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1.
Evaluation of a New Calcaneal Quantitative Ultrasound System and Determination of Normative Ultrasound Values in Southern Chinese Women 总被引:2,自引:0,他引:2
Quantitative ultrasound (QUS) assessment at the calcaneus has been found to be a safe and reliable method for evaluating
skeletal status. The present study aimed at evaluating the precision of the Sahara bone ultrasound densitometer and to determine
the normative QUS data in healthy southern Chinese women. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and
qualitative ultrasound index (QUI) were determined. The long-term in vitro precision of the Sahara machine over 6 months was
4.6% for BUA and 0.39% for SOS. The short-term in vivo precision was 3.2 ± 1.3% for BUA, 0.3 ± 0.2% for SOS and 1.8 ± 1.0%
for QUI. The standardized precision for BUA, SOS and QUI was 4.4, 3.8 and 2.2 respectively. The normative data were determined
in 1086 healthy subjects. Postmenopausal women had significantly lower BUA, SOS and QUI levels than the premenopausal women.
Significant negative correlations were observed between QUS indices and age. Bone mineral density (BMD) assessments was performed
on 349 of these subjects. BUA correlated significantly with lumbar spine BMD (r; = 0.326) and femoral neck BMD (r= 0.395). Similar correlations were observed between SOS, QUI and BMD, with r values ranging between 0.446 to 0.522. Despite the fact that Chinese women have significantly lower BMD values than Caucasian
women, the mean BUA values for pre- and postmenopausal Chinese women (73 ± 18 and 59 ± 18 dB/MHz respectively) were almost
the same as those reported for Caucasian womeo. These normative data will be useful in the assessment of southern Chinese
women with fracture risk.
Received: 7 May 1998 / Accepted: 18 August 1998 相似文献
2.
The aim of this study was to compare quantitative ultrasound (QUS) measurements obtained using a new calcaneal QUS imaging
device with a conventional non-imaging device using fixed transducers. The study group consisted of 340 healthy women with
no risk factors associated with osteoporosis (176 premenopausal and 164 postmenopausal) and 83 women with one or more vertebral
fractures. All women had QUS measurements performed on the Osteometer DTU-one (imaging) and Walker-Sonix UBA575+ (non-imaging)
devices and bone mineral density (BMD) measurements performed at the spine and hip. A subgroup of 81 women had additional
dual-energy X-ray absorptiometry (DXA) scans at the calcaneus. Short-term standardized precision (SP = SD/young adult SD)
based on duplicate measurements was significantly better on the DTU for broadband ultrasound attenuation (BUA) (SP: DTU 0.15
vs UBA 0.21, p= 0.01) and speed of sound (SOS) (SP: DTU 0.14 vs UBA 0.18, p= 0.01). However, long-term SP of the DTU was comparable to or significantly poorer than the SP of the UBA device. The BUA
and SOS measurements obtained on the DTU and UBA were significantly correlated (r= 0.76 and 0.89 for BUA and SOS measurements respectively). The correlations between QUS and BMD measurements were all significant,
ranging from 0.53 to 0.72. No significant improvements in the correlation with axial or peripheral BMD were observed using
the imaging device. All the QUS measurement parameters showed a significant negative relationship between age and years since
menopause in the postmenopausal group. Annual losses were lower for the DTU for BUA (DTU 0.22 dB/MHz per year vs UBA 0.44
dB/MHz per year) but comparable for SOS (DTU 0.29 m/s per year vs UBA 0.22 m/s per year). However, when these figures were
standardized to take into account the clinical range, the annual losses were similar on the DTU and UBA. Age-adjusted odds
ratios for each SD decline were similar on the DTU for BUA (DTU 3.2 vs UBA 3.3) and SOS (DTU 3.4 vs UBA 5.1). The corresponding
odds ratios for BMD at the lumbar spine, femoral neck and total hip were 2.7, 2.9 and 3.3 respectively. Age-adjusted receiver-operating
characteristics analysis yielded values for the area under the curve (AUC) ranging from 0.74 to 0.83. The DTU BUA AUC of 0.83
was significantly greater than the AUC obtained for UBA BUA and BMD measurements at the lumbar spine and femoral neck. Ultrasound
imaging at the calcaneus was found to improve the standardized precision of BUA and SOS measurements in the short term but
not in the long term. Neither the correlation with BMD nor the discriminatory ability of QUS was improved by utilizing QUS
images at the calcaneus. The inconsistencies of the imaging system used for this study demonstrate that further development
is required before it will be possible to show improvements in long-term precision.
Received: 18 June 1999 / Accepted: 29 October 1999 相似文献
3.
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
4.
M. Sosa P. Saavedra M. Mu?oz-Torres J. Alegre C. Gómez J. González-Macías N. Gua?abens F. Hawkins C. Lozano M. Martínez J. Mosquera R. Pérez-Cano M. Quesada E. Salas the GIUMO Study Group 《Osteoporosis international》2002,13(6):487-492
Quantitative ultrasound (QUS) assessment at the calcaneus has been found to be a safe and reliable method for evaluating
skeletal status. In this study we have determined the normative QUS data in the Spanish population for the Sahara Clinical
Sonometer (Hologic). Broadband ultrasound attenuation (BUA), speed of sound (SOS), quantitative ultrasound index (QUI) and
estimated bone mineral density (BMD) were determined. We also studied the precision in vivo and in vitro. The short-term in
vivo precision (CV) was 4.88% for BUA, 0.36% for SOS, 3.45% for QUI and 4.15% for BMD, while in vitro precision was 0.40%
for SOS and 2.67% for BUA. Our results are comparable to reference population data previously published in other countries
and may serve as reference normative data for both genders in Spain.
Received: 9 November 2001 / Accepted: 3 January 2002 相似文献
5.
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
6.
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
7.
E. W. Gregg A. M. Kriska L. M. Salamone R. L. Wolf M. M. Roberts R. E. Ferrell S. J. Anderson L. H. Kuller J. A. Cauley 《Osteoporosis international》1999,10(5):416-424
Quantitative ultrasound (QUS) assessment of bone is a strong predictor of hip fractures and is currently an FDA-approved
tool to identify women at risk of osteoporosis. However, few studies have investigated the lifestyle and genetic correlates
of QUS in women. This study investigated the cross-sectional associates of several lifestyle, demographic and genetic factors
with calcaneal QUS parameters (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) in 393 women aged 45–53 years.
Leisure-time and historical physical activity, dietary calcium and protein, body composition, vitamin D receptor genotypes,
menopause status, other health behaviors, calcaneal QUS parameters and bone mineral density (BMD) were assessed at a single
clinic visit. Lean mass, recent physical activity and African-American race were the strongest correlates of SOS whereas dietary
protein, calcium and recent physical activity were the strongest correlates of BUA. These predictors explained 13% and 6%
of the variance in SOS and BUA, respectively. Smoking, alcohol intake, education, hormone replacement therapy, calcium and
vitamin D supplements, historical physical activity and vitamin D receptor genotypes were not significantly associated with
BUA or SOS. Lean body mass and premenopausal status were the strongest correlates of lumbar BMD whereas lean body mass, physical
activity, African-American race and body mass index were significantly related to femoral neck BMD. Physical activity remained
predictive of SOS after controlling for lumbar BMD. The spectrum and magnitude of risk factors for SOS and BUA, including
lean body mass, physical activity, race, protein and calcium intake, parallel previously observed predictors of BMD.
Received: 25 November 1998 / Accepted: 1 April 1999 相似文献
8.
Quantitative Ultrasound and Bone Mineral Density in Patients with Primary Hyperparathyroidism Before and after Surgical Treatment 总被引:2,自引:0,他引:2
S. Gonnelli A. Montagnani C. Cepollaro R. Monaco L. Gennari B. Rossi S. Pacini C. Gennari 《Osteoporosis international》2000,11(3):255-260
The aim of this study was to assess the pattern of ultrasound (QUS) parameters and bone mineral density at different skeletal
sites in patients with primary hyperparathyroidism (PHPT) before and after surgical treatment. In 22 patients (age range 28–74
years) with PHPT we measured speed of sound (SOS), attenuation (BUA) and Stiffness at the calcaneus, amplitude-dependent speed
of sound (AD-SoS) at proximal phalanges, and bone mineral density at lumbar spine (BMD-LS) and at the mid-radius (BMD-MR)
and ultradistal radius (BMD-UDR) before, 1 and 2 years after surgical operation. Twenty-two age- and sex-matched healthy subjects
provided control data. Before surgery, all parameters apart from SOS were significantly lower in PHPT patients than in controls.
At the end of the study period, BMD-LS increased by 7.0%, BMD-UDR by 7.4% and BMD-MR by 11.0%. The changes in ultrasound parameters
after surgery were lower (0.44% for SOS, 2.2% for BUA, 3.3% for Stiffness and 2.6% for AD-SoS); however, the increase was
statistically significant (p<0.05 and p<0.01, respectively) only for Stiffness and AD-SoS. Our results indicate that parathyroidectomy increases both axial and appendicular
BMD and influences QUS parameters differently at the calcaneus and at the phalanges. The combined use of BMD and QUS could
improve the assessment of skeletal status in patients with PHPT before and after surgery.
Received: 22 January 1999 / Accepted: 25 August 1999 相似文献
9.
Quantitative Ultrasound of the Calcaneus and Falls Risk in the Institutionalized Elderly: Sex Differences and Relationship to Vitamin D Status 总被引:2,自引:0,他引:2
J. Zochling Y. Y. Sitoh T. C. Lau I. D. Cameron R. G. Cumming S. R. Lord J. Schwarz A. Trube L. M. March P. N. Sambrook 《Osteoporosis international》2002,13(11):882-887
Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially
to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing
fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls
risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin
D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men
(mean age 81.2 years, range 65–102 years) and 899 women (mean age 86.7 years, range 65–104 years). Broadband ultrasound attenuation
(BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively (p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women (p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex.
There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8–4.7% per decade and
VOS by 1% per decade (both p<0.001). Mean BUA T-scores were −1.55 and −2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly
associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either
sex.
Received: 7 March 2002 / Accepted: 5 June 2002
Correspondence and offprint requests to: Professor Philip Sambrook, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Tel: +61 2 9926 7281. Fax: +61 2
9906 1859. e-mail: sambrook@med.usyd.edu.au 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.
S. Gonnelli C. Cepollaro A. Montagnani S. Martini L. Gennari. M. Mangeri C. Gennari 《Osteoporosis international》2002,13(5):415-421
The possibility of using quantitative ultrasound (QUS) in monitoring the response to antiresorptive drugs has yet to be defined.
The aim of the present study was to evaluate whether heel ultrasonography, considering its characteristics of long-term precision,
is able to monitor osteoporotic patients treated with alendronate. We studied 150 postmenopausal osteoporotic women (age 59.6
± 5.3 years) treated with alendronate and calcium (n= 74) or with calcium alone (n= 76) for 4 years. At baseline and after 12, 24, 36 and 48 months, we measured bone mineral density (BMD) at the lumbar spine
by dual-energy X-ray absorptiometry (DXA, Hologic 4500), and speed of sound (SOS), broadband ultrasound attenuation (BUA)
and Stiffness at the calcaneus by Achilles plus. Moreover, the longitudinal precision of QUS parameters was assessed by measuring
10 subjects once a month for 1 year and, on the basis of the coefficients of variation we obtained, we calculated the Least
Significant Change between two measurements. In the alendronate-treated patients, at year 1, BMD increased by 4.2%, SOS by
0.4%, BUA by 1.1% and Stiffness by 3.2%; at year 2, BMD increased by 5.0%, SOS by 0.7%, BUA by 1.4% and Stiffness by 5.7%.
At year 3, BMD increased by 6.2%, SOS by 0.9%, BUA by 1.8% and Stiffness by 7.6%. At the end of the study period, BMD increased
by 7.6%, SOS by 1.2%, BUA by 1.9% and Stiffness by 9.0%. The minimal significant difference between two measurements was 0.8%
for SOS, 5.6% for BUA and 5.0% for Stiffness. Among the QUS parameters, Stiffness showed the greatest total treatment effect
and a longitudinal sensitivity which was only slightly lower than BMD. The MTI, which represents the period between scans
required to show that a ‘true’ change has occurred, was 1.8, 2.7, 11.9 and 2.2 years for BMD, SOS, BUA and Stiffness respectively.
Therefore, although the spinal BMD remains the optimal method, QUS at the heel, and in particular Stiffness, seems to be a
sensitive tool for monitoring the response to alendronate.
Received: 30 August 2001 / Accepted: 29 November 2001 相似文献
12.
Y. Q. He B. Fan D. Hans J. Li C. Y. Wu C. F. Njeh S. Zhao Y. Lu E. Tsuda-Futami T. Fuerst H. K. Genant 《Osteoporosis international》2000,11(4):354-360
The incidence of osteoporotic hip fracture increases in postmenopausal women with low hip bone mineral density (BMD). Dual
X-ray absorptiometry (DXA) is the most commonly used technique for the assessment of bone status and provides good measurement
precision. However, DXA affords little information about bone architecture. Quantitative ultrasound (QUS) systems have been
developed to evaluate bone status for assessment of fracture risk. Our study was designed to assess a new QUS system from
Hologic, the Sahara; to compare it with a previous model, the Walker-Sonix UBA 575+; and to investigate whether it is able
to discriminate between women with and without fracture. Using both ultrasound devices, the measurements were performed at
the heels of 33 postmenopausal women who had recently sustained hip fracture. A control group of 35 age-matched postmenopausal
women was recruited for comparison. The total, neck and trochanter femoral BMD values were assessed using DXA for both groups.
QUS and DXA measurements were significantly lower in fractured patients (p<0.005) than in the control group. The short-term, mid-term and standardized short-term precisions were used to evaluate the
reproducibility of the two QUS systems. The Sahara showed a better standardized coefficient of variation for broadband ultrasound
attenuation (BUA) than did the UBA 575+ (p<0.001). The correlation of BUA and speed of sound (SOS) between the two QUS devices was highly significant, with an r value of 0.92 for BUA and 0.91 for SOS. However, the correlation between DXA and ultrasound parameters ranged from 0.28 to
0.44. We found that ultrasound measurements at the heel were significant discriminators of hip fractures with odds ratios
(OR) ranging from 2.7 to 3.2. Even after adjusting the logistic regressions for total, neck or trochanter femoral BMD, QUS
variables were still significant independent discriminators of hip fracture. The areas under the ROC curves of each ultrasound
parameter ranged from 0.75 to 0.78, and compared very well with femoral neck BMD (p>0.05). In conclusion, our study indicated that the calcaneal QUS variables, as measured by the Sahara system can discriminate
hip fracture patients equally as well as hip DXA.
Received: 29 October 1999 / Accepted: 7 September 1999 相似文献
13.
J. P. W. van den Bergh A. R. M. M. Hermus A. I. Spruyt C. G. J. Sweep F. H. M. Corstens A. G. H. Smals 《Osteoporosis international》2001,12(1):55-62
Klinefelter’s syndrome (KS) is a common sex chromosomal disorder associated with androgen deficiency and osteoporosis. Only
few bone mineral density (BMD) and no quantitative ultrasound (QUS) data are available in these patients after long-term testosterone
replacement therapy. We examined in a cross-sectional study 52 chromatin-positive KS patients aged 39.1 ± 12.4 years (mean
± SD). Patients had been treated with oral or parenteral androgens for 9.2 ± 8.2 years (range 1–32 years). Areal BMD and bone
mineral apparent density (BMAD, i.e., estimated volumetric BMD) at the lumbar spine, total hip and femoral neck were determined
by dual-energy X-ray absorptiometry. BMD T-scores in the patient group were calculated based on three different North American reference databases. The QUS parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus using an ultrasound imaging
device (UBIS 3000) and were compared with QUS results in a sex-, age- and height-matched control group. QUS T-scores were calculated based on the results of QUS measurements in 50 normal Dutch men between the ages of 20 and 30 years.
QUS and BMD results in the KS patient group were compared. Overall, based on the three reference databases, 46% and 63% of
the KS patients had a T-score between −1 and −2.5 and a further 10% and 14% had a T-score ≤−2.5 at the total hip and/or lumbar spine, as measured by areal BMD or BMAD, respectively. Thirty-nine percent of
the KS patients had a T-score between −2.5 and −1, while 2% had a T-score ≤−2.5 for BUA and/or SOS. BUA (77.7 ± 15.0 dB/MHz) and SOS (1518.8 ± 36.5 m/s) were significantly lower in the KS patients
than in age- and height-matched controls (87.1 ± 17.8 dB/MHz, p<0.005, and 1536.5 ± 42.5 m/s, p<0.05). Correlation coefficients between the QUS parameters and areal BMD (0.28 to 0.37) or BMAD (0.27 to 0.46) were modest.
ROC analysis showed that discrimination of a BMD or BMAD T-score ≤−2.5 with either BUA or SOS was not statistically significant.
Although a limitation of our study is that direct comparison of BMD and QUS T-scores is not possible because in the control group in which QUS parameters were determined no BMD measurements were performed,
we conclude that despite long-term testosterone replacement therapy, a considerable percentage of patients with KS had a BMD
T-score <−1 or even ≤−2.5, based on different North American reference databases. This percentage was even higher for BMAD.
QUS parameters were also low in the KS patient group when compared with Dutch control subjects. QUS parameters cannot be used
to predict BMD or BMAD in KS patients.
Received: 28 February 2000 / Accepted: 3 August 2000 相似文献
14.
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
15.
Low bone density as assessed by calcaneal ultrasound has been associated with mortality in elderly men and women. We examined
the relationship between bone density measured at the hip and all cause and cardiovascular mortality in elderly men. Men aged
65–76 years from the general community were recruited from general practices in Cambridge between 1991 and 1995. At baseline
survey, data collection included health questionnaires, measures of anthropometry and cardiovascular risk factors, as well
as bone mineral density (BMD) measured using dual energy X-ray absorptiometry. All men have been followed up for vital status
up to December 1999. BMD was significantly inversely related to mortality from all causes and cardiovascular disease, with
decreasing rates with increasing bone density quartile, and an approximate halving of risk between the bottom and top quartile
(p <0.002, test for trend all causes and p <0.025, test for trend for cardiovascular deaths). In multivariate analyses using the Cox proportional hazards model, an
increase of 1 standard deviation (0.144 g/cm2) in total hip bone density was significantly associated with an age-adjusted 0.77 relative risk (95% CI 0.66–0.91) for all-cause
mortality and 0.76 relative risk (95% CI 0.62–0.93) for cardiovascular disease mortality. The association remained significant
after adjusting for age, body mass index, cigarette smoking status, serum cholesterol, systolic blood pressure, past history
of heart attack, stroke or cancer and other lifestyle factors which included use of alcohol, physical activity and general
health status. Low bone density at the hip is thus a strong and independent predictor of all-cause and cardiovascular mortality
in older men.
Received: 16 August 2000 / Accepted: 27 October 2000 相似文献
16.
Does the Combination of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry Improve Fracture Discrimination? 总被引:6,自引:0,他引:6
The widespread availability of quantitative ultrasound (QUS) and X-ray absorptiometry densitometers raises the question of
whether a combination of QUS and bone mineral density (BMD) measurements could provide a clinically useful method of enhancing
the prediction of fracture risk. The aim of this study was to examine whether a combination of axial BMD and calcaneal QUS
measurements can enhance fracture discrimination compared with either method alone. The study population consisted of 154
postmenopausal women with a history of atraumatic fracture at the spine, hip or forearm and 221 healthy postmenopausal women
with no clinical risk factors for osteoporosis. Subjects had dual-energy X-ray absorptiometry (DXA) measurements of the lumbar
spine (LS), femoral neck (FN) and total hip (THIP) and calcaneal broadband ultrasound attenuation (BUA) and speed of sound
(SOS) measurements on the Hologic Sahara (SAH) and Osteometer DTUone (DTU). Z-scores were calculated using the mean and SD obtained from the healthy postmenopausal group. Logistic regression analysis
yielded odds ratios for BMD measurements at the LS, FN and THIP of 2.2, 2.2 and 2.3, respectively. The odds ratios obtained
for QUS measurements ranged from 2.5 for DTU BUA to 3.3 for SAH SOS. While these odds ratios for QUS measurements were higher
than those obtained for BMD measurements, the differences were not statistically significant. When the odds ratios for QUS
were adjusted for BMD at the spine and hip, the odds ratios remained significant in all cases indicating that QUS and BMD
variables contribute independently to fracture discrimination. When the BMD-adjusted odds ratios were compared with those
for QUS alone, they were slightly lower but not significantly so. When the QUS measurements were adjusted for THIP BMD, the
odds ratios for QUS tended to be lower than when adjusted for LS and FN BMD. The Z-scores for each of the QUS measurement variables were combined with spine or hip Z-scores. Logistic regression analysis of the QUS and BMD combined Z-scores yielded slightly higher odds ratios of approximately 3.1 (compared with 2.9 obtained for QUS alone) and increases
in the area under the curve of approximately 2%. However, these increases were not clinically significant. In conclusion,
the combination of axial BMD and calcaneal QUS measurements did not significantly improve fracture discrimination compared
with either method alone.
Received: 29 June 2000 / Accepted: 18 December 2000 相似文献
17.
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
18.
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
19.
M. Sundberg P. Gärdsell O. Johnell E. Ornstein I. Sernbo 《Osteoporosis international》1998,8(5):410-417
We performed ultrasound measurements (QUS) of the calcaneus in a population-based setting on 280 healthy children, aged 11–16
years, from a small urban area in southern Sweden. The results are compared with dual-energy X-ray absorptiometry (DXA) measurements
in the total body, the lumbar spine and the hip, as well as single-energy X-ray absorptiometry (SXA) of the forearm. Normative
data and correlations between the three different techniques were determined. We found significant correlations between QUS
and age (r= 0.34–0.54), height (r= 0.13–0.56) and weight (r= 0.30–0.60), and between QUS and bone mineral density (BMD) measurements (r= 0.44–0.70). Boys increased all their bone mineral variables with age, whereas girls showed a decreasing trend from age 15
years. QUS had a significantly higher increase in standardized value with age than Ward's triangle BMD, but a significantly
lower increase in standardized value with age than distal radius (cortical site) BMD. At other BMD sites we did not find any
significant differences compared with QUS regarding changes with age. The measurements obtained by QUS, DXA and SXA, respectively,
were divided into quartiles. Of all subjects in the lowest quartile for QUS measurements, only 34–50% were also in the lowest
quartiles for DXA and SXA measurements. In conclusion, QUS measurements of the calcaneus in children show similar results
as for adult regarding the correlation with DXA and SXA; they also have a significant correlation with anthropometric data.
QUS did not identify the same individuals with low bone mass as the X-ray techniques.
Received: 23 June 1997 / Accepted: 21 January 1998 相似文献
20.
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