ray absorptiometry (DXA) was performed at the lumbar spine, femur, radius, and total body, and peripheral-quantitative computed tomography (pQCT) at the distal radius, tibia, and femur under in situ conditions with intact soft tissues. Spinal QCT and calcaneal ultrasound parameters were performed ex situ in degassed specimens. Mechanical failure loads of thoracic vertebrae 6 and 10 (T-6 and -10), and lumbar vertebra 3 (L-3) were determined in axial compression on functional three-segment units. In situ anteroposterior DXA and QCT of the lumbar spine explained approximately 65% of the variability of thoracolumbar failure. A combination of cortical and trabecular density (QCT) provided the best prediction in the lumbar spine. However, this was not the case in the thoracic spine, for which lumbar cortical density (QCT) and DXA provided significantly better estimates than trabecular density (QCT). pQCT was significantly less correlated with the strength of lumbar and thoracic vertebrae (r2 = 40%), but was equivalent to femoral or radial DXA. pQCT measurements in the lower limb showed no advantage over those at the distal radius. Ultrasound explained approximately 25% of the variability of vertebral failure strength and added independent information to spinal QCT, but not to spinal DXA. These experimental results advocate site-specific assessment of vertebral strength by either spinal DXA or QCT.

Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study.

Fracture of the proximal humerus is one of the most frequent fractures attributable to osteoporosis; yet, it has seldom been studied. Two types of factors (related to bone fragility and falls) were evaluated to identify risk factors for proximal humerus fractures as well as to examine possible interactions between them. Subjects were 6901 white women aged > or =75 years and all participated in the EPIDOS study of risk factors for osteoporotic fractures (France, 1992-1998). The baseline examination included measurements of femoral neck bone mineral density (BMD) and calcaneal ultrasound parameters (speed of sound [SOS] and broadband ultrasound attenuation [BUA]), a functional clinical examination, and completing a questionnaire on health status and lifestyle. During a mean of 3.6 (0.8) years of follow-up, 165 women had a humeral fracture. Using multivariate Cox regression models, we identified three predictors related to bone fragility-low BMD (relative risk [RR] = 1.4; 95% CI, 1.1-1.7), low SOS (RR = 1.3; 95% CI, 1.0-1.6), and maternal history of hip fracture (RR = 1.8; 95% CI, 1.0-3.0)-and four fall-related predictors-a previous fall (RR = 3.0; 95% CI, 1.5-6.1), a low level of physical activity (RR = 2.2; 95% CI, 1.1-4.4), impaired balance (RR = 1.8; 95% CI, 1.1-2.9), and pain in lower limb extremity (RR = 1.4; 95% CI, 1.0-2.1). The effect of these fall-related predictors varied according to the BMD level; they were significantly associated with proximal humerus fractures in women with osteoporosis (BMD T score < -2.5) but not in nonosteoporotic women. The incidence of proximal humerus fracture in women with osteoporosis and a low fall risk score (5.1 per 1000 woman-years) was only slightly higher than in nonosteoporotic women (4.6 per 1000 woman-years) and similar to the incidence in women without osteoporosis but a high fall risk score (5.3 per 1000 woman-years). On the other hand, the incidence in women who had both types of risk factors was more than two times higher (12.1 per 1000 woman-years) than in women with only one of the two risk factors. These results suggest that women who have both types of risk factors should receive the highest priority for prevention.

Effects of physical excercises on the calcaneal ultrasound parameters in the aged among a mountain village in Kouchi prefecture

Effects of physical excercises on the calcaneal ultrasound parameters in the aged among a mountain village in Kouchi prefecture

Ultrasound velocity and broadband attenuation as predictors of load-bearing capacities of human calcanei.

The main purpose of this study was to determine whether calcaneal ultrasound parameters, measured in the mediolateral direction, reflect load-bearing capacities of human calcanei. Broadband ultrasound attenuation (BUA) and ultrasound velocity (UV) were measured in 20 cadaveric calcanei with a mean age of 74.1 (SD 8.8). Normalized BUA (nBUA) was determined by dividing BUA by the calcaneal thickness obtained using a pulse-echo technique. The bone mineral density (BMD) of each calcaneus was measured by quantitative computed tomography. The calcanei were embedded in PMMA to simulate the midstance physiologic orientation during compressive testing in the load-bearing direction. The failure load, stiffness, and energy absorption were determined for each calcaneus. It was shown that BMD was well correlated with all ultrasound parameters (P < 0.0001). BMD, BUA, nBUA, and UV were all significantly associated with calcaneal failure load, stiffness, and energy absorption capacity (P < 0.05). nBUA was found to be the strongest predictor of all compressive properties. BUA and BMD demonstrated similar predictability of stiffness and energy absorption capacity, however, BUA showed a more significant relationship to the failure load of the calcaneus than did BMD. UV was found to be inferior to BMD, as well as BUA or nBUA, in assessing failure load, stiffness, and energy absorption capacity. It was also shown that nBUA was superior to BUA in the assessment of load-bearing capacity, but not in the prediction of BMD. Multivariate regression analysis showed that the combination of BUA or nBUA with UV did not improve the predictability of failure load, stiffness, and energy absorption capacity over that of BUA or nBUA alone (P > 0.5).