慢性阻塞性肺疾病患者的骨超声和骨矿含量的改变

目的　通过观察慢性阻塞性肺疾病 (COPD)患者的跟骨超声振幅衰减 (BUA)、超声声速 (SOS)、髋部骨矿含量(BMC)及骨密度 (BMD)变化 ,进一步了解COPD与骨质疏松的关系。方法　测定COPD老年男性患者及对照组各 3 0例的跟骨BUA、SOS和股骨颈、Ward’s三角、股骨粗隆的BMD、BMC以及动脉血气。结果　老年COPD组的股骨颈、Ward’s三角、股骨粗隆的BMD、BMC以及跟骨的BUA、SOS均较对照组的测定值低 ,差异有显著性。COPD组动脉血气分析氧分压较对照组低 (P <0 .0 1)。结论　COPD患者因缺氧引起各脏器受损 ,加速骨量丢失而易患骨质疏松症     

应用骨超声衰减评估绝经后骨质疏松药物疗效的研究

目的 :研究跟骨超声衰减 (BUA)测量对药物治疗骨质疏松疗效评价的作用。方法 :40例绝经 3年以上患骨质疏松的老年女性服用阿伦膦酸钠 6个月。服药前后分别用超声测量跟骨的BUA ,双能X线测量第 2～ 4腰椎和髋部的骨密度 (BMD) ,行配对t检验并作相关回归分析 .结果 :用药前左跟骨BUA平均值为 ( 5 3 7± 5 2 )dB/MHz ,服药后为 ( 5 5 7± 2 8)dB/MHz (P =0 0 2 ) ,显示BUA检测能反映疗效变化 ,并与左股骨颈的BMD变化有相关 (r =0 387,n =40 ,P <0 0 5 ) ,但与腰椎和髋部总的BMD变化无相关。结论 :服药后BUA值比服药前有明显增加 ,提示BUA可初步估计治疗效果。     

正常儿童跟骨超声骨密度测定及其影响因素

目的 在建立定量超声骨密度测量精密度的基础上,分析正常儿童超声骨密度的变化规律及其影响因素.方法 采用定量超声(QUS)技术测定长居广州市的475名6～12岁正常儿章的跟骨QUS参数[超声传导速度(SOS)、超声衰减系数(BUA)和骨强度指数(STI)],同时测量受检者身高和体重.结果 同年龄男、女章的SOS、BUA和STI差异均无统计学意义.6～12岁正常儿童SOS值随年龄增加而降低,BUA值随年龄增加而增加.STI值男童在9岁、女童在8岁降至最低,之后随年龄增加而增加,在11岁出现一个高峰后又下降.年龄和身高是超声骨密度参数的主要决定因素.结论 6～12岁正常儿童的跟骨超声骨密度因年龄不同而呈现不同规律;年龄和身高是影响儿童骨密度的重要因素.     

老年人跟骨超声检测的临床意义

目的探讨老年人跟骨超声骨质量变化的临床意义。方法用定量超声骨质量测定仪(DMS5000)测定了201例老年人和139例青年人跟骨超声振幅衰减(BUA)、超声声速(SOS)以及骨硬度指数(STI)。结果两组老年人3项超声指标均显著低于青年人(P<0.01).累积丢失率在STI下降最大.男女差异在BUA和STI有显著性(P<0.01).两组老年人的骨腩疏检出率在SOS最低,BUA和STI相近,结论老年人世间跟骨质量显著下降,但下降顺序为STI>BUA>SOS。     

山西地区正常人群定量骨超声检测结果811例分析

目的经体重指数标准化,分不同年龄段进行比较,探讨定量骨超声测定的统一标准。方法采用UBIS5000型定量超声仪,对山西地区811例20～80岁正常成人(女468例,男343例)行跟骨定量超声参数测量。结果跟骨超声振幅衰减(BUA)和刚度(STI)的峰值女性在45～49岁犤BUA为(67.71±4.91)dB/MHz,STI为(86.3±14.5)%犦,BUA峰值男性在50～54岁犤(71.41±7.69)dB/MHz犦。经体重指数校正后,不论男性或女性BUA、STI及超声波传导速度(SOS)峰值均在20～24岁。结论跟骨BUA、SOS和STI随年龄增长而变化,消除体重指数影响后差异仍明显,且随增龄逐年降低,男性变化趋势不如女性明显。     

定量超声测量甲亢患者骨质变化的临床价值

目的研究定量超声法测量甲亢患者骨质变化的临床价值。方法用定量超声法测量了347例存在高T3和T4的甲亢患者及性别和年龄相匹配的健康对照组的右跟骨超声参数超声振幅衰减(BUA)和超声传导速度(SOS)。结果甲亢患者的BUA值明显低于正常对照组(P＜0.01),骨质量丢失发生率明显高于正常对照组。BUA、SOS与T3、T4、促甲状腺激素(TSH)之间均无明显相关关系(|r|＜0.15,p＞0.05)。结论定量超声参数可以敏感地检测甲亢对骨质量的影响。     

跟骨及游离股骨头超声测定法预测股骨颈骨折发生危险性的价值

目的:探讨股骨颈骨折患者跟骨及游离股骨头超声观测值的变化及两者的相关性,以及跟骨超声测定法预测股骨颈骨折发生危险性的价值。方法:股骨颈骨折女性患者60例,为骨折组。未罹患骨折的女性患者60例,为对照组。采用UBIS5000型跟骨超声仪测定两组跟骨超声骨密度参数超声波振幅衰减系数(broadbandultrasonicattenuation,BUA)值及骨折组游离股骨头BUA值。取骨折组游离股骨头骨折断端骨块作骨形态计量法测量。结果:骨形态计量法测量显示骨折组游离股骨头骨折断端具有明显骨质疏松特性,骨小梁数目减少、变薄、联结点减少,髓腔扩大。骨折组跟骨BUA:(51.6±2.8)dB/MHz,对照组BUA:(55.8±2.6)dB/MHz,两者之间差异有显著性意义(t=2.83,P<0.01)。游离股骨头BUA:(48.3±2.4)dB/MHz,与跟骨BUA相关系数r=0.8,两者密切相关。结论:股骨颈骨折患者股骨颈部存在明显骨质疏松,且BUA下降较跟骨明显,超声测定可能可反映骨结构的变化。跟骨BUA与股骨颈部BUA一致下降,两者正相关,跟骨超声测定可能预测股骨颈骨折危险性。     

山西地区正常人群定量骨超声检测结果811例分析

目的 经体重指数标准化，分不同年龄段进行比较，探讨定量骨超声测定的统一标准。方法 采用UBIS5000型定量超声仪，对山西地区8ll例20—80岁正常成人(女468例，男343例)行跟骨定量超声参数测量。结果 跟骨超声振幅衰减(BUA)和刚度(STI)的峰值女性在45—49岁[BUA为(67．7l&;#177;4．91)dB／MHz，Sn为(86．3&;#177;14．5)％]，BUA峰值男性在50—54岁[(71．41&;#177;7．69)dB／MHz]。经体重指数校正后，不论男性或女性BUA、STI及超声波传导速度(SOS)螺值均在20-24岁。结论 跟骨BUA、SOS和STI随年龄增长而变化，消除体重指数影响后差异仍明显，且随增龄逐年降低，男性变化趋势不如女性明显。     

跟骨及游离股骨头超声测定法预测股骨颈骨折发生危险性的价值

目的：探讨股骨颈骨折患者跟骨及游离股骨头超声观测值的变化及两者的相关性，以及跟骨超声测定法预测股骨颈骨折发生危险性的价值。方法：股骨颈骨折女性患者60例，为骨折组。未罹患骨折的女性患者60例，为对照组。采用UBIS 5000型跟骨超声仪测定两组跟骨超声骨密度参数超声波振幅衰减系数(broadband ultrasonic attenuation，BUA)值及骨折组游离股骨头：BUA值。取骨折组游离股骨头骨折断端骨块作骨形态计量法测量。结果：骨形态计量法测量显示骨折组游离股骨头骨折断端具有明显骨质疏松特性，骨小梁数目减少、变薄、联结点减少，髓腔扩大。骨折组跟骨BUA：(5l_6&;#177;2．8)dB／MHz，对照组BUA：(55．8&;#177;2．6)dB／MHz，两者之间差异有显著性意义(t=2．83，P&;lt;O．01)。游离股骨头BUA：(48．3&;#177;2．4)dB／MHz，与跟骨BUA相关系数r=O．8，两者密切相关。结论：股骨颈骨折患者股骨颈部存在明显骨质疏松，且BUA下降较跟骨明显，超声测定可能可反映骨结构的变化。跟骨BUA与股骨颈部BUA一致下降，两者正相关，跟骨超声测定可能预测股骨颈骨折危险性。     

阿仑膦酸钠联合脉冲电磁场治疗老年女性原发性骨质疏松症的临床观察

目的观察阿仑膦酸钠联合脉冲电磁场治疗老年女性原发性骨质疏松症的疗效。方法52例老年女性原发性骨质疏松症患者随机分成两组:对照组(26例),口服复方碳酸钙;治疗组(26例)口服复方碳酸钙及阿仑膦酸钠,同时采用骨质疏松治疗仪进行治疗;观察患者骨痛的缓解情况并分别检测治疗前和治疗后6个月右侧跟骨超声振幅衰减值(BUA)和超声声速(SOS)变化。结果治疗组患者骨痛明显缓解,总有效率达96.2%,而对照组为38.5%(P<0.01);治疗组BUA及SOS较治疗前明显升高(P<0.05),而对照组治疗前后无明显变化(P>0.05);治疗后治疗组BUA及SOS与对照组相比显著升高(P<0.05)。结论阿仑膦酸钠联合脉冲电磁场治疗老年女性原发性骨质疏松症有肯定疗效。     

In vivo measurements of ultrasound transmission through the human proximal femur

Quantitative ultrasound (QUS) measurements can be used to estimate osteoporotic fracture risk. The commonly used variables are the speed of sound (SOS) and the frequency dependent sound attenuation (broadband ultrasound attenuation, [BUA]) of a wave propagating through the bone, preferably the calcaneus. The technology, so far, is less suitable for direct measurement in vivo at the spine or the femur for prediction of bone mineral density (BMD) or fracture risk at the main osteoporotic fracture sites. To improve the clinical performance of QUS, we built a device for direct QUS measurements at the human femur in vivo. In vivo images of ultrasound transmission at one of the main fracture sites, the proximal femur, could be acquired. The estimated precision of SOS measurements of 0.5% achieved at the femur is comparable with the precision of peripheral QUS devices.     

Odds ratios for hip- and lower forearm fracture using peripheral bone densitometry; a case-control study of postmenopausal women

Background: Dual‐energy X‐ray absorptiometry (DXA) measured at the lumbar spine and particularly at the hip remain the gold‐standard for diagnosing osteoporosis. However, devices for assessing the peripheral skeleton present several advantages in terms of lower price and portability. A major concern when using peripheral densitometry is the poor correlation with the central measurements. The main aim of this study is, therefore, to assess the possibility of expressing ultrasound measurements at the heel and bone mineral density (BMD) measured at the distal forearm as fracture odds ratios rather than an absolute measure of bone mass. Methods: A total of 76 women with lower forearm fracture, 47 women with hip fracture and 231 age‐matched women (controls) were included. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel using the DTU‐one ultrasound scanner as well as BMD measured by dual X‐ray absorptiometry on the DTX‐200 at the distal forearm. Results: BUA, SOS and BMD at the distal forearm were all significantly lower in fracture patients compared with their respective control groups. The odds ratio for lower forearm fracture was 3·1 (95% CI: 1·8; 5·2) for heel‐BUA (T‐score cut‐off: –2·3), 4·1 (2·3; 7·4) for heel‐SOS (–2·1) and 2·2 (1·3; 3·7) for lower forearm BMD (–2·7). The odds ratio for hip fracture was 3·4 (1·5–7·7) for heel‐BUA (–2·7), 3·6 (1·6; 8·1) for heel‐SOS (–2·6) and 3·2 (1·4; 7·4) for lower forearm BMD (–2·9). Conclusion: Peripheral densitometry can discriminate between hip‐ and lower forearm fracture patients and age‐matched controls. Significantly elevated odds ratios for incurring these fractures can be calculated using device‐ and site specific t‐score cut‐off values. The results from this case–control study need to be confirmed by prospective cohort studies.     

Investigation of bone changes in microgravity during long and short duration space flight: comparison of techniques

BACKGROUND: Loss of bone mass is a continuing problem in long-term space flight. Although counter-measure programmes have been developed, effective assessment of these programmes is hampered by a lack of monitoring techniques that can be used in-flight. MATERIALS AND METHODS: Three techniques were used to evaluate changes in bone during two missions of 180 and 20 days to the MIR space station, involving three subjects. Dual energy X-ray absorptiometry (DXA) was used before and after flight to measure whole body and regional bone mineral density (BMD). Ultrasonic measurements of velocity (SOS) and broadband attenuation (BUA) of the calcaneus were measured during the 180 day mission and before and after the 20 day mission. Phase velocity of flexural waves in the tibia was also measured on the same days as the ultrasonic measurements of the calcaneus. RESULTS: DXA measurements demonstrated significant variation between different sites in the body for changes in BMD, with the greatest changes occurring in the lumbar spine and proximal femur. There was a trend for increasing phase velocity in the tibia during the 180 mission, but this was not significant. BUA and SOS measurements of the calcaneus showed consistent but divergent patterns of changes during the mission. CONCLUSION: Although in-flight measurements of bone using ultrasound or phase velocity may provide information on the kinetics of bone loss in space flight, the heterogeneity of response in the skeleton means that it is difficult to predict overall bone loss from measurements at one particular site.     

Hip fracture discrimination by imaging ultrasound measurements of the calcaneus

Quantitative ultrasound measurements of the os calcis have recently been upgraded with imaging facilities. This has made measurements of a specific region of interest possible and improved the reproducibility of the method, but the diagnostic ability of imaging ultrasound has not yet been investigated thoroughly. We measured broadband ultrasound attenuation (BUA) and speed of sound (SOS) using imaging ultrasound as well as forearm bone mineral density (BMD_arm) using dual-energy X-ray absorptiometry in three age-matched groups of women: (1) 25 women who were admitted to hospital due to a hip fracture; (2) 23 women who were admitted to hospital due to a fall without any fracture; and (3) 26 normal women. Furthermore, BMD of the hip (BMD_hip) was measured in a subgroup of the hip fracture patients and those who had fallen. All measurements were performed during the index hospitalization in order to avoid any influence from bone loss due to immobilization after the fracture. We found a –0·48 SD deviation from expected age-matched values in BUA among the hip fracture patients, whereas the patients who had fallen showed a +0·16 SD deviance. For SOS, the figures were –0·70 SD for the hip fracture group and –0·06 SD for the patients who had fallen. For BMD of the arm we found values of –0·65 SD and +0·08 SD, respectively, whereas the figures for BMD of the hip were –0·66 SD and +0·13 SD, respectively. All parameters were significantly lower in the hip fracture group compared with the patients who had fallen. None of the parameters in the patients who had fallen deviated significantly from expected normal age-matched values. Neither BMD of the arm or BMD of the hip separated hip fracture patients and patients who had fallen significantly better than ultrasound (BUA or SOS) did. We conclude that imaging ultrasound (BUA or SOS) separates age-matched groups of hip fracture and non-fracture patients as well as BMD measurements do.     

Quantitative Ultrasound of the Calcaneus in Hemodialysis Patients

The aim of this study was to investigate the bone status of hemodialysis patients and identify factors that have influence on bone quality. Four hundred eighty-nine subjects (213 males and 276 females) on maintenance hemodialysis and 696 healthy subjects (309 men, 387 women) were enrolled in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) were assessed by quantitative ultrasound (QUS) at the right calcaneus in both groups. Serum levels of intact parathyroid (iPTH), total alkaline phosphatase (ALP), calcium and phosphate were measured to determine their influence on bone status in hemodialysis patients. All QUS parameters were significantly lower in hemodialysis patients than in controls (p < 0.0001). Stepwise multiple linear regression analysis in male patients indicated that age, weight, calcium-phosphate product and ALP were significant predictors of QUS parameters (adjusted R² = 0.15 in SOS; adjusted R² = 0.17 in BUA and QUI). In female patients, same findings including number of parity were observed in SOS only (adjusted R² = 0.25 in SOS). In postmenopausal patients, the duration of menopause was significant negatively correlated with all QUS parameters (p < 0.01). In conclusion, patients on maintenance hemodialysis had additional risk of bone loss. Advanced age, low body weight, high calcium-phosphate product and high ALP level were important risk factors for deterioration of bone quality. (E-mail: tcchu@mx.nthu.edu.tw)     

The role of quantitative ultrasound in the assessment of bone: a review

Quantitative ultrasound (QUS) bone measurement is a promising, relatively new technique for the diagnosis of osteoporosis. Unlike to the more established method of bone densitometry [measurement of bone mineral density (BMD) e.g. using dual X-ray absorptiometry (DEXA)], QUS does not use ionizing radiation. It is cheaper, takes up less space and is easier to use than densitometry techniques. The two QUS parameters currently measured are broadband ultrasound attenuation (BUA) and speed of sound (SOS). The reported age-related changes for healthy women range from ?0·27% to ?1·62% per year for BUA and from ?0·06% to ?0·19% per year for SOS. Precision ranges from 1·0 to 3·8% (CV) for BUA and from 0·19 to 0·30% (CV) for SOS. The new method of imaging ultrasound has improved the precision of QUS measurements. QUS is significantly correlated with BMD. Studies with the latest equipment have shown r-values between 0·6 and 0·9 in site-specific measurements, and QUS is thus believed to reflect mainly BMD. However, other studies indicate that QUS measures something other than the actual mineral content of bone, namely bone quality, e.g. in vitro studies have shown that QUS reflects trabecular orientation independently of BMD. In both cross-sectional and prospective studies, QUS seems to be as good a predictor of osteoporotic fractures as BMD. In two large prospective studies, QUS also predicted fracture risk independently of BMD. QUS has just begun to be used systematically for monitoring the response to anti-osteoporotic treatments in prospective trials. In the studies performed, QUS has been found to be useful in the follow-up of patients. QUS is thus a promising new technique for bone assessment.     

Discriminatory ability of calcaneal quantitative ultrasound in the assessment of bone status in patients with inflammatory bowel disease

A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff 相似文献   

Ability of ultrasound bone profile score (UBPS) to discriminate between fractured and not fractured osteoporotic women

In this study, we evaluated the ability of different quantitative ultrasound (QUS) parameters (speed of sound, SOS, coefficient of variation, CV, = 0.34% and broadband ultrasound (US) attenuation, BUA, CV = 3.25% measured at the heel by an Hologic Sahara unit; Ad-Sos and ultrasound bone profile score (UBPS) at the proximal phalanges by an Igea DBM Sonic 1200 unit, Ad-Sos CV = 0.57%) to detect differences between osteoporotic patients with vertebral fractures and osteoporotic patients without fractures. We examined 87 women with primary osteoporosis: 53 women with femoral neck bone mineral density (BMD) T scores less than -2.5 SD and no vertebral fractures and 34 women with one or more vertebral fractures, regardless of T score values. Considering all the patients together, the correlations between QUS parameters and BMD resulted in statistical significance (p < 0.05) only for BUA and femoral neck BMD. Lumbar and femoral neck BMD did not statistically differ between the two groups, while UBPS, which is a quality control of measurement and is correlated with bone quality, was significantly higher in women without fractures than those with fractures; the other QUS parameters were not statistically different. Our data indicate that, among QUS parameters, only UBPS is able to detect differences among osteoporotic patients with and without vertebral fractures.     

How does quantitative ultrasound compare to dual X‐ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories?

The World Health Organisation (WHO) has proposed a set of guidelines for the diagnosis of osteoporosis in adult women based on a measurement of bone mineral density (BMD) expressed as the number of SD below young adult mean (t‐score). In this study, we investigated the number of subjects classified as either osteopenic or osteoporotic according to these guidelines using dual X‐ray absorptiometry (DXA), at the hip, at the spine and at the lower forearm and quantitative ultrasound (QUS), at the heel. A total of 247 men, 209 postmenopausal women and 195 premenopausal women were included in the study. Furthermore, the study provides the first normative data showing the influence of sex, age and menopause on broadband ultrasound attenuation (BUA) and speed of sound (SOS), as measured by the DTU‐one imaging ultrasound scanner. The difference between the number of patients classified into either diagnosis group by the investigated parameters is large ranging from 25·9% of the women being diagnosed as osteopenic by BUA at the heel to 43·0% by BMD at the femoral neck. For men, the same range is from 20·5% by BUA to 44·1% by BMD at the femoral neck. For the classification into the osteoporotic group, the range is from 2·5% by intertrochanteric BMD to 24·4% by BMD at Ward’s triangle for women and from 0% by SOS to 29·0% by BMD at Ward’s triangle for men. Using total hip BMD as the reference parameter to categorize the subjects as normal, osteopenic or osteoporotic, the agreement of the other parameters with this classification is assessed in terms of sensitivity and specificity. We conclude that there are significant differences in the classification of osteoporosis/osteopenia depending on the site measured and the technique used for the bone mass assessment. Furthermore, we suggest that development of technique and site specific cut‐off values may increase the accuracy of the classification of osteoporosis/osteopenia in both men and women.