Biomedical subjects

P H Nicholson

Publications and source records attributed to P H Nicholson.

At least 19 recordsLinked to original sources

PubMed2000

Scattering of ultrasound in cancellous bone: predictions from a theoretical model.

An understanding of the interaction between acoustic waves and cancellous bone is needed in order to realize the full clinical potential of ultrasonic bone measurements. Scattering is likely to be of central importance but has received little attention to date. In this study, we adopted a theoretical model from the literature in which scattering was assumed to be proportional to the mean fluctuation in sound speed, and bone was considered to be a random continuum containing identical scatterers. The model required knowledge only of sound speeds in bone and marrow, porosity, and scatter size. Predicted attenuation, broadband ultrasonic attenuation (BUA) and backscatter coefficient were obtained for a range of porosities and scatterer sizes, and were found to be comparable to published values for cancellous bone. Trends in predicted BUA with porosity agreed with previous experimental observations. All three predicted acoustic parameters showed a non-linear dependence on scatterer size which was independent of porosity. These data confirm the value of the scattering approach and provide the first quantitative predictions of the independent influence of structure and porosity on bone acoustic properties.

Bone and Bones↗

PubMed2000

Quantitative ultrasound does not reflect mechanically induced damage in human cancellous bone.

This study investigated the ability of quantitative ultrasound (QUS) to detect reductions in the elastic modulus of cancellous bone caused by mechanical damage. Ultrasonic velocity and attenuation were measured using an in-house parametric imaging system in 46 cancellous bone cores from the human calcaneus. Each core was subjected to a mechanical testing regime to (a) determine the predamage elastic modulus, (b) induce damage by applying specified strains in excess of the yield strain, and (c) measure the postdamage elastic modulus. The specimens were divided into four groups: a control group subjected to a nominally nondestructive 0.7% maximum strain (epsilonm) and three damage groups subjected to increasing strain levels (epsilonm = 1.5, 3.0, and 4.5%). QUS measurements before and after the mechanical testing showed no significant differences between the control group and damage groups, despite highly significant (p < 0.001) reductions in the elastic modulus of up to 72%. These results indicate that current QUS techniques do not intrinsically reflect the elastic properties of cancellous bone. This is consistent with ultrasonic properties being determined by other factors (apparent density and/or architecture), which normally are associated strongly with elastic properties, but only when bone is mechanically intact. Clinically, this implies that ultrasound cannot be expected to detect bone fragility in the absence of major changes in bone density and/or trabecular architecture.

Aged↗

PubMed1999

On the prediction of Young's modulus in calcaneal cancellous bone by ultrasonic bulk and bar velocity measurements.

This study evaluated two different approaches to the prediction of Young's modulus (E) from ultrasonic velocity and density measurements in 23 cubes of cancellous bone from human calcaneae. The first approach used clinically applicable measurements of bulk velocity and bone mineral density (BMD), whilst the second involved bar velocity and apparent density, which are strictly in vitro measurements. Bulk velocities were measured with an immersion technique with 1 MHz transducers using three different transit time markers (first arrival, thresholding, zero-crossing). Bar velocities were measured in the defatted specimens using a contact technique with 37 kHz transducers in air. Volumetric BMD was derived from dual-energy X-ray absorptiometry measurements, and apparent density was measured directly. Compressive mechanical testing was used to determine E. Bulk velocity, bar velocity and E all displayed significant anisotropy, being greatest in the proximo-distal (PD) axis and least in the medio-lateral (ML) axis. Bulk velocity was dependent on the transit time marker used, with velocity differences of up to 20% observed between different markers. Bar velocities were significantly lower than bulk velocities in all directions. Both bulk and bar velocities correlated with E (r2 = 0.26-0.83, r = 0.36-0.81, respectively) with stronger relationships obtained when the data for the three axes were pooled. The predictive ability of bulk velocities determined using different markers was similar. In general, combining velocity and density measurements yielded improved correlations with E. Thus, strong correlations were observed between E and the product of BMD and bulk velocity2 (r2 = 0.58-0.89), and the product of apparent density and bar velocity2 (r2 = 0.58-0.89). These results demonstrate that clinically applicable measurements of bulk velocity and BMD are good predictors of the elastic modulus of calcaneal bone, and that bulk and bar velocity, both alone and when combined with density measurements, have a similar predictive ability for mechanical properties.

Absorptiometry, Photon↗

PubMed1999

Ultrasonic slow waves in air-saturated cancellous bone.

This paper describes preliminary observations of ultrasonic wave propagation in air-saturated defatted cancellous bone from the human vertebra. Using a broadband pulse transmission system, attenuation and phase velocity were measured over a wide frequency range (100 kHz-1 MHz). The observed behaviour was consistent with that expected for the decoupled slow wave predicted by Biot's theory. Velocity was lower than that of free air, and there was marked frequency-dependent attenuation and velocity dispersion. The tortuosity (alpha) of the trabecular microstructure was estimated from the high frequency limit of the dispersion curve, with a mean value of alpha = 1.040 +/- 0.004 obtained in five specimens. Ultrasonic measurements in air represent a valuable new approach, capable of yielding parameters that directly characterise bone structure. Furthermore, they may give useful insights into wave propagation in bone in vivo, where the trabecular framework is saturated with marrow fat rather than air.

Air↗

PubMed1999

On the ultrasonic attenuation and its frequency dependence in the os calcis assessed with a multielement receiver.

Measurements of broadband ultrasound attenuation (BUA) on a single sample using different devices have previously shown significant variations. We have used a new 3x3 array transducer to allow the evaluation of three new approaches to the BUA algorithms and the extent to which the variations might be reduced. Ten human os calces were measured using the array. The attenuation and its slope, the BUA, were calculated using three methods: 1. A phase sensitive approach, summing the individual signals from the multielement array in the time domain (TD); 2. a phase insensitive approach, summing the signals in the frequency domain (FD); 3. averaging of the individually measured attenuation and BUA values (AV). The TD and AV approaches resulted in slightly larger values for both attenuation (approximately 4%) and BUA (approximately 7%) than with the FD method. The differences between the TD and FD method may be due to phase cancellation. However, the three sets of results were not significantly different (p<0.05), which suggests that measurements on commercial equipment using large receiver apertures are not strongly affected by phase cancellation, averaging or scattering. Nevertheless, it is not clear if the differences observed are of clinical relevance, which should be investigated in the future. Our study shows that the 3 approaches are strongly related (r2> or =0.94), suggesting that translation may be possible between methods.

Calcaneus↗

PubMed1999

Measurement of airborne ultrasonic slow waves in calcaneal cancellous bone.

Measurements of an airborne ultrasonic wave were made in defatted cancellous bone from the human calcaneus using standard ultrasonic equipment. The wave propagating under these conditions was consistent with a decoupled Biot slow wave travelling in the air alone, as previously reported in gas-saturated foams. Reproducible measurements of phase velocity and attenuation coefficient were possible, and an estimate of the tortuosity of the trabecular framework was derived from the high frequency limit of the phase velocity. Thus the method offers a new approach to the acoustic characterisation of bone in vitro which, in contrast to existing techniques, has the potential to yield information directly characterising the trabecular structure.

Adult↗

PubMed1998

Measurements of vertebral shape by radiographic morphometry: sex differences and relationships with vertebral level and lumbar lordosis.

OBJECTIVE: To examine sex-related and vertebral-level-specific differences in vertebral shape and to investigate the relationships between the lumbar lordosis angle and vertebral morphology. DESIGN AND PATIENTS: Lateral thoracic and lumbar spine radiographs were obtained with a standardized protocol in 142 healthy men and 198 healthy women over 50 years old. Anterior (Ha), central (Hc) and posterior (Hp) heights of each vertebra from T4 to L4 were measured using a digitizing technique, and the Ha/Hp and Hc/Hp ratios were calculated. The lumbar lordosis angle was measured on the lateral lumbar spine radiographs. RESULTS: Ha/Hp and Hc/Hp ratios were smaller in men than women by 1.8% and 0.7%, respectively, and these ratios varied with vertebral level. Significant correlations were found between vertebral shape and the lumbar lordosis angle. CONCLUSIONS: These results demonstrate that vertebral shape varies significantly with sex, vertebral level and lumbar lordosis angle. Awareness of these relationships may help prevent misdiagnosis in clinical vertebral morphometry.

Aged↗

PubMed1998

Do quantitative ultrasound measurements reflect structure independently of density in human vertebral cancellous bone?

Ultrasonic measurements were made in three orthogonal directions on 70 vertebral bone cubes. Apparent density (rho) was determined, and microcomputed tomography was used to derive a range of microstructural parameters. Qualitatively different ultrasonic behavior was observed in the craniocaudal (CC) axis, in which two distinct waves propagated. In this direction, only attenuation correlated strongly with rho (r2 = 80%), whereas, in the anteroposterior (AP) and mediolateral (ML) axes, there were significant correlations between all ultrasonic parameters and rho (r2 = 57%-79%). Microstructural parameters were, in general, correlated with ultrasonic properties, but when adjusted for rho, few significant relationships remained and the additional variance explained by individual microstructural parameters was relatively small (< 25% for CC axis, < 3% for AP, 0% for ML). In stepwise regression analysis including rho and all of the microstructural parameters, rho remained the primary determinant of ultrasonic properties in the transverse axes: Combinations of structural parameters explained, at most, an additional of 6% of the variability in ultrasonic properties in the AP axis, but failed to contribute significantly in the ML axis. In the CC axis, structural parameters played a greater role, but the pattern of associations was complex and the predictive power of the models was generally much less than that for the transverse axes. These data indicate that the ability of ultrasound to reflect aspects of trabecular structure is strongly dependent on the direction in which ultrasonic measurements are made, and provide only qualified support for the hypothesis that ultrasound reflects cancellous bone structure independently of bone density.

Absorptiometry, Photon↗

PubMed1998

A model for ultrasonic scattering in cancellous bone based on velocity fluctuations in a binary mixture.

A scattering model based on velocity fluctuations in a binary mixture (marrow fat and cortical matrix) was used to estimate the ultrasonic attenuation in cancellous bone as a function of volume fraction. The calculation of velocity fluctuations alone seems to be suitable for the qualitative estimation of attenuation. The predicted values of the attenuation were of the same order of magnitude as experimentally determined values from the literature. This agreement was achieved with only a small number of variables (the velocities of the two components and the scatterer size) in the model, representing a major advantage compared with other theories. Hence the suggested approach appears to be a good starting point for further theoretical investigations using scattering theories. However, this has to be accompanied by accurate ultrasonic and microstructural measurements.

Adipose Tissue↗

PubMed1998

Prediction of vertebral and femoral strength in vitro by bone mineral density measured at different skeletal sites.

The aim of the present study was to investigate the prediction of vertebral and femoral strength in vitro by bone mineral density (BMD) measured at different skeletal sites. The third lumbar vertebral body, the right proximal femur, and the right calcaneus were removed from 38 male and 32 female cadavers (mean age 69 years, range 23-92 years). Areal BMD of all bone specimens was determined by dual-energy X-ray absorptiometry (DXA). The failure load of the vertebral body and the femur was determined by mechanical testing. Vertebral and femoral strength were both greater in males than females (p < 0.01), as was BMD at all sites (p < 0.01). Vertebral strength correlated well with vertebral BMD (r2 = 0.64) but was only moderately correlated with BMD measured at the femur (r2 = 0.36) or the calcaneus (r2 = 0.18). Femoral strength showed the highest correlations with femoral BMD (r2 = 0.88) and somewhat weaker relationships with BMD at the vertebra (r2 = 0.50) and the calcaneus (r2 = 0.54). BMD values at the vertebra, femur, and calcaneus were only moderately interrelated (r2 = 0.31-0.65), and vertebral strength correlated only modestly with the strength of the femur (r2 = 0.36). These in vitro results support the concept that optimal prediction of vertebral or femoral strength by DXA requires site-specific assessments.

Absorptiometry, Photon↗

PubMed1997

Factors associated with cortical and trabecular bone loss as quantified by peripheral computed tomography (pQCT) at the ultradistal radius in aging women.

Peripheral quantitative computed tomography (pQCT) allows the separate determination of cortical and trabecular bone mineral density in the peripheral skeleton. This cross-sectional study was designed to examine the effects of healthy aging on pQCT measurements at the ultradistal radius. In a well-defined sample of 129 community-based women, aged 70-87 years, the differences in cortical and trabecular density over the age range were equivalent to losses of -0.41% and -0.65% per year, respectively. To investigate the mechanism of this age-related decline, we assessed relationships between both parameters and height, weight, body mass index, dietary calcium intake, grip strength, and serum concentrations of insulin-like growth factor-I (IGF-I), calcidiol (25(OH)D3), calcitriol (1,25(OH)2D3), parathyroid hormone (PTH), and sex hormone binding globulin (SHBG). Multiple regression was used to adjust for potential confounders. Age was not significant after controlling for other covariables. Body mass index, grip strength, serum IGF-I, 25(OH)D3, and PTH (1-84) were found to be independent predictors of total bone density. Including (total or free) 1,25(OH)2D3 did not improve the model precision. These findings provide evidence that, among other factors, the activity of the growth hormone-IGF-I-axis is of importance for skeletal integrity. Grip strength, serum IGF-I, and PTH (1-84) were discovered to be significantly related to cortical but not to trabecular density, suggesting that different mechanisms may be involved in compact and cancellous bone loss.

Aged↗

PubMed1997

Prevalence of trabecular microcallus formation in the vertebral body and the femoral neck.

Trabecular microcallus formation (TMF) has been described previously in the human vertebra and femur, but the difference in TMF prevalence at these two sites has not been studied and the role of TMF remains controversial. In this study, the 4th lumbar vertebra (L4) and right proximal femur were removed from 27 male and 23 female cadavers. A 2 cm cube cut from the center of L4 and a 1 cm-thick slice cut from the femoral neck were cleaned, defatted, and dried. The apparent density of the L4 cubes was determined as dry weight/bulk bone volume. Using a dissecting microscope at low magnification (4-60x), TMF were identified and counted in both the vertebral and femoral samples. A 8 mm diameter core was then cut from the center of the L4 cubes in the vertical direction, and selected histomorphometric parameters of the core were evaluated with an X-ray microcomputed tomography system (micro-CT). There was a significantly greater prevalence of TMF in vertebral cubes (82%) than in the femoral slices (11%) (P < 0.001). TMF prevalence did not differ significantly between males and females, but the mean number of TMF in the vertebra was significantly (P < 0.05) greater in females (15.0/vertebra) than in males (7.7/vertebra). In the vertebra, the majority of the observed TMF were in vertical trabeculae. Subjects over 60 years old had a higher TMF prevalence than those under 60 years old (P < 0.01). TMF numbers increased with decreasing apparent density (P < 0.05), whereas no significant correlations were found between TMF and bone volume (BV/TV), trabecular number (Tb.N), or trabecular thickness (Tb.Th) as assessed by micro-CT. In two fractured vertebra, very few TMFs (2 and 4, respectively) were observed. These results demonstrated that the occurrence of TMF is strongly related to the anatomical site, probably due to differences in the applied loads and the trabecular structure between sites. The results were consistent with the hypothesis that TMF is a mechanism acting to maintain bone strength, but further studies are needed to clarify this important issue.

Adult↗

PubMed1997

Structural and material mechanical properties of human vertebral cancellous bone.

The structural Young's modulus (i.e. that of the cancellous framework) was determined by non-destructive compressive mechanical testing in the three orthogonal axes of 48 vertebral bone cubes. In addition, the material Young's modulus (i.e. of the trabeculae themselves) was estimated using an ultrasonic technique. Apparent and true density were determined by direct physical measurements. Significant mechanical anisotropy was observed: mean structural Young's modulus varied from 165 MPa in the supero-inferior direction to 43 MPa in the lateral direction. Structural Young's modulus correlated with apparent density, with power-law regression models giving the best correlations (r2 = 0.52-0.88). Mechanical anisotropy increased as a function of decreasing apparent density (p < 0.001). Material Young's modulus was 10.0 +/- 1.3 GPa, and was negatively correlated with apparent density (p < 0.001). In multiple regression models, material Young's modulus was a significant independent predictor of structural Young's modulus only in the supero-inferior direction. The data suggest the presence of two effects in vertebral bone associated with decreasing apparent density and, by implication, bone loss in general: (a) increased mechanical anisotropy, such that there is relative conservation of stiffness in the axial direction compared with the transverse directions; and (b) increased stiffness of the trabeculae themselves.

Adult↗

PubMed1997

Assessment of the strength of the proximal femur in vitro: relationship with ultrasonic measurements of the calcaneus.

Matched pairs of the right proximal femur and right calcaneus were obtained from 64 cadavers (28 female, 36 male). Ultrasonic velocity and broadband ultrasonic attenuation were measured in the calcaneus using a laboratory ultrasound system. Bone mineral density (BMD) was measured at the calcaneus and at the trochanteric and neck regions of the femur using dual-energy X-ray absorptiometry. Femoral strength was determined in a mechanical test simulating a fall onto the greater trochanter. Femoral BMD was more strongly correlated with femoral strength (r2 = 0.71, 0.88 for neck BMD and trochanteric BMD, respectively) than were any of the other predictive variables investigated (p < 0.05). Calcaneal ultrasonic measurements alone produced correlations with femoral strength of r2 = 0.40-0.47, with no significant differences observed in predictive ability between the various ultrasonic parameters. In multiple regression analysis, ultrasound was, in general, not a significant additional independent predictor of femoral strength when combined with either femoral or calcaneal BMD, and combining ultrasonic parameters did not improve the ability to predict femoral strength. Calcaneal width was found to be significantly correlated with both femoral strength and femoral BMD, and this explained the slightly better correlations with femoral strength found for those ultrasonic parameters which were not effectively normalized for calcaneal width. In summary, calcaneal ultrasound did not significantly enhance the prediction of femoral strength compared to femoral BMD measurements alone. Given the substantial differences between the in vitro and in vivo situations, this finding does not necessarily contradict emerging clinical data indicating that ultrasound and BMD have comparable and independent predictive ability for hip fracture risk. Reasons for the apparent discrepancy are discussed, including the enhanced accuracy of DXA in vitro. Nevertheless, it is suggested that further fundamental investigations into the efficacy of current ultrasonic techniques are warranted.

Biomechanical Phenomena↗

PubMed1997

Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry.

Femoral neck axis length, neck width, and neck-shaft angle were measured on radiographs of right proximal femora from 64 cadavers (28 female, 36 male). Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA) for various regions of interest, and quantitative computed tomography (QCT) was used to determine BMD and bone areas for cortical and trabecular bone at the trochanter and femoral neck. The strength of the femur was determined by a mechanical test simulating a fall on the greater trochanter, and the fracture type (cervical or trochanteric) was subsequently determined from radiographs. Twenty-six cervical fractures and 38 trochanteric fractures were observed, with no significant sex difference in the distribution of fracture types. Femoral strength was significantly elevated in males compared to females. DXA trochanteric BMD was more strongly (p < 0.05) correlated with femoral strength (r2 = 0.88) than were any of the other DXA BMD measurements (r2 = 0.59-0.76). In multiple regression models, a combination of different DXA BMD measurements produced only a small increase (1%) in the explained variability of femoral strength. Of the QCT measurements, trochanteric cortical area yielded the optimal correlation with femoral strength (r2 = 0.83). Weak, but significant, correlations were observed between femoral strength and cortical BMD at trochanteric (r2 = 0.28) and neck regions (r2 = 0.07). In multiple regression models, combining QCT parameters yielded, at best, an r2 of 0.87. Of the geometrical parameters, both neck axis length and neck width were significantly correlated with femoral strength (r2 = 0.24, 0.22, respectively), but no significant correlation was found between strength and the neck-shaft angle. Combining DXA trochanteric BMD with femoral neck width resulted in only a small increase in the explained variability (1%) compared to trochanteric BMD alone. The results demonstrated that DXA and QCT had a similar ability to predict femoral strength in vitro. Trochanteric BMD was the best DXA parameter, and cortical area (not cortical BMD) was the optimal QCT parameter. Geometric measurements of the proximal femur were only weakly correlated with the mechanical strength, and combinations of DXA, QCT, and geometric parameters resulted in only small increases in predictive power compared to the use of a single explanatory variable alone.

Absorptiometry, Photon↗

PubMed1997

Effects of anteversion on femoral bone mineral density and geometry measured by dual energy X-ray absorptiometry: a cadaver study.

The effect of femoral neck anteversion on bone mineral density (BMD) and geometry as measured by dual energy X-ray absorptiometry (DXA) was assessed using 64 right proximal femora from 36 male and 28 female cadavers. The anteversion angle was measured on computed tomography (CT) images, and DXA measurements were made both in the neutral position (i.e, at 0 degree anteversion, femoral neck axis parallel to the table) and in the simulated anteverted position (i.e., femoral shaft axis parallel to the table, greater and lesser trochanters in contact with the table, and femoral neck free). The mean anteversion angle measured by CT was 19.3 degrees (range 6 degrees-38 degrees). Anteversion was associated with a significant elevation in femoral neck BMD of +2.8% (range -5.3%-(+)9.8%) (p < 0.05), and the femoral neck BMD increased with increasing anteversion (p < 0.01). Trochanteric BMD was less affected by anteversion, with an average increase of only 0.2% (range -5%-5.9%) (p = n.s.) in the anteverted position, but there was a significant positive association between the change in trochanteric BMD and the anteversion angle (p < 0.01). Anteversion produced a mean reduction of -2.4% (range -7.6%-(+)4.3%) (p < 0.001) in apparent femoral neck axis length, while femoral neck width remained generally unaffected. These data confirm that femoral BMD as measured by DXA is affected by femoral anteversion with a lesser magnitude than previously reported. The use of trochanteric BMD may minimize the influence of anteversion. While the mean changes in BMD and neck axis length attributable to anteversion are modest, the considerable interindividual variability in the magnitude of the effects demonstrates that other factors, such as, the complex geometry of femoral neck modifies the effect of anteversion on BMD measurements. The error in BMD introduced femoral anteversion may represent a significant confounding influence in cross-sectional and longitudinal studies. Careful repositioning of the foot and leg is essential in monitoring changes in BMD longitudinally. Knowledge of the effects of femoral anteversion may assist in understanding the relation of femoral BMD and neck axis length to hip fracture.

Absorptiometry, Photon↗

PubMed1997

The accuracy of peripheral skeletal assessment at the radius in estimating femoral bone density as measured by dual-energy X-ray absorptiometry: a comparative study of single-photon absorptiometry and computed tomography.

OBJECTIVES: One of the latest developments in bone densitometry is peripheral quantitative computed tomography (pQCT), a method which allows the separate determination of cortical and trabecular bone mineral density (BMD) in the peripheral skeleton. This study was designed to compare the relative abilities of single-photon absorptiometry (SPA) and pQCT to reflect BMD of the proximal femur as measured by dual-energy X-ray absorptiometry (DXA), an established predictor of osteoporotic hip fracture risk. DESIGN: Cross-sectional study. SUBJECTS: A well-defined community-based sample of 129 skeletally healthy women aged 70-87 years. MEASUREMENTS: Radial BMD by SPA and pQCT and femoral BMD by DXA. Univariate and multivariate regression analyses were performed relating the DXA measurements at the femoral neck and the trochanteric region with the values of SPA and pQCT. RESULTS: Approximately 38% of the variance in femoral neck BMD could be explained by BMD of the midradius assessed by SPA, in contrast to only 18-27% by pQCT. At the trochanter, 32% of BMD could be predicted by SPA as compared to 19-26% by pQCT. Moreover, according to multiple regression, prediction of femoral BMD by SPA was not enhanced by performing pQCT. CONCLUSIONS: Radial pQCT has little value as a screening tool to identify elderly women with low femoral BMD. Additional research is needed to determine whether or not pQCT will enhance fracture prediction beyond that obtainable from a density measurement by SPA.

Absorptiometry, Photon↗

PubMed1997

Low-frequency ultrasonic velocity measurements in human calcaneal trabecular bone.

Ultrasonic velocities were measured in three orthogonal directions for 17 cubes (2 x 2 x 2 cm approximately) of defatted calcaneal trabecular bone using a novel pulse transmission method with 37 kHz transducers. Since the wavelength was greater than the cross-sectional dimensions of the specimens, it was assumed that bar wave propagation was occurring and this allowed Young's modulus to be derived from velocity and apparent density. Velocity varied from 1585 +/- 104 m s-1 in axis 1 (proximo-distal) to 947 +/- 131 m s-1 in axis 3 (medio-lateral). Thus, the velocities measured in axis 3 were considerably lower than those typically seen in clinical measurements of the calcaneus. The derived Young's moduli ranged from 834 +/- 248 MPa (axis 1) to 299 +/- 98 MPa (axis 3), and were comparable in magnitude to some previously published data from mechanical testing. The results suggest that velocities measured with this technique do indeed correspond to bar velocities, and consequently that low-frequency ultrasound can be used to directly predict the mechanical properties of trabecular bone specimens in vitro. On the other hand, given the marked differences in geometry, wavelengths used and the presence of fat, it raises questions about the validity of applying the bar wave equation in the context of higher-frequency velocity measurements in the intact calcaneus in vivo, despite the fact that this has been found to be useful by a number of previous workers. This may require a review of the clinical implications of high-frequency ultrasound data.

Adult↗