Quantitative ultrasound bone measurement.
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Bone and Bones↗
Biomedical subjects
D Hans
Publications and source records attributed to D Hans.
Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study.
BACKGROUND: The ability of ultrasonographic measurements to discriminate between patients with hip fracture and age-matched controls has until now been tested mainly through cross-sectional studies. We report the results of a prospective study to assess the value of measurements with ultrasound in predicting the risk of hip fracture. METHODS: 5662 elderly women (mean age 80.4 years) had both baseline calcaneal ultrasonography measurements and femoral radiography (dual-photon X-ray absorptiometry, DPXA) to assess their bone quality. Follow-up every 4 months enabled us to identify incident fractures. 115 hip fractures were recorded during a mean follow-up duration of 2 years. FINDINGS: Low calcaneal ultrasonographic variables (obtained from measurements of broadband ultrasound attenuation by, and speed of sound through the bone) were able to predict an increased risk of hip fracture, with similar accuracy to low femoral bone mineral density (BMD) obtained by DPXA. The relative risk of hip fracture for 1 SD reduction was 2.0 (95% CI 1.6-2.4) for ultrasound attenuation and 1.7 (1.4-2.1) for speed of sound, compared with 1.9 (1.6-2.4) for BMD. After control for the femoral neck BMD, ultrasonographic variables remained predictive of hip fracture. The incidence of hip fracture among women with values above the median for both calcaneal ultrasound attenuation and femoral neck BMD was 2.7 per 1000 woman-years, compared with 19.6 per 1000 woman-years for those with values below the median for both measures. INTERPRETATION: Ultrasonographic measurements of the os calcis predict the risk of hip fracture in elderly women living at home as well as DPXA of the hip does, and the combination of both methods makes possible the identification of women at very high or very low risk of fracture.
Absorptiometry, Photon↗
No diffuse osteoporosis in lumbar scoliosis but lower femoral bone density on the convexity.
The aims of our study were to find out, in 15 female volunteers with untreated structural lumbar idiopathic scoliosis, through dual-photon X-ray absorptiometry measurements, whether femoral bone mineral density (BMD) was different between the right and the left side and whether this difference was related to scoliosis convexity. We showed that no statistical significant difference between femoral neck BMD measured on both sides of the same patient (p = 0.6). However, neck BMD from the same side as the convexity side was significantly lower than the opposite one.
Absorptiometry, Photon↗
Bone density and quality measurement using ultrasound.
Techniques for measuring bone mineral density have been widely accepted for the diagnosis and management of osteoporosis. These techniques are clinically feasible, and their fracture prediction capability has been proven in numerous studies. However, it has been demonstrated that bone strength and fracture risk are affected not only by the density of bone but also by other skeletal features including bone composition and microarchitecture. Available techniques for measuring bone mineral density have some disadvantages because they offer limited ability to assess bone quality, are relatively expensive, and use ionizing radiation.
Bone Density↗
Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. EPIDOS Study Group.
It was recently demonstrated that calcium and vitamin D supplements were capable of decreasing the incidence of hip fractures in institutionalized elderly subjects through a reduction of senile secondary hyperparathyroidism. As there are no appropriate data to recommend such a supplement to the elderly living at home, the aim of this study was to determine the incidence of senile secondary hyperparathyroidism in old French women from the general community, its relation to vitamin D status, and its contribution to bone turnover. Four hundred and forty women, aged 75-90 yr, were randomly selected from the general community by mailing from electoral listing in 5 French cities whose latitude varies from 49 degrees 9N to 43 degrees 6N. At the end of the winter, with previous hip fractures or those who were institutionalized were excluded. The results obtained in these women were compared to those obtained in 59 institutionalized old women and 54 younger healthy women. In the five cities for the women living at home, we found a mean PTH value greater than that obtained in young women (63 +/- 28 vs. 43 +/- 15 pg/ml; P = 0.001), but lower that that found in institutionalized women (76 +/- 49 pg/mL; P = 0.05). The mean 25-hydroxyvitamin D (25OHD) level was not different in subjects from the 5 cities, but in all of them it was significantly greater than that found in 59 institutionalized women (42.5 +/- 25.0 vs. 15.5 +/- 6.5 nmol/L; P = 0.0001) but lower than that in young adults (P < 0.001). The main determinants of PTH were in equal ratio, i.e. age (r = 0.19; P < 0.001), 25OHD, and, to a lesser degree, creatinine clearance (r = 0.10; P = 0.03). For 25OHD, the main determinant was the personal outdoor score and, to a lesser extent, the amount of daily sunlight in the city. The mean values of biochemical markers of bone turnover, bone alkaline phosphatase, osteocalcin, and Crosslaps, were significantly increased compared with the results obtained in young women, and significant negative correlations were found between these markers and hip bone mineral density. These results show that vitamin D status of a French aged population in good health and living at home depends mainly on lifestyle. Like institutionalized women, old women living at home exhibit clear evidence of senile hyperparathyroidism in the winter, secondary in part to a reduced 25OHD level and associated with biological signs of increased bone turnover. The maintenance of PTH within the normal range for healthy adults by vitamin D and calcium treatment might constitute an approach for the prevention of bone loss in the entire aged population.
Aged↗
Ultrasound velocity measured at the proximal phalanges: precision and age-related changes in normal females.
To determine the precision of a new ultrasound device and to establish a reference curve for normal French females, amplitude-dependent speed of sound (AD-SoS, m/sec) was measured using a DBM Sonic 1200 device (IGEA, Carpi) at four proximal phalanges of the nondominant hand in healthy women. In vitro precision from 21 measurements of a plexiglass phantom was 0.3%. In vivo short-term precision was 0.84% +/- 0.48% in 15 younger adults (age 31 +/- 10 years) and 0.81% +/- 0.038% in 15 older adults (age 62 +/- 16 years). Interobserver coefficient of variation was 0.77%. One hundred twenty-eight healthy female hospital staff members or friends of hospital staff members were studied (age 51.2 +/- 17.4 years). AD-SoS decreased by 9.6% between 30 and 80 years of age. Separate analyses of pre and postmenopausal women and of ten-year age groups demonstrated that AD-SoS remained unchanged before menopause but decreased by 7.6% after menopause (age 64.14 +/- 7.5 years; range 41-80). These data from normal females were compared with those reported by others in females and males. Age at menarche apparently influenced AD-SoS in later life. Reproducibility of the device used for this study was acceptable. Our cross-sectional data suggest that AD-SoS measurement is effective for detecting postmenopausal bone loss. Further investigations in osteoporosis are warranted.
Adult↗
Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density.
We measured the heels of 43 women who had recently sustained a hip fracture and 86 age matched controls, using an Achilles ultrasound device. Average BUA, SOS, and Stiffness were significantly lower in fractured patients (p < 0.0001). We also estimated ultrasound parameters for patients as a function of controls and found the mean BUA to be -1.09 SD compared with controls, the mean SOS -0.89 SD, and the mean Stiffness -0.98 SD. Femoral BMD measured at the neck, Ward's triangle, and the trochanter with a DPX Plus was also significantly lower in fractured patients (p < 0.0001). The increased risk of hip fracture associated with low ultrasound values was estimated with logistic regression analysis for each bone parameter, adjusted for height and weight. The adjusted regression coefficients associated with BUA, SOS, Stiffness, and BMD were all significant (p < 0.0001) demonstrating the influence of all ultrasound and DXA parameters on the risk of hip fracture. After adjusting the logistic regressions for BMD neck, BUA, SOS, and Stiffness were still significant independent predictors of hip fracture. Sensitivity and specificity of all measures were analyzed with the area under the ROC curve which were for BUA, 0.77 +/- 0.04; for SOS, 0.75 +/- 0.04; for Stiffness, 0.78 +/- 0.04; and for BMD, 0.74 +/- 0.04. We determined the range for the best compromise between sensitivity and specificity of BUA, 97-98 dB/MHz; SOS, 1482-1487 m/s; Stiffness 59-62% Young Adult; and of BMD, 0.64-0.69 g/cm2. The area under the ROC curves of BUA, SOS, Stiffness, and DXA were compared and no statistically significant difference was found.(ABSTRACT TRUNCATED AT 250 WORDS)
Absorptiometry, Photon↗
Influence of anthropometric parameters on ultrasound measurements of Os calcis.
Few data have been published concerning the influence of height, weight and body mass index (BMI) on broadband ultrasound attenuation (BUA), speed of sound (SOS) and Lunar "stiffness" index, and always in small population samples. The first ain of the present cross-sectional study was to determine whether anthropometric factors have a significant influence on ultrasound measurements. The second objective was to establish whether these parameters have real effect on whether their influence is due only to measurement errors. We measured, in 271 healthy French women (mean age 77 +/- 11 years; range 31-97 years), the following parameters: age, height, weight, lean and fat body mass, heel width, foot length, knee height and external malleolus (HEM). Simple linear regression analyses between ultrasound and anthropometric parameters were performed. Age, height, and heel width were significant predictors of SOS; age, height, weight, foot length, heel width, HEM, fat mass and lean mass were significant predictors of BUA; age, height, weight, heel width, HEM, fat mass and lean mass were significant predictors of stiffness. In the multiple regression analysis, once the analysis had been adjusted for age, only heel width was a significant predictor for SOS (p = 0.0007), weight for BUA (p = 0.0001), and weight (p = 0.0001) and heel width (p = 0.004) for the stiffness index. Besides their statistical meaning, the regression coefficients have a more clinically relevant interpretation which is developed in the text. These results confirm the influence of anthropometric factors on the ultrasonic parameter values, because BUA and SOS were in part dependent on heel width and weight. The influence of the position of the transducer on the calcaneus should be taken into account to optimize the methods of measurement using ultrasound.
Adult↗
Age-related changes in Os calcis ultrasonic indices: a 2-year prospective study.
We performed repeated ultrasound measurements approximately 2 years apart (average 23 months +/- 3 months) on the os calcis of 113 healthy postmenopausal women recruited from two large prospective cohort studies named OFELY and EPIDOS. Group A (from OFELY) consisted of 88 women aged 52-72 (63 +/- 5) years, randomly selected from a large insurance company, and group B (from EPIDOS) consisted of 25 women aged 75-88 (80 +/- 4) years, randomly selected from the voting lists. We obtained broadband ultrasonic attenuation (BUA) and speed of sound (SOS) measurements, as well as the Stiffness index, with a Lunar Achilles ultrasound machine. We performed dual energy X-ray absorptiometry (DXA) measurements of femoral neck bone mineral density (neck BMD) with a Hologic QDR 2000 for group A and with a Lunar DPX Plus for group B. The decrease that we observed over 2 years was on average +/- 1 SD: -1.01 +/- 4.6 dB/MHz (p = 0.02) for BUA (which is approximately equal to the long-term precision error in vitro), -11.3 +/- 9.2 m/s (p = 0.0001) for SOS (approximately 5 times the precision error), -3.8 +/- 4.2% YA (p = 0.0001) for Stiffness (2.5 times the precision error) and -0.01 +/- 0.03 g/cm2 (p = 0.0001) for neck BMD (approximately equal to the precision error). In terms of percentage change this represents: -1.0% +/- 4.3% for BUA, -0.8% +/- 0.6% for SOS and -1.85% +/- 4.4% for neck BMD. At the individual level, most SOS and Stiffness values were consistent with a decrease, whereas BUA and neck BMD values were spread out above and below the zero line of no change. The decreases in SOS and Stiffness were significantly larger in the early postmenopause (< or = 20 years since menopause [YSM]) than in the late postmenopause (> 20 YSM). We observed a similar trend for BUA and BMD but this did not reach statistical significance. We found a weak but significant correlation between changes in ultrasound variables and changes in neck BMD. However, the 2-year changes observed in SOS were not significantly correlated with changes in BUA. This study suggests that the heel ultrasound measurements of SOS and Stiffness are valuable indices of postmenopausal bone loss, and could be used for follow-up in therapeutic trials.
Absorptiometry, Photon↗
Inadequacy of the standard hip positioners provided with Hologic and Lunar scanners.
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Absorptiometry, Photon↗
Do ultrasound measurements on the os calcis reflect more the bone microarchitecture than the bone mass?: a two-dimensional histomorphometric study.
Few studies have analyzed the relationship between ultrasound measurements (US) and corresponding histomorphometric parameters of the calcaneus. To address this question we have compared US and histomorphometric parameters in 17 whole human os calcis from amputation or necropsy. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and bone mineral density (BMD) were measured on the whole foot at the calcaneal site using an Achilles device and a DPX-L densitometer (Lunar). The os calcis was dissected and a 1-cm-wide transcortical parallelepiped extracted with a biopsy needle, focused on the center of the measured area. Histomorphometry was performed on undecalcified biopsies. Structural and connectivity parameters were measured on 7-microns-thick sections with both automatic (Biocom) and semiautomatic analyzers (Ibas 1, Kontron). We found that all ultrasonic and densitometric parameters reflected the true amount of bone and were correlated with only some of the parameters reflecting bone microarchitecture. From stepwise regression analysis, we found that 68%, 67%, 72%, and 74% of the variance of SOS, BUA stiffness, and BMD, respectively, were explained significantly by trabeculae thickness only. Ultrasonic measurements appear to reflect bone quantity rather than bone microarchitecture. The current conclusion is fairly negative with respect to the ability of ultrasound to assess structural parameters, but our limited sample size did not give enough power to our study to reach statistically significant correlations. In addition, the calcaneus is anisotropic and the ultrasound interaction in bone is a three-dimensional phenomenon. So, a three-dimensional study rather than a two-dimensional one should be performed.
Absorptiometry, Photon↗
Comparison between bone density and bone strength in glucocorticoid-treated aged ewes.
In order to assess if bone densitometry could be used as an indicator to evaluate bone fragility in short term studies performed on glucocorticoid-treated ewes, correlations between DXA measurements and biomechanical parameters obtained on the same bones were established in 27 aged ewes including sixteen animals treated with methylprednisolone 15 mg/day for 4 months and eleven untreated animals. DXA measurements were performed ex-vivo on HOLOGIC QDR-1000+ device. Biomechanical testings included a three-point bending test on the femur and a compression test on cylinders of cancellous bone excised from two lumbar vertebrae selected between L6 and L4. At the femoral site, bone mineral density was correlated with the bending stiffness (r = 0.65) and the ultimate bending strength (r = 0.64) whereas, at the vertebral site, biomechanical parameters failed to correlate with bone mineral density assessed by DXA. This apparent lack of correlation between vertebral bone mass and trabecular bone strength is mainly linked to anatomical characteristics of the ewe: in this species, the vertebral posterior arches, which consist mainly of cortical bone, are very large compared to the vertebral body and strongly influence the bone mineral density evaluated on the intact vertebra. This is not the case with other large animals, for instance non-human primates. In conclusion, DXA can give a good evaluation of bone strength for ewe femurs, but results must be interpreted carefully at the vertebral site due to the anatomical characteristics of this animal species.
Absorptiometry, Photon↗
[Conservative treatment of sub-clinical noninfiltrating cancers of the breast (102 EOA in situ, TONO)].
102 patients with sub-clinical intra ductal non invasive breast cancer (T0N0) treated by limited surgery and curative radiation therapy. Follow-up ranged from 2 to 10 years with a median follow-up of 59 months. The long term survival rate of this therapeutic approach, consisting of simple excision without any adjuvant treatment and radical mastectomy was close to 100%. The actuarial local recurrence rate was only 8.6% at 10 years (confidence interval: 4.6 to 12.6%), which strongly suggests that radiation therapy is active on multicentric foci. Salvage surgery could be performed in every case of local recurrence. The survival rate of in situ breast cancer (T0N0) treated by conservative radio-surgery is comparable to that of radical mastectomy, while cosmetic results and psychological impact appear to be better for the conservative technique (breast preservation rate = 91 to 96%).
Breast Neoplasms↗
Influence of fat on ultrasound measurements of the os calcis.
Measurements of the speed-of-sound (SOS) and of the broadband ultrasound attenuation (BUA) on the os calcis were recently proposed to assess osteoporotic fragility. Velocity and attenuation were measured through the heel which can be divided in three phases including hydroxyapatite, soft tissue, and fat. The aim of this study was to evaluate the influence of fat composition and heel width on SOS and BUA. This influence was determined from both in vitro investigations examining fat samples, phantoms, and cadaver heels, and in vivo ones observing adult volunteers as well as a wide sample section of healthy elderly women. Ultrasound velocities on various fat samples were significantly lower than those on distilled water (-65 m/second to -123 m/second). The excision of the surrounding soft tissue from cadaver heels made SOS steadily increase whereas the insertion of a 10 mm piece of lard in the lateral face of cadavers' and volunteers' heels os calcis lowered SOS about 30 m/second. Furthermore, a difference of SOS was estimated at 15 m/second for a 12.5% variation of the marrow fat weight. Among 334 elderly and healthy women aged 75 and over, a significant negative correlation was found between SOS and heel width (r = -0.27; P < 0.0001). On the other hand, fat composition had no significant effect on BUA measurement, and no significant relationship was found between BUA and heel width. This study demonstrates that an increase of heel width and fat thickness provides an underestimation of os calcis SOS, but has no significant effect on BUA.
Adipose Tissue↗
Ultrasound measurements on the os calcis in a prospective multicenter study.
Ultrasonic assessment is a new approach to assess both quality and density. Two ultrasonic parameters are measured on the os calcis: the attenuation or broadband ultrasound attenuation (BUA) and the velocity or speed of sound (SOS). The interunit variations in vitro and in vivo of an ultrasound instrument, the Lunar Achilles system, used in a French multicenter study named EPIDOS, were calculated and the stability of these instruments over a 12-month period was evaluated. A third parameter called "stiffness index," calculated from the SOS and BUA, was also used in this study. The average CV in vitro for the BUA and SOS was 0.92% and 0.12%, respectively, and the average CV in vivo for the BUA, the SOS, and the stiffness index was 1.83%, 0.23%, and 1.9%, respectively. The interunit (or inter-machines) variations were calculated by a one-way analysis of variance. We detected small but significant measurement differences among centers on a phantom for both SOS (maximum significant difference 0.4%) and stiffness (maximum significant difference 3.5%) but not for BUA. Similar differences were found in vivo. The precision over 12 months of the interunit variations in vitro was evaluated by measuring a single phantom traveling from one center to another several times. The range of the CV for the BUA (1.54-0.51%), for the SOS (0.25-0.14%), and for the stiffness index (2.26-1.10%) are explained in part by technical failures. The variation among the five Achilles was estimated by the combined CV which was 1.42% for the BUA, 0.32% for the SOS, and 2.33% for the stiffness index. In conclusion, our findings indicate that equipment from one manufacturer appears to be consistent between machines for the BUA, but not completely for the SOS. The results for this stiffness index are necessarily influenced by both SOS and BUA. The short-term and long-term interunit precision is good, both in vitro and in vivo. Such results provide increased confidence in multicenter clinical trials where ultrasonic data are pooled.
Adult↗
Ultrasound measurements on os calcis: precision and age-related changes in a normal female population.
We performed ultrasound measurements in the calcaneus of 512 healthy women. Broadband ultrasonic attenuation (BUA) and speed of sound (SOS) were obtained with a Lunar Achilles ultrasonic instrument. Subjects studied were one group of 67 women working in our hospital (group A) and two groups which are part of two large prospective cohort studies (groups B and C). Group B consisted of 244 women aged 31-79 years randomly selected from a large insurance company, and group C consisted of 201 women aged 74-91 years randomly selected from the electoral rolls. Dual-energy X-ray absorptiometry (DXA) measurements of femoral neck and total body were performed with a Hologic QDR 2000 for group B and with a Lunar DPX Plus for group C. The in vitro precision of the Achilles, estimated by measuring a phantom daily for 45 days, was 0.84% for BUA and 0.12% for SOS. We assessed the in vivo short-term precision in 20 healthy volunteers working at the hospital, measured three times each. The coefficients of variation were 0.93% (+/- 0.21) for BUA and 0.15% (+/- 0.03) for SOS. The precision error was compared with the true variation, to obtain a standardized coefficient of variation. We analysed the three groups pooled together (n = 512) and found for BUA an average 20% decrease and for SOS a 5% decrease between the ages of 20 and 90 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Ultrasonic assessment of bone: a review.
In the last 25 years several non-invasive techniques based on the attenuation of ionizing radiation have been developed to quantify bone mineral density in the axial and peripheral skeleton. The use of ultrasounds is another technique which has recently been developed to provide information on the architecture and elasticity of bone. The basic principle of ultrasound measurements is that the speed (SOS = speed of sound) at which ultrasounds propagate in the bone, or the extent of their attenuation (BUA = broad-band ultrasound attenuation) through the bone is determined by bone density and by certain physical properties which are intimately correlated with bone strength. Theoretically, ultrasound bone measurements should provide more information about bone fragility and structure than densitometric techniques. As a result of preliminary studies, several ultrasound devices have been developed by manufacturers. Most of them measure the os calcis which consists almost exclusively of trabecular bone. Measurement precision varies with the instrument used and the site of measurement. The in vitro and in vivo precision for SOS and for BUA are reported in this review. The correlations between ultrasound and bone mineral density measurement suggest that these techniques measure different entities. A significant difference is constantly found between normal and osteoporotic women. Transversal studies have shown a negative correlation between ultrasound measurements and age. Age-related variations are much more significant with BUA than with SOS. Several studies suggest the potential of ultrasound measurements to assess the risk for individuals to develop osteoporosis and its usefulness in treatment follow-up. Further prospective studies are needed to better understand the effectiveness of ultrasounds.(ABSTRACT TRUNCATED AT 250 WORDS)
Bone Density↗
Calibration of dual-energy x-ray absorptiometry for bone density.
Bone mineral content (BMC, g) using DEXA (Lunar DPX) was measured on known hydroxyapatite samples in a water bath in the presence of uniform and nonuniform covering of fat-equivalent materials. Selective placement of paraffin over bone had a greater effect than lard in reducing apparent BMC, and polycarbonate plastic had a lesser effect. Measured BMC was 100.1 +/- 1.1% of actual hydroxyapatite weight when (1) fat over bone was about twice the mass of hydroxyapatite, and (2) the surrounding soft tissue was 15-30% fat. There was a linear relationship between observed and expected BMC, area (cm2), and bone mineral density (BMD, g/cm2) measured on an aluminum phantom using either the Lunar DPX or the Hologic QDR-1000. The measured area with the two densitometers was identical, but BMC differed. For both an anthropomorphic phantom and human subjects, use of a constant-threshold (0.2 g/cm2) edge-detection algorithm excluded less low-density bone from the transverse processes than the standard DPX edge-detection algorithm. Differences in edge detection could influence the results obtained with phantoms and in vivo and make system intercomparison difficult.
Absorptiometry, Photon↗