Correlação entre ultrassonometria quantitativa de calcâneo e densitometria óssea duo-energética de coluna e fêmur na avaliação óssea

The dual-energy X-ray absorptiometry (DEXA) is the most commonly used technique for bone mass density (DMO), although the quantitative calcaneus bone ultrasonometry (USQ) shows good results as a predictor for fracture risk. We compared the results obtained by these two methods in patients referred to the Endocrine Division at the Universidade Federal de São Paulo (UNIFESP) for DEXA evaluation. A total of 189 patients were studied, 165 women / 24 men, with ages from 20 to 84 years (Mi: 51 and 53, respectively for women and men) with distinct diagnosis. All were submitted on the same day to DEXA (Lunar,DPX-L) for lumbar spine (LOMB), neck (COLO) and major throcanter (TROC) and to USQ of calcaneus (Lunar, Aquilles), measuring speed of sound (SOS) and broadband ultrasound attenuation (BUA). A significant positive correlation was found between DEXA values in all sites and USQ. The best correlation was seen in men, between TROC and SOS (r=0.82). When only individuals 50 years or older (n=102) were evaluated, the coefficient of correlation was lower than in the younger than 50, but still significant. In evaluating the utility of USQ as a screening for DEXA measurement, we found that 21.4% of patients with normal values for T score on USQ were osteopenic or osteporotic on TROC. This discrepancy was even more evident on LOMB, where 29.9% of the patients with normal DMO presented T<-1 on USQ, and 35.8% of the patients with normal USQ had T<-1 on DMO of the same region. The coefficient of variation of USQ obtained after 9 measurements in the same person on different days was 0.66% for SOS and 2.75% for BUA. In conclusion, the USQ is only moderately related to DMO and has little utility as a screening for DEXA examination. Its value to determine fracture risk is already established, however prospective studies are necessary to evaluate its usefulness in the diagnosis and follow-up of osteoporosis.A densitometria óssea com raio X duo-energético (DEXA) é o método atualmente mais utilizado para medição de massa óssea; porém, a ultrassonometria óssea quantitativa (USQ) vem apresentando resultados promissores na predição de fraturas. Visando comparar DEXA e USQ, correlacionamos os resultados obtidos com estes métodos em pacientes rotineiramente encaminhados para realização de DEXA em nosso serviço. Estudamos 165 mulheres e 24 homens com idades entre 20 e 84 anos (Mi: 51 e 53 anos, para mulheres e homens respectivamente) com diagnósticos variados. Todos foram submetidos a medição da densidade mineral óssea (DMO) pela DEXA (Lunar DPX-L) em coluna lombar (LOMB) e em colo (COLO) e trocanter maior (TROC) e USQ em calcâneo (Lunar- Aquilles), onde foram considerados os parâmetros de velocidade do som (SOS) e atenuação do som (BUA). Houve correlação positiva significante entre as medidas de DMO em todos os sítios e SOS e BUA. Quando separamos por sexo, a melhor correlação foi observada nos homens, entre TROC e SOS, com r= 0,82. Quando separamos por idade, a correlação foi menor naqueles com mais de 50 anos, comparados aos com menos de 50 anos. Dentre os 89 pacientes considerados normais pela DEXA em LOMB, 29,8% apresentavam valores abaixo de 1 DP na USQ. Por outro lado, 35,8% dos indivíduos cujos valores de USQ estavam a menos de 1 DP abaixo da média, apresentavam-se com osteopenia ou osteoporose (T<-1) pela DEXA de LOMB. O coeficiente de variação dos valores obtidos de USQ para as 9 medidas realizadas na mesma pessoa foi de 0,66% para SOS e 2,75% para BUA. Concluindo, a USQ correlaciona-se apenas moderadamente com DMO e, portanto, sua utilização como um teste de rastreamento para a realização de DEXA é de pouca utilidade, uma vez que a discordância entre os métodos para um mesmo indivíduo é elevada. O valor da USQ na avaliação do risco de fratura já está estabelecido, porém estudos prospectivos são necessários para que se padronize sua utilidade no diagnóstico e acompanhamento das doenças ósseas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Quantitative ultrasound of the calcaneus, bone densitometry and vertebral morphometry in men over the age of 60 years

Objetivos: Comparar a ultrassonometria do calcâneo com a densitometria óssea na avaliação de fraturas vertebrais morfométricas em homens acima de 60 anos. Sujeitos e métodos: Foram analisados 96 homens com mais de 60 anos por meio de densitometria óssea da coluna, fêmur e rádio, radiografia lateral da coluna torácica e lombar e ultrassonometria do calcâneo. Resultados: Cinquenta e um por cento dos homens apresentaram osteoporose e fraturas vertebrais. Foi observada correlação entre índice de stiffness e T-score da ultrassonometria e as densidades minerais ósseas (DMO) de todos os sítios. Quanto à presença de fraturas, identificou- se correlação com a DMO do rádio ultradistal e 33%. Por meio da curva ROC, observou-se acurácia da DMO do rádio UD na detecção de fraturas vertebrais. Conclusões: Nosso estudo mostrou correlação entre a ultrassonometria e a densitometria no diagnóstico de osteoporose em homens acima dos 60 anos. Também se identificou correlação entre fratura vertebral morfométrica e a DMO do rádio.Objectives: To compare calcaneal ultrasonometry and bone densitometry in the evaluation of morphometric vertebral fractures in men over 60 years of age. Subjects and methods: We studied 96 men over 60 years of age by means of bone densitometry of the spine, femur and radius, lateral radiograph of the thoracic and lumbar spine, and calcaneal ultrasonometry. Results: Fifty-one percent of men had osteoporosis and vertebral fractures. Correlation was found between ultrasonometry stiffness index, T-score and bone mineral density of the spine, femur and radius (p < 0.01). Regarding the presence of fractures, there was a correlation only with BMD of the ultradistal radius (UD) and radius 33%. ROC curve showed accuracy only of UD radius BMD in detecting vertebral fractures. Conclusions Our study showed a correlation between osteoporosis diagnosis by ultrasonometry and densitometry in men over 60 years. It also showed a correlation between morphometric vertebral fracture and bone mineral density of the forearm

Quantitative ultrasound and bone health

Copyright © 2013 Instituto Nacional de Salud PúblicaOpen Access journalThis review of quantitative ultrasound (QUS) and bone health uses the current literature to summarise the clinical and research effectiveness of QUS. QUS has been demonstrated to have the ability to predict fracture, particularly at the hip. However, the magnitude of prediction is fracture-site, measurement-site and device dependent. The correlations between dual X-ray absorptiometry (DXA) and bone mineral density (BMD) are weak to moderate, resulting in different subjects being identified as being at risk of fracture by the two different methods. QUS is sensitive to age and menopause-related changes and to clinical risk factors and lifestyle factors associated with osteoporosis. Whilst a limited ability of QUS to monitor therapeutic intervention has been demonstrated, this is still an area where it's poorer precision, in comparison to DXA, results in limited applicability. Whilst DXA remains the gold standard for the diagnosis of osteoporosis, QUS may be of use for the prediction of those at risk of future fracture in areas where there is limited availability of DXA

Association of Nutritional, Functional Status and Lifestyle Habits with Bone Health Status Amongst the Institutionalized Elderly

The rising incidence of osteoporosis is well established especially among institutionalized residents. The aim of the study was to determine the association of nutritional status, functional status and lifestyle habits with bone health status among institutionalized elderly. Bone health status was assessed using Quantitative Ultrasound Sonometry (QUS-2), which measures Broadband Ultrasound Attenuation (BUA, dB/MHz) at the calcaneus. Body weight, height and body fat were assessed using SECA 767 and body fat analyzer (HBF-302 Omron). Sociodemographic background, reproductive history, history of bone fracture, lifestyle habits, dietary intake and functional status (Elderly Mobility Scale-EMS and Instrumental Activity Daily Living- IADL) of the subjects were assessed using appropriate instruments. Data were analyzed using SPSS software version 13.0 and Malaysian food composition database A total of 363 subjects comprising of 158 males (43.5%) and 205 females (56.5%) were recruited from 33 old folk’s homes and nursing homes in the Klang Valley. The subjects comprised of 79.3% Chinese, 11.6% Indians, 5.5% Malays and other races (3.6%). The mean age of the subjects was 75.8 ± 9.1 years old. The mean weight, height and body fat mass for male and female were 56.7 ± 11.9 and 50.6 ± 13.8, 161.9 ± 7.7 and 149.5 ± 11.7, 15.6 ± 7.0 and 16.7 ± 11.8, respectively. Mean Body Mass Index (BMI) for male and female were 21.6 ± 4.3kg/m 2 and 22.4 ± 5.6 kg/m 2 . Based on BMI classification, 23.3% of the subjects were underweight, 52.9% with normal weight and 23.8% were overweight and obese. The mean BUA was 61.4 ± 19.8 dB/MHz. Majority of the subjects had second tertile of BUA and there was only 10.0% of subject with third tertile of BUA. The mean energy intake was 1311 ± 312 Kcal. The mean calcium intake was low, with 428 ± 277 mg in males and 454 ± 281 mg in females. More than 50% of the subjects had daily calcium intake less than RNI for Malaysian. Approximately half of the subjects achieved 75 th percentile for EMS. However, score for IADL was low, with a mean of 8.6 ± 4.6. There were 61.7% of subjects who exercised currently with a majority of them practicing brisk walking. The results revealed significant correlation between BUA and weight (r=0.390, p<0.01), fat mass (r=0.156, p<0.01), phosphorus intake (r=-0.148, p<0.05), protein intake (r=-0.121, p<0.05), vitamin C (0.120, p<0.05), EMS (r=0.241, p<0.01) and IADL (r=0.250, p<0.01), duration exercise per session (r=0.138, p<0.05). Body weight, IADL score, and vitamin C intake were the main contributors for bone health status among the subjects, which explain 21.5% of the variation in the BUA significantly (p<0.001). As a conclusion, institutionalized elderly should be given better care or intervention in achieving optimal body weight and dietary intakes through providence of better nutrition and rehabilitation efforts to improve functional status

Luude kvaliteedi sõeluuringud kvantitatiivse ultraheli meetodil

Ultraheli kasutamise eelisteks luukoe hindamise sõeluuringutes peetakse kiirguse puudumist, odavust, läbiviimise lihtsust ja kiirust, kuid enim kasutatav luude tiheduse määramise meetod on siiski DXA (kaheenergialine röntgenabsorptsiomeetria). Luude kvaliteedi hindamise uuringu eesmärgiks oli võrrelda 1998. a tervete naiste uurimisel saadud andmeid tervisekontrolli andmetega. Luude seisundit uuriti kokku ligi 7000 naisel Eesti eri piirkondades. Andmete võrdlemisel selgus, et vanemates vanuserühmades oli tervisepäevadel osalenud naistel osteoporoosi esinemissagedus oluliselt väiksem kui tervete naiste hulgas 1998. a. Igas järgnevas vanuserühmas osteoporoosi esinemissagedus suurenes. Kuna valimid ei olnud otseselt võrreldavad, ei saa siiski teha järeldust, nagu oleks Eestis naiste luude kvaliteet oluliselt paranenud. Eesti Arst 2009; 88(Lisa3):52−5

Best Practices for Conducting Observational Research to Assess the Relation between Nutrition and Bone: An International Working Group Summary

Diet is a modifiable factor that can affect bone strength and integrity, and the risk of fractures. Currently, a hierarchy of scientific evidence contributes to our understanding of the role of diet on bone health and fracture risk. The strength of evidence is generally based on the type of study conducted, the quality of the methodology employed, the rigor and integrity of the data collected and analysis plan, and the transparency and completeness of the results. Randomized controlled trials (RCTs) are considered to be the gold standard from a clinical research paradigm, but there is a dearth of high-quality diet-related intervention trials with bone as the primary outcome, forcing the use of observational research to inform research and clinical practices. However, for observational research to be of the most utility, standardization and optimization of the study design, accurate and reliable measurement of key variables, and appropriate data analysis and data reporting are paramount. Although there have been recommendations made in relation to RCTs in the field of nutrition, no clear rubric exists for best practices in conducting observational research with regard to nutrition and bone health. Therefore, the purpose of this paper is to describe the best practices and considerations for designing, conducting, analyzing, interpreting, and reporting observational research specifically for understanding the role of nutrition in bone health, amassed by a global panel of scientific experts with strengths in bone, nutrition epidemiology, physical activity, public health, clinical and translational trials, and observational study methods. The global panel of scientific experts represents the leadership and selected participants from the 10th annual International Symposium for the Nutritional Aspects of Osteoporosis. The topics selected and best practices presented reflect expert opinion and areas of scientific expertise of the authors rather than a systematic or comprehensive literature review or professional reporting guidelines

The effect of the body mass index on calcaneal quantitative ultrasound parameters in women of the City of Rijeka

Cilj: Žene u menopauzi zbog nedostatka hormona estrogena izložene su ubrzanom gubitku koštane mase, što dovodi do bolesti koštanog defi cita kakva je osteoporoza. Smanjenju koštane mase u menopauzi mogu pridonijeti i neki drugi faktori rizika kao što su to nizak indeks tjelesne mase, neuravnotežena prehrana i tjelesna neakti vnost. Cilj ovoga rada bio je ispitati ako i u kojem opsegu, s obzirom na hormonski status, antropometrijski parametri i starosna dob predviđaju vrijednosti parametara kvanti tati vnog ultrazvuka petne kosti u žena. Istraživanjem je obuhvaćeno 499 žena grada Rijeke. Metode: Periferna gustoća petne kosti mjerena je pomoću ultrazvučnog aparata Clinical Bone Sonometar Sahara Hologic (Hologic Inc., Massachussets, SAD). Mjerenje je izvršeno u sjedećem stavu ispitanica, na konstantnom mjestu (desno stopalo). Rezultati : Stati sti čkom obradom svih ispitanica utvrđeno je da prediktorske varijable (menopauza, starosna dob, antropometrijski parametri) značajno predviđaju vrijednosti parametara kvanti tati vnog ultrazvuka petne kosti. U žena koje su više od 5 godina u menopauzi utvrđeno je da iste prediktorske varijable s izuzetkom menopauze statistički značajno predviđaju vrijednosti parametara kvantitativnog ultrazvuka petne kosti. Zaključak: U menopauzi izostaje povoljan utjecaj hormona na fiziološke procese u koštanom tkivu koji zbog toga postaju katabolični. U takvim uvjeti ma posti gnuta tjelesna masa ostaje jedina rezerva koja čuva koštani sustav od bolesti koštanog defi cita kakve su osteoporoza i osteopenija.Aim: Menopausal women, due to lack of hormones-estrogen are exposed to accelerated bone loss leading to bone defi ciency diseases, such as osteoporosis. In menopause, other risk factors such as: low body mass index, unbalanced diet and physical inactivity may reduce bone mass. The aim of this study was to examine whether, and to what extent anthropometric parameters and age predict the value of quanti tati ve ultrasound parameters of the calcaneus in women with respect to hormonal status. The study included 499 women of the City of Rijeka. Methods: Peripheral density of the calcaneus was measured using an ultrasound machine Clinical Bone Sonometar Sahara Hologic (Hologic Inc., Massachusett s, USA). The measurements were performed in sitting subjects, at a constant location (right foot). Results: Stati sti cal analysis of all subjects has determined that independent variables (age, menopause, anthropometric parameters) signifi cantly predict the value of quanti tati ve ultrasound parameters of the calcaneus. In women who are more than 5 years of menopause, the same independent variables, with the excepti on of menopause significantly predicted the value of quanti tati ve ultrasound parameters of the calcaneus. Conclusion: In menopause, the beneficial effect of hormones on the physiological processes in bone ti ssue is absent, which therefore become catabolic. In such conditi ons, achieved body mass remain the only backup system that preserves skeletal system from bone deficiency diseases such as osteoporosis and osteopenia

Bone ultrasonometric features and grow hormone secretion in asthmatic patients during chronic inhaled corticosteroid therapy

8Background: Quantitative ultrasound bone densitometry (QUBD) is a new method to assess bone mineral density and bone microarchitecture. Corticosteroid (CS) therapy may diminish bone mass, alter bone quality and may influence growth hormone (GH) secretion and bone metabolism markers. Therefore, the aim of this study was to evaluate the effects of long-term therapy with inhaled CSs (ICSs) on structural bone characteristics and their correlations with GH secretion and bone markers in asthmatic patients. Methods: In a cross-sectional study, we enrolled 60 adult patients with mild to moderate persistent asthma: 22 on chronic (N1 year) ICS therapy, 10 naive to ICSs treatment and 28 healthy control subjects. The groups were matched for age and BMI. Each subject underwent to QUBD at the phalanxes to assess bone microarchitecture by ultrasound bone profile index (UBPI), bone density by amplitude-dependent speed of sound (AdSos); test with GH-releasing hormone (GHRH) injection with calculation of peak GH and the Δ GH (peak GH–basal GH); and hormonal and bone markers measurements. Results: Asthmatics treated with long-term ICS therapy showed a lower UBPI (P b 0.01) compared to controls (49.8 ± 19.3 vs. 77.0 ± 10.1, respectively) and to asthmatics never taking ICSs (73.2 ± 9.6). In ICS-treated asthmatics, ΔGH and GH-peak showed a significant correlation with UBPI. A significant difference was observed comparing asthmatics treated with ICSs to controls and asthmatics naive to ICSs in GH response to GHRH iv bolus. Serum osteocalcin was significantly reduced in asthmatic patients treated with ICSs. Conclusions: In asthmatic patients, long-term ICSs treatment produces negative effects on bone quality assessed by QUBD, and such effects are associated to an impaired GH secretion.openopenMalerba M.; Bossoni S.; Radaeli A.; Mori E.; Romanelli G.; Tantucci C.; Giustina A.; Grassi V.Malerba, M.; Bossoni, S.; Radaeli, A.; Mori, E.; Romanelli, Giuseppe; Tantucci, Claudio; Giustina, Andrea; Grassi, V

Calcium intake, physical activity and bone health status among Chinese early adolescents

The objective of this cross-sectional study was to determine the relationship between calcium intake and physical activity with bone health status among Chinese early adolescents. A selfadministered questionnaire was used to obtain socio-demographic background, family history of osteoporosis, lifestyle practices and eating habits; while daily calcium intake was assessed using one-day dietary recall and two-day dietary record. Physical activity was examined using PAQ-A (Physical Activity Questionnaire for Adolescents). Height, weight and bone health status was assessed using stadiometer, weighing scale (TANITA), and ultrasonometry QUS-2, respectively. Data was analysed using the Statistical Package for Social Sciences (SPSS), version 15.0. A total of 236 Chinese subjects were recruited into this study. The mean age of subjects was 13.6 ± 0.5 years old. Mean daily calcium intake was low, that is 573.4 ± 405.1mg. The mean score of PAQ-A was 2.14 ± 0.64. Mean weight, height, and BMI were 50.9 ± 11.4kg, 1.62 ± 0.08m and 19.40 ± 3.72kg/m2, respectively. Based on CDC classification of BMI-for-age (2000), 68.2% of subjects were in the normal category, 16.1% were underweight, 11.4% were at risk of overweight and 4.2% overweight. Mean Broadband Ultrasound Attenuation (BUA) was 77.55 ± 11.73dB/MHz. According to diagnostic criteria for osteoporosis by WHO (1994), 49.2% of subjects had normal bone mass (t-score > -1.0), more than half of the subjects were either osteopenic (49.6%) or osteopototic (1.3%). This might be due to subjects being in the early adolescents state and their peak bone mass has yet to be attained. T-test showed that there was significant difference between mean body weight among male and female subjects. There was also significant higher mean BUA among female subjects than their counterparts. Pearson correlation test showed that there was no significant relationship between BUA with calcium intake (r= -0.05, p= 0.42) or physical activity (r= 0.03, p= 0.69). However, weight had a significant positive correlation with BUA (r= 0.39, p<0.05). In conclusion, female subjects have better bone health status as compared to males. Although no significant relationship was shown between calcium intake and physical activity with bone health, these two factors are known to reduce future risk of osteoporosis. It is recommended that prevention and management of low bone mass should be focused on factors recognised as determinants of bone health status among early adolescents. This is to ensure optimal bone health being attained among the young population in reducing risk of osteoporosis in future