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1.
Changes in Bone Mass and Bone Turnover Following Ankle Fracture 总被引:6,自引:0,他引:6
Bone loss and increased bone turnover are recognized local changes after a fracture, but the exact patterns of these changes
after different fractures are unclear. We aimed to investigate the changes in bone density and biochemical markers following
ankle fracture. Fourteen subjects (7 postmenopausal women and 7 men, mean age 63 years) were recruited following fracture
of the distal tibia and fibula. Bone mineral density (BMD) of the ankle and proximal femur were measured by dual-energy X-ray
absorptiometry (DXA) and quantitative ultrasound (QUS) of the calcaneus at 0, 6, 12, 26 and 52 weeks after fracture. Serum
and urine samples were collected at 0, 3 and 7 days and at 2, 4, 6, 12, 26 and 52 weeks after fracture to measure markers
of bone turnover. For bone formation we measured: bone alkaline phosphatase (iBAP), osteocalcin (Oc), procollagen type I N-terminal
propeptide (PINP); and for bone resorption: tartrate-resistant acid phosphatase (TRAcP), deoxypyridinoline (iFDpd), N-telopeptides
of type I collagen (NTx). We used the nonfractured limb to calculate values for baseline BMD and QUS. There was a significant
decrease in BMD at the ultradistal ankle (p<0.001), the trochanteric region of the hip (p<0.01) and QUS of the heel after ankle fracture. This bone loss was maximal for ultradistal ankle BMD by 6 weeks at 13% (p<0.001) and for the trochanter by 26 weeks at 3% (p<0.01). The ankle BMD returned to baseline at 52 weeks but the trochanter BMD did not. Velocity of sound (VOS) decreased at
6 weeks by 2% (p<0.01) and broadband ultrasound attenuation (BUA) by 15% (p<0.01). VOS recovered completely by 52 weeks, but BUA did not return to baseline. Bone formation markers increased significantly
between 1 and 4 weeks by 11–78% (p<0.01), and iBAP returned to baseline at 52 weeks but PINP and Oc remained elevated. Bone resorption markers did not increase
and NTx was decreased at 52 weeks. We conclude that BMD decreased distal and immediately proximal to the fracture line when
measured with DXA and QUS. Ankle BMD and heel VOS recovered at 52 weeks (trochanteric BMD and heel BUA did not) and the bone
turnover markers returned toward baseline.
Received: 27 January 1999 / Accepted: 19 April 1999 相似文献
2.
T. Andrew Y. T. Mak P. Reed A. J. MacGregor T. D. Spector 《Osteoporosis international》2002,13(9):745-754
In this confirmatory candidate gene study, we investigated possible linkage and association for bone density, heel ultrasound
and bone turnover with the osteocalcin gene using the nearby (50–180kb) microsatellite marker D1S3737. Non-identical twin
sisters aged 18–75 years at first interview were recruited for the study from the St Thomas’ UK Adult Twin Registry with 1366
women being genotyped for marker D1S3737. Linkage, allelic association and joint linkage and association tests were carried
out using quantitative transmission disequilibrium tests (QTDT), along with post-hoc multivariate tests of linkage and association.
Phenotypes tested were bone mineral density (BMD) at the spine, left forearm and left total hip; quantitative ultrasound measurements
of the heel including velocity of ultrasound (VOS) and broadband ultrasound attenuation (BUA); and bone turnover markers,
urine deoxypyridinoline (DPD), serum osteocalcin, bone specific and total alkaline phosphatase (ALP). BMD and ultrasound variables
showed evidence of pleiotropic linkage (p= 0.05) and association (p= 0.02) with the marker in postmenopausal women. Bone markers showed little or no evidence of linkage and association for
any age group. Evidence for pleiotropic linkage appeared to be strongest for BUA and spine BMD in postmenopausal women. The
univariate test statistic for BUA was χ2
1=12.8 (p= 0.0003), equivalent to a LOD score of 2.8. DPD showed borderline evidence of linkage to the marker for women of all ages.
Multivariate model-fitting showed allele 10 to be negatively associated with BMD, VOS and BUA via a common pathway, suggesting
the putative functional polymorphism affects both bone content and structure through shared underlying metabolic pathways.
It is likely that the alleles are in linkage disequilibrium with functional polymorphism(s) in or nearby the osteocalcin gene,
which may contribute to the onset of osteoporosis.
Received: 24 January 2002 / Accepted: 25 April 2002 相似文献
3.
M. A. Krieg A. F. Jacquet M. Bremgartner S. Cuttelod D. Thiébaud P. Burckhardt 《Osteoporosis international》1999,9(6):483-488
Supplementation of elderly institutionalized women with vitamin D and calcium decreased hip fractures and increased hip bone
mineral density. Quantitative ultrasound (QUS) measurements can be performed in nursing homes, and easily repeated for follow-up.
However, the effect of the correction of vitamin D deficiency on QUS parameters is not known. Therefore, 248 institutionalized
women aged 62–98 years were included in a 2-year open controlled study. They were randomized into a treated group (n = 124), receiving 440 IU of vitamin D3 combined with 500 mg calcium (1250 mg calcium carbonate, Novartis) twice daily, and a control group (n = 124). One hundred and three women (42%), aged 84.5 ± 7.5 years, completed the study: 50 in the treated group, 53 in the
controls. QUS of the calcaneus, which measures BUA (broadband ultrasound attenuation) and SOS (speed of sound), and biochemical
analysis were performed before and after 1 and 2 years of treatment. Only the results of the women with a complete follow-up
were taken into account. Both groups had low initial mean serum 25-hydroxyvitamin D levels (11.9 ± 1.2 and 11.7 ± 1.2 mg/l;
normal range 6.4–40.2 mg/l) and normal mean serum parathyroid hormone (PTH) levels (43.1 ± 3.2 and 44.6 ± 3.5 ng/l; normal
range 10–70 ng/l, normal mean 31.8 ± 2.3 ng/l). The treatment led to a correction of the metabolic disturbances, with an increase
in 25-hydroxyvitamin D by 123% (p50.01) and a decrease in PTH by 18% (p50.05) and of alkaline phosphatase by 15% (p50.01). In the controls there was a worsening of the hypovitaminosis D, with a decrease of 25-hydroxyvitamin D by 51% (p50.01) and an increase in PTH by 51% (p50.01), while the serum calcium level decreased by only 2% (p5 0.01). After 2 years of treatment BUA increased significantly by 1.6% in the treated group (p50.05), and decreased by 2.3% in the controls (p50.01). Therefore, the difference in BUA between the treated subjects and the controls (3.9%) was significant after 2 years
(p50.01). However, SOS decreased by the same amount in both groups (approximately 0.5%). In conclusion, BUA, but not SOS, reflected
the positive effect on bone of supplementation with calcium and vitamin D3 in a population of elderly institutionalized women.
Received: 23 February 1998 / Accepted: 19 October 1998 相似文献
4.
C. Heldan de Moura Castro M. Medeiros Pinheiro V. Lúcia Szejnfeld 《Osteoporosis international》2000,11(11):923-928
Quantitative ultrasound (QUS) can be a helpful alternative to identify osteoporotic patients. In this study we establish
the QUS Brazilian normal range (BNR) and compare its values (means and standard deviations) with the manufacturer’s normal
range (MNR). We measured three QUS parameters (broadband ultrasound attenuation, BUA; speed of sound, SOS; stiffness index,
SI) at the right calcaneus in 352 healthy Caucasian Brazilian women, aged 20–84 years. We studied the age-dependent changes
in QUS values and correlation with body size and years since menopause (YSM). A comparison of fracture risk classification
using the BNR and MNR is also presented. Age was the most significant predictor for all QUS parameters (r=−0.49 for BUA, r=−0.66 for SOS, r=−0.64 for SI). Weight was accepted as the second determinant for BUA (final regression model: BUA = 101.3 − 0.282 × Age +
0.373 × Weight; p<0.001; adjusted R
2= 0.33). Body mass index (BMI) was accepted as the second predictor for SI (SI = 94.8 −0.595 × Age + 0.851 × BMI; p<0.001; adjusted R
2= 0.44). Height and YSM were accepted as second and third determinants for SOS values (SOS = 1718.7 − 1.147 × Age − 69.863
× Height − 0.521 × YSM; p<0.001; adjusted R
2= 0.45).There was a decline in SI of about 41% from the values in young adulthood to those of women in their eighties, about
76.4% of which occurred from age 45–49 years onward. Variation of mean SI with age from the BNR was consistent with the MNR
in all but two 5-year age groups. In these two groups (50–54 years, p<0.01; 65–69 years, p<0.05), values derived from the BNR were 5.08% and 5.45% higher than the MNR values, respectively. Comparison of standard
deviations in SI with age between the two populations did not show statistically significant differences. Using the fracture
risk criteria proposed by the manufacturer, we observed that the MNR was appropriate for skeletal fragility evaluation in
Brazilian women.
Received: 8 November 1999 / Accepted: 26 April 2000 相似文献
5.
Comparison of Six Calcaneal Quantitative Ultrasound Devices: Precision and Hip Fracture Discrimination 总被引:1,自引:0,他引:1
C. F. Njeh D. Hans J. Li B. Fan T. Fuerst Y. Q. He E. Tsuda-Futami Y. Lu C. Y. Wu H. K. Genant 《Osteoporosis international》2000,11(12):1051-1062
Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of
QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation
algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between
normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). The short-term
and mid-term precisions of these devices were also determined. Thirty-five women (mean age 74.5 ± 7.9 years) who had sustained
a hip fracture within the past 3 years, and 35 age-matched controls (75.8 ± 5.6 years) were recruited. Ultrasound measurements
were acquired using six ultrasound devices: three gel-coupled and three water-coupled devices. Bone mineral density was measured
at the hip using DXA. Discrimination of fracture patients versus controls was assessed using logistic regression analysis
(expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver
operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The
sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA).
The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson
correlation coefficients between different devices was highly significant (SOS, r= 0.79–0.93; BUA, r= 0.71–0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r= 0.30–0.55; BUA, r= 0.35–0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than
water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r= 0.48–0.57 for BMD and r= 0.18–0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip
fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1–2.8) and BUA (2.4–3.4) were comparable
to those for femoral BMD (2.6–3.5), as were the area under the curve (SOS, 0.65–0.71; BUA, 0.62–0.71; BMD, 0.65–0.74) from
ROC analysis. Within the limitation of the sample size all devices show similar diagnostic sensitivity.
Received: 2 February 2000 / Accepted: 1 May 2000 相似文献
6.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献
7.
Quantitative Ultrasound Measurements of the Tibia and Calcaneus in Comparison with DXA Measurements at Various Skeletal Sites 总被引:2,自引:0,他引:2
The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people
(age range 65–87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and
SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation
(CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral
density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry
(DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations
with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r= 0.48–0.64, r= 0.30–0.47, r= 0.35–0.47, respectively; p<0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body
weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values.
After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests
that correction for body weight is important and could add to the predictive value of QUS measurements.
Received: 16 July 1997 / Accepted: 8 July 1998 相似文献
8.
Can the WHO Criteria for Diagnosing Osteoporosis be Applied to Calcaneal Quantitative Ultrasound? 总被引:4,自引:0,他引:4
With the increasing number of quantitative ultrasound (QUS) devices in use worldwide it is important to develop strategies
for the clinical use of QUS. The aims of this study were to examine the age-dependence of T-scores and the prevalence of osteoporosis using the World Health Organization Study Group criteria for diagnosing osteoporosis
and to examine the T-score threshold that would be appropriate to identify women at risk of osteoporosis using QUS. Two groups of women were studied:
(i) 420 healthy women aged 20–79 years with no known risk factors associated with osteoporosis; (ii) 97 postmenopausal women
with vertebral fractures. All subjects had dual-energy X-ray absorptiometry (DXA) measurements of the spine and hip and QUS
measurements on three calcaneal ultrasound devices (Hologic Sahara, Hologic UBA575+, Osteometer DTUone). A subgroup of 102
(76 on the DTUone) healthy women aged 20–40 years was used to estimate the young adult mean and SD for each QUS and DXA measurement
parameter to calculate T-scores. The age-related decline in T-scores for QUS measurement parameters was half the rate observed for the bone mineral density (BMD) measurements. The average
T-score for a woman aged 65 years was –1.2 for QUS measurements and –1.75 for the BMD measurements. When osteoporosis was defined
by a T-score ≤–2.5 the prevalence of osteoporosis in healthy postmenopausal women was 17%, 16% and 12% for lumbar spine, femoral
neck and total hip BMD respectively. When the same definition was used for QUS measurements the prevalence of osteoporosis
ranged from 2% to 8% depending on which ultrasound device and measurement parameter was used. Four different approaches, based
on DXA-equivalent prevalence rates of osteoporosis, were utilized to examine which T-score threshold would be appropriate for identifying postmenopausal women at risk of osteoporosis using QUS measurements.
These ranged from –1.05 to –2.12 depending upon the approach used to estimate the threshold and on which QUS device the measurements
were performed, but all were significantly lower than the threshold of –2.5 used for BMD measurements. In conclusion, the
WHO threshold of T=–2.5 for diagnosing osteoporosis requires modification when using QUS to assess skeletal status. For the three QUS devices
used in this study, a T-score threshold of –1.80 would result in the same percentage of postmenopausal women classified as osteoporotic as the WHO
threshold for BMD measurements. Corresponding T-score thresholds for individual measurement parameters on the two commercially available devices were –1.61, –1.94 and –1.90
for Sahara BUA, SOS and estimated heel BMD respectively and –1.45 and –2.10 for DTU BUA and SOS respectively Additional studies
are needed to determine suitable T-score thresholds for other commercial QUS devices.
Received: 25 June 1999 / Accepted: 29 September 1999 相似文献
9.
M. M. K. Donaldson C. W. McGrother D. G. Clayton M. Clarke D. Osborne 《Osteoporosis international》1999,10(4):316-324
This study demonstrates the relationship between past fracture, body size and broadband ultrasound attenuation (BUA) and
investigates two sites of BUA measurement in a representative elderly population of men and women (n= 2106). We measured BUA at a fixed position and at a consistent anatomic position within the calcaneus. We found fixed BUA
was less closely correlated with stature and age than anatomic BUA. Both correlations were substantially weaker in men than
in women. Mean BUA was significantly lower in women with a past fracture compared with nonfracturers (fixed BUA 63.3 vs 69.4
dB/MHz, p= 0.0004; anatomic BUA 77.6 vs 81.7 dB/MHz, p= 0.013). However, in women, the fixed BUA was better than the anatomic BUA at discriminating between fracturers and nonfracturers
(OR 1.38/SD (95% CI 1.12–1.68) and OR 1.22/SD (0.99–1.52), respectively) when adjusted for body size and age. There was no
significant difference in either BUA in men with or without a past fracture. In conclusion, currently the fixed position for
BUA measurement is preferable and, whilst we have demonstrated that it is possible to locate an anatomically consistent point
in the calcaneus, the position chosen by this study did not provide a measurement with more discriminatory capability than
the fixed position. In women, BUA behaves similarly to bone mineral density in relation to stature and in its strength of
association with past fracture, while the lack of association in men may reflect differing contributions by bone strength
to fracture risk in the sexes.
Received: 13 January 1999 / Accepted: 25 March 1999 相似文献
10.
Ultrasound Measurements for the Prediction of Osteoporotic Fractures in Elderly People 总被引:13,自引:7,他引:6
In this prospective study we investigated the predictive value of quantitative ultrasound (QUS) measurements and other potential
predictors of osteoporotic fractures in the elderly. During a 1-year period, 710 participants (132 men and 578 women), aged
70 years and older (mean age ± SD: 82.8 ± 5.9), were recruited from seven homes and apartment houses for the elderly. QUS
measurements (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) were assessed with a clinical bone densitometer.
A structured questionnaire was used to collect information on other potential predictors. Follow-up of fractures was done
each half year by telephone interviews. During the study period (median follow-up 2.8 years, maximum 3.7 years), 30 participants
had a first hip fracture and 54 suffered from a first other nonspinal fracture. Cox regression analyses, adjusted for age
and sex, showed that the relative risk (RR) of hip fracture for each standard deviation reduction was 2.3 (95% CI, 1.4–3.7)
for BUA and 1.6 (95% CI, 1.1–2.3) for SOS. Slightly weaker relationships were found for any fracture (BUA: RR, 1.6; 95% CI,
1.2–2.1; SOS: RR, 1.3; 95% CI, 1.0–1.6). Multivariable analyses identified low BUA values and immobility as the strongest
predictors for hip fractures and any fracture. Female gender proved to be the strongest predictor for other nonspinal fractures.
It can be concluded that QUS measurements can predict the risk for hip fracture and any fracture in elderly people.
Received: 23 July 1998 / Accepted: 19 November 1998 相似文献
11.
The aim of this study was to establish a normative database, assess precision, and evaluate the ability to identify women
with low bone mass and to discriminate women with fracture from those without for a highly portable, scanning calcaneal ultrasonometer:
the QUS-2. Fourteen hundred and one Caucasian women were recruited for the study. Among them were 794 healthy women 25–84
years of age evenly distributed per 10-year period to establish a normative database. Of these, 171 aged 25–34 years were
defined as the young normal group for the purpose of T-score determination. Precision was assessed within 1 day (short-term) and over a 16-week period (long-term) in 79 women aged
25–84 years. Five hundred twenty-eight women ranging from 50 to 84 years of age with or without prevalent fractures of the
spine, hip or forearm were measured to compare the QUS-2 with bone mineral density (BMD) of the hip and spine. Mean calcaneal
broadband ultrasound attenuation (BUA) was constant in healthy women from 25 to 54 years of age and decreased with increasing
age thereafter. Short-term precision, with and without repositioning of the heel, and long-term precision yielded comparable
results (BUA SDs of 2.1–2.4 dB/MHz, coefficients of variations (CVs) of 2.5–2.9%). Calcaneal BUA was significantly correlated
with BMD of the total hip (TH), femoral neck (FN) and lumbar spine (LS) in 698 women (r= 0.6–0.7, all p<0.0001). A similar relationship was observed for LS BMD compared with either TH or FN BMD (r= 0.7, p<0.0001). Prevalence of osteoporosis in our population (WHO criteria) was 20%, 17%, 21%, and 24% for BUA, BMD of the TH, FN
and LS, respectively. Age-adjusted values for a 1 SD reduction in calcaneal BUA and TH and FN BMD predicted prevalent fractures
of the spine, forearm, and hip with significant (p<0.05) odds ratios of 2.3, 2.0 and 2.1, respectively. Areas under the receiver operating characteristic curves for age-adjusted
bone mass values predicting prevalent fracture were 0.62 for BUA, 0.59 for TH BMD, 0.60 for FN BMD, and 0.57 for LS BMD; all
statistically equivalent. We conclude that the QUS-2 calcaneal ultrasonometer exhibits reproducible clinical performance that
is similar to BMD of the spine and hip in identifying women with low bone mass and discriminating women with fracture from
those without.
Received: 19 July 2000 / Accepted: 6 December 2000 相似文献
12.
Quantitative ultrasound (QUS) has been proposed as a tool which can measure both the quantitative and qualitative aspects
of bone tissue and can predict the future risk of osteoporotic fractures. However, the usefulness of QUS in long-term monitoring
has yet to be defined. We studied a group of early postmenopausal women over a 4-year period. Thirty subjects were allocated
to hormone replacement therapy and 30 selected as controls matched for age, years past the menopause (YPM) and bone mineral
density (BMD) at the anteroposterior spine (AP spine). The mean age of the subjects was 52.4 years (SD 3.9 years), mean YPM
4.0 years (SD 3.2) and all subjects had a BMD T-score above −2.5 SD (number of standard units related to the young normal mean population). BMD was measured at baseline
and annually by dual-energy X-ray absorptiometry (DXA) at the AP spine and total hip, and QUS carried out at the calcaneus,
measuring broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness. Mean percentage changes from baseline
were assessed at 2 and 4 years. The overall treatment effect (defined as the difference in percentage change between the two
groups) was: AP spine BMD, 11.4%; total hip BMD, 7.4%; BUA, 6.4%; SOS, 1.1%; and Stiffness, 10.4% (p<0.01). To compare the long-term precision of the two techniques we calculated the Standardized Precision, which for QUS was
approximately 2–3 times that of DXA, for a given rate of change. The ability of each site to monitor response to treatment
was assessed by calculating the Treatment Response Index (Treatment Effect/Standardized Precision), which was: AP spine BMD,
10.4; total hip BMD, 3.9; BUA, 3.1; SOS, 0.3; and Stiffness, 4.2. This was then normalized for AP spine BMD (to compare the
role of QUS against the current standard, AP Spine BMD), which was: total hip BMD, 0.38; BUA, 0.30; Stiffness, 0.40 (p<0.01); and SOS, 0.03 (NS). In summary, QUS parameters in the early menopause showed a similar rate of decline as AP spine
BMD and total hip BMD measured by DXA. Hormone replacement therapy results in bone gain at the AP spine and total hip, and
prevents loss in BUA and SOS measured by QUS at the calcaneus. QUS has a potential role in long-term monitoring, although
presently the time period to follow individual subjects remains 2–3 times that for DXA, for a given rate of change. Anteroposterior
spine remains the current optimal DXA monitoring site due to its greater rate of change and better long-term precision.
Received: 20 January 1999 / Accepted: 14 June 1999 相似文献
13.
Petra J Buizert Natasja M van Schoor Paul Lips Dorly JH Deeg Elisabeth M Eekhoff 《Journal of bone and mineral research》2009,24(6):1103-1109
Epidemiological observations support a positive relationship between cardiovascular diseases (CVD) and osteoporosis, where cholesterol has been indicated to be a possible link. Only a few studies have investigated the relation between lipids and BMD, but the association remains unclear. We studied the relationship between serum lipids and BMD of the calcaneus. A cross‐sectional population‐based study was performed, based on data from the Longitudinal Aging Study Amsterdam, including 620 men and 635 women, 65–88 yr of age. BMD was measured by quantitative ultrasound (QUS), velocity of sound (VOS; m/s), and broadband ultrasound attenuation (BUA; dB/MHz). Models were adjusted for age, body mass index, physical activity, smoking, alcohol, diabetes mellitus, hypertension, testosterone, and 25‐hydroxyvitamin D. No association was found between total cholesterol (TC) and QUS. Men and women in the highest quartile of high‐density lipoprotein cholesterol (HDL‐c) had a significantly lower QUS (men—VOS: β = ?20.8, p = 0.00; BUA: β = ?5.2, p = 0.02; women—VOS: β = ?18.6, p = 0.00) compared with men and women in the lowest quartile. An even stronger positive association was seen between TC/HDL‐c ratio and QUS (men—VOS: β = 21.8, p = 0.00; BUA: β = 5.5, p = 0.01; women—VOS: β = 19.2, p = 0.00; BUA: β = 3.6, p = 0.05). Our analysis shows that the lipid profile that is favorable in the prevention of CVD (i.e., high levels of HDL‐c and low TC/HDL‐c ratio) is unfavorable for QUS. These results indicate that HDL‐c levels do not explain the association between osteoporosis and CVD. 相似文献
14.
Quantitative Ultrasound of the Heel and Some Parameters of Bone Turnover in Patients with Acromegaly 总被引:2,自引:0,他引:2
Acromegaly caused by growth hormone (GH) hypersecretion is characterized by enhanced skeletal growth and soft tissue enlargement.
Insulin-like growth factor-1 (IGF-1) is the main peripheral mediator of GH action and it has a crucial role in the maintenance
of a normal bone mass. However, in some patients with acromegaly, secondary osteoporosis is observed, despite the strong anabolic
effect of GH and IGF-1 in bones. It is thought to be due to hypogonadism. The bone changes are accompanied by increased turnover.
The aim of this study was to assess bone properties by ultrasound and turnover in patients with acromegaly. The study was
carried out in 26 patients (13 men, 13 women): 14 with active acromegaly and 12 cured by surgery who had non-active disease.
Speed of sound (SOS), broadband ultrasound attenuation (BUA) and their combination Stiffness Index (SI) by quantitative ultrasound
(QUS) of the heel, hormonal status, serum osteocalcin (OC) concentration and the urinary excretion of pyridinoline collagen
crosslinks (PYR) were all studied. Controls were 20 age- and sex-matched healthy persons. We observed statistically significantly
lower QUS values in patients with active disease than in those whose disease was cured. The differences were more pronounced
in men. QUS values were lower in the entire group of patients compared with the controls; however, the differences were not
statistically significant. Serum OC concentrations and urinary PYR excretion were higher in active disease. Statistically
significant inverse correlations between serum GH levels and SOS (r=–0.58, p = 0.002); BUA (r=–0.66; p= 0.0001); T-score (r = −0,65, p= 0.0001) and Z-score (r=–0.66, p = 0.0001) were found only in male patients. No correlations between IGF-1, duration of the disease, OC, PYR and other data
studied were observed. In conclusion, we have shown decreased QUS parameters suggesting impaired bone properties and quality
in terms of density and elasticity in men, but not in women, with active acromegaly. This finding suggests osteoporosis with
increased bone turnover. The above-mentioned changes might be caused by the action of GH on trabecular bone and its metabolism,
since no hypogonadism in male patients was shown. Moreover, the influence of acromegaly on heel geometry and soft tissue swelling
should also be considered.
Received: 20 February 2001 / Accepted: 23 October 2001 相似文献
15.
The aim of this study was to assess a dry calcaneal quantitative ultrasound (QUS) device by examining: (i) short- and long-term
precision; (ii) the ability of the ultrasound parameters to identify women with vertebral fractures; (iii) age- and menopause-related
bone loss; (iv) applicability of the WHO criteria in scan interpretation. The study group consisted of 422 healthy women with
no risk factors associated with osteoporosis (227 premenopausal and 195 postmenopausal) and 93 women with one or more vertebral
fractures. All women had calcaneal QUS and bone mineral density (BMD) measurements of the lumbar spine and hip performed.
Broadband ultrasound attenuation (BUA) and speed of sound (SOS) measurements in the heel were combined and expressed as estimated
heel BMD. Short-term precision studies yielded coefficient of variations of 0.3% for SOS, 4% for BUA and 3.3% for estimated
heel BMD. Standardized short-term precision values were approximately 0.2 SD. Long-term standardized precision errors ranged
from 0.17 to 0.38 SD. All the QUS and BMD measurement parameters showed significant negative relationships with age in the
postmenopausal group. Annual losses were 0.35 dB/MHz per year for BUA, 0.56 m/s per year for SOS and 0.002 g/cm2 per year for estimated heel BMD. All the QUS and BMD parameters were able to discriminate between healthy postmenopausal
women and women with vertebral fracture. Age-adjusted odds ratios for each SD decline in QUS measurements were 3.63, 5.25
and 4.79 for BUA, SOS and estimated heel BMD respectively. Corresponding odds ratios for BMD at the lumbar spine, femoral
neck and total hip were 2.39, 2.51 and 2.95 respectively. When the QUS and BMD parameters were expressed as T-scores, estimated heel BMD showed the least age-related decline, while femoral neck BMD displayed the greatest decrease with
age. The mean T-score and prevalence of osteoporosis (T<−2.5) for a Caucasian woman aged 60–65 years were −1.35 and 21% respectively for the lumbar spine compared with −0.59 and
2% for estimated heel BMD. In conclusion, this study revealed that contact ultrasound can detect age- and menopause-related
influences on bone status and was able to discriminate between healthy individuals and women with vertebral fracture. However,
the widely accepted threshold of a T-score of less than −2.5 for the definition of osteoporosis may need modifying for the interpretation of QUS scans.
Received: 8 February 1999 / Accepted: 5 May 1999 相似文献
16.
S. Daens A. Peretz V. de Maertelaer M. Moris P. Bergmann 《Osteoporosis international》1999,10(4):278-283
Bone loss due to corticosteroid treatment differs from that of postmenopausal osteoporosis with regard to bone structure.
Corticosteroids affect both horizontal and vertical trabeculae while horizontal trabeculae are damaged in postmenopausal osteoporosis.
Dual-energy X-ray absorptiometry (DXA) is the gold standard to evaluate bone loss. The place of quantitative ultrasound (QUS),
a technique that could theoretically provide information on bone structure, is not well established in corticosteroid-induced
bone impairment. The aim of the study was to determine the usefulness of QUS in the assessment of corticosteroid-induced bone
impairment. We hypothesized that the relationship between QUS and DXA could be influenced by changes in bone structure and
thus differ with regard to corticosteroid treatment. Seventy-seven women with inflammatory diseases chronically treated with
corticosteroids (dose: 7.5–15 mg/day), 29 without corticosteroids and 100 controls were investigated. Bone mineral density
at the lumbar spine (BMDL) was measured by DXA and QUS parameters were measured at the calcaneus. Both the QUS parameters
(SOS, BUA, Stiffness) and BMDL were significantly lower (by 1.3% for SOS, 5.8% for BUA, 12.7% for Stiffness and 11% for BMDL)
in patients treated with corticosteroids compared with patients not taking corticosteroids and with controls (p<0.001, ANCOVA, with age and height as covariates). Multiple linear regressions of Stiffness, SOS and BUA as dependent variables
on age, BMDL, corticosteroid treatment and a computed new variable designed to test the interaction between BMDL and the treatment
group showed that Stiffness, SOS and BUA were dependent on age and BMDL (p<0.001); BUA and Stiffness were dependent on treatment group. Taking into account the age of the patients, a significant difference
was observed in the relation between BUA and BMDL according to treatment with corticosteroids. A similar difference was found
in the subgroup of patients without fractures. SOS and BUA were strongly correlated but their relation did not differ according
to treatment. Thus, QUS is useful in the assessment of corticosteroid-associated bone loss. Furthermore, the observation of
a significant difference in the relationship between BUA and BMDL with regard to corticosteroid treatment might support the
hypothesis that QUS, especially BUA, could give additional information about bone structure.
Received: 24 August 1998 / Accepted: 4 March 1999 相似文献
17.
S. M. F. Pluijm M. G. Dik C. Jonker D. J. H. Deeg D. J. H. Deeg G. J. van Kamp P. Lips P. Lips 《Osteoporosis international》2002,13(9):701-709
The aim of this study was to examine whether the presence of apolipoprotein E ε4 (ApoE ε4) is associated with a lower bone
mineral density (BMD), lower quantitative ultrasound (QUS) measurements, higher bone turnover and fracture risk, and whether
these relations are modified by gender and age. A total of 1406 elderly men and women (≥65 years) of the Longitudinal Aging
Study Amsterdam (LASA) participated in this study. In all participants, QUS measurements were assessed, as well as serum osteocalcin
(OC) and urine deoxypyridinolin (DPD/Cr urine). Follow-up of fractures was done each three months. In a subsample (n = 604), total body bone mineral content (BMC) and BMD of the hip and lumbar spine were measured. In addition, prevalent vertebral
deformities were identified on radiographs. In women, the presence of ApoE ε4 was associated with significantly lower femoral
neck BMD (g/cm2; mean ± SEM; ε4+, 0.64 ± 0.01 vs. ε4−, 0.67 ± 0.01; p= 0.04), lower trochanter BMD (g/cm2; mean ± SEM; ε4+, 0.58 ± 0.01 vs. ε4–, 0.61 ± 0.01; p= 0.01) and lower total body BMC (g; mean ± SEM; ε4+, 1787 ± 40.0 vs. ε4–, 1863 ± 23.8; p= 0.04). Women with ApoE ε4 also had a higher risk of severe vertebral deformities (OR=2.78; 95%CI: 1.21–6.34). In men, the
associations between ApoE status and both hip BMD and QUS depended on age. Only among the younger men (65–69 years) was the
presence of ApoE ε4 associated with lower BMD values. Bone markers and fractures were not associated with ApoE ε4 in either
women, or men. In conclusion, this large community-based study confirms the importance of ApoE ε4 as a possible genetic risk
factor related to BMD and vertebral deformities and demonstrates that its effect is gender related, and depends on age in
men only.
Received: 6 July 2001 / Accepted: 2 April 2002 相似文献
18.
G. A. Hawker G. A. Hawker S. A. Jamal S. A. Jamal R. Ridout R. Ridout C. Chase 《Osteoporosis international》2002,13(5):400-406
Identifying premenopausal women at risk for osteoporosis and related fractures is a potentially important way to reduce the
burden of illness from this disease as low peak bone mass is a risk factor for postmenopausal osteoporosis. We examined predictors
of ‘low’ peak bone mass in 668 healthy, pre-menopausal, Caucasian women ages 18–35 years. Predictors of bone mass were assessed
using a detailed, standardized interview. Bone mass was assessed using two measures: dual-energy X-ray absorptiometry (DXA)
at the femoral neck and lumbar spine, and quantitative ultrasound (QUS) of the heel, which evaluates stiffness, speed of sound
(SOS) and broadband ultrasound attenuation (BUA). Bone mass was considered ‘low’ if the corresponding Z-score was <–1.00 (DXA values, stiffness) or if values were in the lowest quintile (BUA, SOS). Using multivariate logistic
regression modeling, predictors of low bone mass based on QUS, DXA or both were determined. The mean age of the cohort was
27.3 years. Independent predictors of low bone mass by both DXA and QUS were: low body weight, menarche at age 15 years or later and physical inactivity as an adolescent. Individuals
with all three risk factors had a 92% chance of having low bone mass using both techniques. This suggests that a simple risk
factor assessment can identify most young women with low peak bone mass. Early intervention in this group of women may reduce
the risk for osteoporosis in later life.
Received: 2 June 2000 / Accepted: 20 November 2001 相似文献
19.
There is growing evidence to support the use of quantitative ultrasound (QUS) to identify fracture risk in late postmenopausal
women but few data are available in younger women. In order to address this issue all women between 45 and 75 years of age
registered in two general practices in Bournemouth, Dorset, UK were invited to attend for heel QUS. Measurements were made
in 79% of the 4018 women identified. The mean QUS results for 5-year age groups were very similar to those from reported reference
ranges from North America and the north of England. The odds ratios (95% confidence limits) for self-reported fractures after
45 years per standard deviation of age-adjusted QUS parameters were: broadband ultrasound attenuation (BUA) = 1.40 (1.26–1.56),
speed of sound (SOS) = 1.56 (1.41–1.74) and Stiffness = 1.52 (1.37–1.68). The results suggest that QUS is associated with
fracture history in early postmenopausal women.
Received: 11 March 1997 / Accepted: 12 October 1997 相似文献
20.
B. Cortet C. Cortet F. Blanckaert M. d’Herbomez X. Marchandise J.-L. Wémeau M. Decoulx D. Dewailly 《Osteoporosis international》2001,12(2):117-123
Quantitative ultrasound (QUS) of bone is a valuable tool in the assessment of postmenopausal osteoporosis. QUS and new markers
of bone turnover have been poorly assessed in Cushing’s syndrome, however. Twenty-five patients with Cushing’s syndrome (20
women, 3 men; mean age ± SEM: 38 ± 2 years) were studied and compared with 35 age- and sex-matched control patients (mean
age ± SEM: 38 ± 2 years). The following variables were measured in both groups: QUS parameters at the heel (BUA; SOS; Stiffness
Index, SI); bone mineral density (BMD) at both the lumbar spine (LS) and femoral neck (FN) by dual-energy X-ray absorptiometry;
and serum markers of bone turnover (osteocalcin, procollagen type I N- and C-terminal propeptides (PINP and PICP), bone alkaline
phosphatase (BAP), procollagen type I C-terminal telopeptide (ICTP) and urinary type I collagen C-telopepetide breakdown products
(CTX)). Both BUA and SI were decreased in patients with Cushing’s syndrome (p<0.01) but not SOS (p=0.08). BMD was also strongly decreased in Cushing’s syndrome, at both the LS and FN (p<0.005). The two markers of bone turnover statistically significantly different between the two groups were osteocalcin (mean
± SEM: 3.5 ± 0.7 ng/ml (Cushing’s syndrome) vs 6.4 ± 0.5 ng/ml (controls, p<0.01)) and CTX (mean ± SEM: 148.7 ± 17.1 μg/mmol Cr (Cushing’s syndrome) vs 220.8 ± 22.9 μg/mmol Cr (controls), p<0.05). The areas under the receiver operating characteristic curve (AUC) were 0.72 (BUA), 0.73 (SI), 0.90 (BMDLS), 0.81 (BMDFN), 0.83 (osteocalcin) and 0.64 (CTX) respectively. AUC was significantly higher for BMDLS than for both BUA and SI (p<0.05). Conversely AUC was not statistically significantly different for BMDFN as compared with either BUA or SI. AUC was also higher for osteocalcin than for other markers of bone turnover. In conclusion,
QUS of bone seems to be a relevant tool for assessing bone involvement in Cushing’s syndrome. QUS does have a lower sensitivity
compared with DXA, however, and the relevance of QUS cannot be ascertained until some longitudinal data are forthcoming. Except
for CTX, the other new markers of bone turnover assessed in this study (PINP, PICP, BAP and ICTP) do not seem of interest
in Cushing’s syndrome.
Received: February 2000 / Accepted: 24 August 2000 相似文献