Comparison of ultrasound and bone mineral density assessment of the calcaneus with different regions of interest in healthy early menopausal women.

This study investigated the effect of different sized regions of interest (ROIs) on quantitative ultrasound (QUS) variables of the calcaneus. The effect on QUS of using a fixed ROI as opposed to an ROI adjusted for foot length was also assessed. Eighty Caucasian women, aged 50-57 yr (mean 53 +/- 2) who were healthy and within 0. 5-5 yr of the onset of menopause participated in this study. Using the QUS-1(trade mark) Ultrasonometer (Metra Biosystems, Mountain View, CA), we assessed broadband ultrasound attenuation ([BUA] and UBI-4, dB/MHz), the average transit time through the heel ([TTH], mus) and a multiple-factor index (UBI-4T = UBI-4/TTH, dB/[MHz. mus]). The QUS measurement results were calculated from three different sizes of ROI as well as one in a fixed location and one adjusted for foot size. Bone thickness, bone width, bone mineral content ([BMC], g/cm), bone mineral density area ([BMD(a)], g/cm(2)), and bone mineral density volume ([BMD(v)], g/cm(3)) were measured by single-energy photon absorptiometry. Lateral radiography of the foot was used to ensure the QUS scanning location in a subgroup. The results showed that there was a 1.4-5.9% difference in QUS parameters among different ROIs (p = 0.076-0.001). No significant differences between fixed and adjusted location were found regarding the mean values of QUS. The correlation between the fixed and adjusted locations was very strong, although there was a 12-42% unexplained variation. On the other hand, QUS in the size-adjusted ROI increased the correlation with BMC/BMD compared to the fixed QUS assessments. After controlling for body weight and height, a significant correlation between QUS and bone mass variables remained, and in some cases correlations became stronger. Lateral radiography showed that when using a fixed location to scan a large foot, the scanning area might be close to the bone edge, an area of higher BMD and potential acoustic artifacts. When scanning a small foot, the scanning area was confined to the middle of the calcaneus. Our results indicate that bone size has a modest effect on BUA. There is a better correlation with BMD when the measurement region is appropriately located in the calcaneus. This suggests that measurement location based on foot size may improve the accuracy of the measurements, resulting in good diagnostic sensitivity.

Calcaneal bone mineral and ultrasound attenuation in male athletes exposed to weight-bearing and nonweight-bearing activity. A cross-sectional report.

BACKGROUND: To determine if the expected differences in bone mineral content/density of the calcaneus among male athletic groups that undertake weight-bearing and nonweight-bearing activity are also apparent for bone quality as assessed by quantitative ultrasound (QUS) attenuation. EXPERIMENTAL DESIGN: cross-sectional. SETTING: a University research laboratory. PARTICIPANTS: we studied 30 young men: 10 Finnish national level jumpers whose training incorporates repeated impacts to the heel, 10 aquatics athletes whose skeletons are exposed to nonweight-bearing activity, and 10 sedentary men matched for age and body weight. MEASURES: bone mineral content (BMC, g x cm(-1)), areal bone mineral density (BMDa; g x cm(-2)) and presumed volumetric BMD (BMDv, g x cm(-3)) was measured by single energy photon absorption (SPA). Broadband ultrasound attenuation (BUA using Fourier spectral estimation and UBI-4 using Burg spectral estimation, both in db/MHz) was assessed by a new QUS device (QUS-1TM, Metra Biosystems). RESULTS: There was no difference in years of sport specific training or total training time per week between athlete groups. BMC, BMDa and BMDv were significantly different among groups (p=0.0001) with jumpers being higher than aquatics athletes and controls. BMC of jumpers was 52% and 39% higher than controls and aquatics athletes, respectively, while the corresponding values for BMDv were 34% and 28%. However, BUA values were not significantly different (p=0.10) among groups nor was UBI-4 (p=0.03; jumpers values were 7% and 6% higher than aquatics athletes and controls, respectively). CONCLUSIONS: These cross-sectional results indicate that bone mineral content and density of the calcaneus are substantially higher in jumpers than individuals engaged in nonweight-bearing or regular weight-bearing activity. However, parameters assessed by QUS attenuation are not markedly different, which suggests that bone quality properties may not be as responsive as that of bone mineral content/density to habitual skeletal loading.

Ultrasound velocity and cortical bone characteristics in vivo.

Axial transmission of ultrasound along cortical bone may reflect a combination of material and structural properties of long bone cortices. The goal of this study was to determine the association of speed of sound (SOS) with cortical density (CoD), cortical wall thickness (CWT), and total cortical area (CoA). Quantitative ultrasound (QUS) and peripheral quantitative computed tomography (pQCT) were used to measure the above variables in the distal third of radius and the midshaft of tibia in 51 postmenopausal women aged 62 to 71 years. Univariate regression analysis showed that the site-specific CoD accounted for 34% of the variability in the radial SOS and 29% of that in the tibial SOS (p < 0.001 both). SOS was only moderately associated with radial CWT (R2 = 0.14, p < 0.05) and CoA (R2 = 0.12, p < 0.05), but not with tibial CWT nor CoA. After controlling for CoD, these dimension-related associations disappeared. Stepwise multiple regression analysis showed that CoD was the only significant determinant of radial SOS (adjusted R2 = 0.31), whereas for tibia, not only CoD but also the years since menopause were associated with SOS (adjusted R2 = 0.41). In conclusion, out of the studied macroscopic cortical variables, CoD (an apparent surrogate for material properties of bone) was the only determinant of SOS measured in vivo at radial and tibial shafts. The key question that still needs to be answered is whether the SOS information obtained from the peripheral long bone cortical shafts can be translated to describe the mechanical competence and quality of clinically pertinent bones (e.g. proximal femur) of a given individual.