Bone mineral density and fracture in postmenopausal women

Summary This retrospective study examined bone mineral density (BMD) for discrimination of female patients with fractures. Bone densitometry was done in 146 patients over the age of 50 years at radius, lumbar spine, and proximal femur sites using single and dual photon absorptiometry. The patients were divided into three groups: (A) no osteoporotic fractures (n=92); (B) mild spine fractures with >15% compression (n=38); and (C) hip fractures (n=16). Groups B and C did not differ significantly from each other in BMD, but these groups differed significantly from group A for spine and femur BMD. No significant differences between groups were found for the radius. Receiver operating characteristic (ROC) analysis showed that the BMD of the proximal femur had the highest diagnostic sensitivity for both spine and femur fractures; the radius had the lowest overall sensitivity, and the spine was intermediate.     

Bone mineral density,ultrasound velocity,and broadband attenuation predict mechanical properties of trabecular bone differently

Measurement of areal bone mineral density (BMD(areal)), broadband ultrasound (US) attenuation (BUA), and speed-of-sound (SOS) are widely used ways to perform clinical assessment of bone quality. In this study, bovine (n = 37) and human (n = 32) trabecular bone was investigated in vitro and in vivo to reveal relationships between mechanical properties, mineral density, and US parameters BUA and SOS. To fulfill these aims, clinical US and dual-energy X-ray absorptiometry (DXA) techniques, as well as dynamic and destructive mechanical testing, were utilized. BUA correlated positively and linearly with BMD(areal) only in human calcaneus of low or moderate density (r = 0.849, n = 32, p < 0.01). When calcaneal areas with high BMD(areal) were included in the analysis, however, the in vivo study revealed that the BUA-BMD(areal) relationship could be described by a second-order polynomial fit (r(2) = 0.618, n = 408). In high-density human or bovine bone, the BUA-bone density relationship was negative. In the in vitro assessment, BUA correlated linearly and negatively with volumetric BMD (BMD(vol)) (r = -0.540, n = 29, p < 0.01) and with storage modulus, as measured at 1 Hz (r = -0.505, n = 28, p < 0.01). A weak positive correlation was found between BUA and mechanical loss tangent (r = 0.322, n = 28, p < 0.1). SOS correlated strongly positively with BMD(vol) (r = 0.888, n = 29, p < 0.01), as well with storage modulus (r = 0.649, n = 28, p < 0.01). In contrast, SOS correlated negatively with loss tangent (r = -0.417, n = 28, p < 0.05). When tested dynamically in the frequency range of 0.01-22.7 Hz, bovine trabecular bone was only slightly viscoelastic. In summary, the most accurate parameters for measuring storage modulus and strength of bovine trabecular bone were SOS and BMD(vol), respectively. BUA failed to predict the mechanical properties of high-density trabecular bone. In vivo mapping of the calcaneus revealed the importance of standardized and reproducible localization of the measurement site for the validity of BUA values.     

Bone properties as estimated by mineral density, ultrasound attenuation, and velocity

Quantitative ultrasound (QUS) analysis of bone has been suggested to have a level of performance equal to dual-energy X-ray absorptiometry (DXA) for the assessment of fracture risk. In this study, QUS and DXA measurements were conducted on bovine trabecular bone in vitro using commercially available clinical instruments. The samples were then mechanically tested to obtain Young’s modulus and ultimate strength. In addition, QUS and DXA parameters of the human calcaneus (n = 34) were measured in vivo. The measurements revealed a significant effect of bovine bone size on broadband ultrasound attenuation (BUA) and speed of sound (SOS) in vitro. By normalizing the DXA and QUS results with bone thickness we could systematically improve their ability to predict bone strength. However, in bovine trabecular bone, BUA showed no significant linear correlation with either bone mineral density (BMD), Young’s modulus, or ultimate strength. This finding may be typical of only high-density and low-porosity bovine bone. We significantly improved prediction of ultimate strength by combining density and ultrasound velocity results as compared with assessments of volumetric BMD_vol (p < 0.05) or SOS (p < 0.001) alone. However, the improvement was not significant if BMD_vol, instead of wet density, was used. Altogether, 88% of the variation in the ultimate strength of bovine bone could be explained by combined density and ultrasound velocity. In vivo, SOS showed a weak negative correlation with heel width (r = −0.350). The in vivo measurements also showed a close correlation for BUA with BMD in the human calcaneus. This suggests that BUA is more suitable for quantitative analysis of low-density trabecular bone.     

Long-term estrogen replacement therapy in postmenopausal women sustains vertebral bone mineral density

The cross-sectional relationship between long-term estrogen use and vertebral (L2-4) bone mineral density (BMD) was determined in 65 postmenopausal white women between 55 and 75 years who were at least 10 years from their menopause. Long-term estrogen users began therapy within 5 years of menopause and continued for a duration of at least 10 years. The mean duration of use was 19.8 years. Controls used estrogen for less than 1 year. There was a significant difference (p less than 0.02) in mean spinal BMD between estrogen users (1.219 g/cm2) and controls (1.092 g/cm2). There was no significant difference in age, height, weight, or dietary calcium (Ca) intake between the two groups. The statistical difference in BMD was retained when (1) 23 estrogen users were paired with age-matched controls, (2) only women with a natural menopause or history of bilateral oophorectomy were included, and (3) only women with a natural menopause were compared. A spinal BMD below the estimated fracture threshold of 0.965 g/cm2 was found in 11 of 40 controls and only 2 of 25 estrogen users. Comparison of estrogen users with a natural menopause to those with bilateral oophorectomy revealed no significant difference in BMD. These data confirm the salutary effect of long-term estrogen use in the maintenance of vertebral bone mass in postmenopausal women.     

Spine and femur density and broadband ultrasound attenuation of the calcaneus in normal Spanish women

Summary Bone density of the spine and femoral neck and broadband ultrasound attenuation of the calcaneus were measured in 111 normal Spanish women between the ages of 30 and 70 years. The cross-sectional study showed that spine and hip density decreased by 36 and 29%, respectively, and the ultrasound attenuation value decreased by 32% between 30 and 70 years of age. The rate of bone loss at the three sites was significant in women over age 50 and in postmenopausal women. These normative data will be helpful in assessing bone mass in Spanish women suspected of having osteoporosis.     

The relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women

The aim of this cross-sectional study was to use a novel method of data analysis to demonstrate that patients with osteoporosis have significantly lower ultrasound results in the heel after correcting for the effect of bone mineral density (BMD) measured in the spine or hip. Three groups of patients were studied: healthy early postmenopausal women, within 3 years of the menopause (n=104, 50%), healthy late postmenopausal women, more than 10 years from the menopause (n=75, 36%), and a group of women with osteoporosis as defined by WHO criteria (n=30, 14%). Broadband ultrasound attenuation (BUA), speed of sound (SOS) and Stiffness were measured using a Lunar Achilles heel machine, and BMD of the lumbar spine and left hip was measured using dual-energy X-ray absorptiometry (DXA). SOS, BUA and Stiffness were regressed against lumbar spine BMD and femoral BMD for all three groups combined. The correlation coefficients were in the range 0.52–0.58, in agreement with previously published work. Using a calculated ratio R, analysis of variance demonstrated that the ratio was significantly higher in the osteoporotic group compared with the other two groups. This implied that heel ultrasound values are proportionately lower in the osteoporotic group compared with the other two groups for an equivalent value of lumbar spine and femoral neck BMD. We conclude that postmenopausal bone loss is not associated with different ultasound values once lumbar spine or femoral neck BMD is taken into account. Ultrasound does not give additional information about patterns of bone loss in postmenopausal patients but is important in those patients with osteoporosis and fractures.     

绝经妇女骨密度变化与雌激素、生长激素水平的相关关系初探

收集61饲病例，分为生育年龄组13例，绝经前组10例，绝经后组38例，均进行血碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)、雌二醇(E2)、促卵泡素(FSH)、生长激素(GH)及空腹尿钙／尿肌酐(尿Ca／Cr)测定，其中3组进行定量CT测定腰椎骨密度(BMD)，分别为13、7、28例；其中绝经后组中10侧患者服用尼尔雌醇(CEE3)3个月：结果显示绝经后妇女BMD显著下降，其BMD与E2及GH呈正相关．在绝经早期组中BMD与尿Ca／Cr值呈负相关．诨步回归分析显示绝经年限对绝经后妇女BMD影响最大，其次为GH；服CEE3 3个月后血ALP显著下降，尿Ca／Cr显著下降，GH升高。本文提示GH的下降是绝经后骨代谢变化的膨响因素之：CEE，能有效防止绝经后妇女的骨丢失，但长期应用有待进一步的研究。     

Bone mineral density in women with sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Almost any organs of the body, but mostly the lungs, are involved. Bone mineral density (BMD) can be affected directly or indirectly in chronic granulomatous systemic diseases such as sarcoidosis. The aim of our study was to evaluate BMD in premenopausal and postmenopausal sarcoidosis patients with or without prednisone treatment and to compare their BMD values with those of a control group having the same menopausal status. Thirty-five premenopausal women (18 untreated, 8 treated, and 9 controls) and 21 postmenopausal women (5 untreated, 5 treated, and 11 controls) were included in the study. All of the patients had a histologically proven diagnosis and were being followed-up at the Sarcoidosis Outpatient Clinic of our unit. BMD of the lumbar (L) spine and femoral neck was measured by dual-energy absorptiometry (DEXA). The subgroups of premenopausals and postmenopausals were compared separately. Comparison among the groups was performed by using analysis of variance. Age, duration of the disease, and body mass index were comparable in treated, untreated, and control subgroups of the pre- and postmenopausal groups, and the subgroups of postmenopausals had comparable durations since menopause. For premenopausals, BMD values at L1–4 were not significantly different among the subgroups (0.920 ± 0.08g/cm², 0.801 ± 0.09g/cm², and 0.910 ± 0.05g/cm², for untreated, treated, and controls, respectively). However, the BMD value at the femoral neck in treated patients (0.921 ± 0.1g/cm²) was significantly lower than the values in untreated patients (1.080 ± 0.2g/cm²; P 0.01) and in controls (1.028 ± 0.17g/cm²; P 0.05). For postmenopausals, the BMD value at L1–4 in controls (1.019 ± 0.07g/cm²) was significantly higher than the values in untreated patients (0.783 ± 0.01g/cm²) and in treated patients (0.751 ± 0.08g/cm²; P 0.001 for both). The BMD value at the femoral neck in controls (0.890 ± 0.1g/cm²) was higher than the values in untreated patients (0.745 ± 0.08g/cm²) and treated patients (0.747 ± 0.1g/cm²), but the difference was not statistically significant (P = 0.06). We concluded that sarcoidosis patients, especially postmenopausal patients with corticosteroid treatment, may have an increased risk of bone mineral loss. Large-scale studies are warranted in order to delineate the exact roles of the disease itself, menopausal status, and corticosteroid treatment in this bone mineral loss.     

Comparison of broadband ultrasound attenuation to single X-ray absorptiometry measurements at the calcaneus in postmenopausal women

Broadband ultrasound attenuation (BUA), a radiation-free and portable technology, may be useful in assessing bone density and fracture risk. In this study, we compared cross-sectional BUA measurements to the more established single energy X-ray absorptiometry measurements of bone mineral density (BMD) at the calcaneus in 259 healthy postmenopausal women, aged 45–76 years. Paired measurements with repositioning of the subject's dominant heel were made consecutively by each method. A coefficient of variation (CV) for each method was calculated for each individual from the paired scans. BUA and BMD of the heel were also compared with BMD of the lumbar spine and femoral neck, as measured by dual energy X-ray absorptiometry. BUA was significantly correlated with BMD at the calcaneus (r=0.66, P<0.01). Heel BUA was also correlated with lumbar spine BMD (r=0.43, P<0.01) and femoral neck BMD (r=0.43, P<0.01) but the correlations were lower than those between heel BMD and spine (r=0.63, P<0.01) or femoral neck BMD (r=0.62, P<0.01). The mean CV for heel BUA (3.60±3.50%) was significantly greater than that for heel BMD (1.06±0.99%, P<0.01). The moderate correlation of calcaneal BUA and BMD, the lower correlations of BUA than heel BMD with both spine and hip BMD, and lower precision of BUA indicate BUA does not predict bone density as effectively as absorptiometry, the current standard methodology.The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.     

Bone mineral density, body mass index, postmenopausal period and outcomes of low back pain treatment in Korean postmenopausal women

Women going through menopause experience bone loss and increased musculoskeletal pain, including low back pain. This study explored the relationships between bone mineral density (BMD) and body mass index (BMI), postmenopausal period and outcomes of treatment for low back pain in postmenopausal Korean women. On examining the medical records of 78 postmenopausal women hospitalized for low back pain, investigators found that women with low BMD were older and had been postmenopausal for longer periods than women with normal BMD. Postmenopausal length was positively correlated with pain scores at day 15 and 20 post-admission (P = 0.011 and 0.006) and negatively correlated with T-scores (P = 0.002). BMI was positively correlated with T-scores (r = 0.283, P = 0.022). In conclusion, age, postmenopausal length and BMI correlate with BMD in Korean women suffering from LBP. Larger studies investigating the associations between menopause, BMD, BMI and LBP seem desirable. Moreover, evidence-based therapeutic approaches should be explored for BMD and LBP management.     

血糖控制对绝经后糖尿病妇女骨密度水平影响的研究

目的 分析血糖水平控制良好的绝经和绝经后Ⅰ型糖尿病、Ⅱ型糖尿病和非糖尿病妇女腰椎和髋部骨密度(BMD)变化特点及与相关因素的相互关系。方法 对绝经和绝经后排除其他影响骨代谢疾病的，并经内科治疗血糖水平控制良好的151例Ⅰ型糖尿病、270例Ⅱ型糖尿病和574非糖尿病妇女，用双能X线骨密度仪(DEXA)测量髋部和腰椎骨密度，通过计算机分析用SSPS10．0医学统计软件比较3类人群腰椎和髋部骨密度的差异及其与有关因素的相互关系。结果 血糖水平控制良好的绝经和绝经后Ⅰ型糖尿病、Ⅱ型糖尿病和非糖尿病妇女髋部和腰椎骨密度随年龄增长，绝经时间的延长和病程的延长呈同步下降趋势，其中以Ward’s区骨密度下降最为明显。同时随着年龄的增加，Ⅰ型糖尿病、Ⅱ型糖尿病和非糖尿病妇女骨质疏松及骨量减少的发生率呈明显增加的趋势。而且与年龄和绝经时间呈明显的负相关，其相关程度要大于与病程和体重的相关程度。结论 糖尿病妇女良好的血糖控制有利于其骨量的保护，但绝经后雌激素水平的下降乃是其骨量丢失的主要原因。     

Bone mineral density in postmenopausal Chinese women treated with calcium fortification in soymilk and cow's milk

Summary  

Eighteen months of daily consumption of milk containing 250 mg calcium prevented bone mineral density (BMD) loss at the hip and the femoral neck in postmenopausal Chinese women aged 45 to 65.     

Bone density changes with once weekly risedronate in postmenopausal women.

Risedronate 5 mg daily is approved by the Food and Drug Administration to treat postmenopausal osteoporosis. Gastrointestinal (GI) symptoms are common with daily bisphosphonates, but recent studies show that once weekly treatment may be better tolerated. Risedronate 30 mg is approved to treat Paget s disease of bone. In this retrospective study, we assessed the GI tolerability of 30 mg of risedronate once weekly and evaluated the effect on bone mineral density (BMD) in a subset of women. Review of patients treated in our osteoporosis clinic identified 150 postmenopausal women with low BMD treated with 30 mg of risedronate once weekly, between February 1998 and March 2001. Baseline GI symptoms or previous intolerance of bisphosphonates was present in 32 patients. An additional antiresorptive treatment was continued with risedronate in 50% of these patients (estrogen, raloxifene, or calcitonin). Risedronate 30 mg was taken once weekly with vitamin D 400 iu daily and 1200 mg of calcium daily. Patient age ranged from 46 to 86 yr. Baseline and followup BMD data were available in 36 patients. Of the 32 patients with baseline GI symptoms or previous intolerance of a bisphosphonate, 1 developed GI symptoms. In those patients with baseline and follow-up BMD results (n = 36), BMD increased 1.9% (p = 0.02) at the trochanter and 2.1% (p = 0.001) at the total hip. In conclusion 30 mg of risedronate once weekly increased BMD at the trochanter and total hip (p < 0.05). This dosage was well tolerated with a low incidence of GI side effects.     

Genistein effects on quantitative ultrasound parameters and bone mineral density in osteopenic postmenopausal women

Summary  

This study aimed at evaluating the effects of genistein (54 mg/die) on calcaneus and phalanges ultrasound (QUS) parameters and bone mineral density in osteopenic postmenopausal women. We concluded that genistein prevented bone loss in the osteopenic postmenopausal women and improves QUS parameters at the calcaneus and phalanges.     

不同孕期妇女跟骨骨量检测结果分析

目的 探讨不同孕期妇女骨量的变化，指导孕妇合理补钙。方法 采用UBIS5000型超声成像骨量仪，测量300例不同孕期健康妇女跟骨超声振幅衰减（BUA）参数值，并与同年龄组非孕妇女结果进行比较。结果 中，晚期孕妇骨量均值均低于非孕及早孕期妇女，晚孕组与非孕组比较差异有显性（P＜0．05）。结论 孕期妇女存在不同程度骨量减少。骨量测定对孕期保健指导有重要意义。     

安徽地区绝经后妇女雌激素受体基因多态性与骨密度的相关性研究

目的探讨安徽地区绝经后妇女雌激素受体（ER）基因多态性的分布及其与骨密度的相关性。方法随机选择288名安徽合肥地区健康绝经后妇女，运用双能X线骨密度吸收法（DEXA）测定腰椎和股骨颈、大转子骨密度（BMD），并采用PCR-RFLP（聚合酶链反应-限制性片断长度多态性）法分析ER基因多态性，并分析其相关性。结果安徽地区绝经后妇女ER基因型分布频率PP（13．2％）、Pp（45．8％）、pp（40．9％），XX（5．21％）、Xx（31．6％）、xx（63．2％），联合PvuⅡ和XbaⅠ这两种基因型后得到：PPXX（5．6％），PPXx（3．8％），PPxx（6．3％），PpXX（1．4％），PpXx（23．3％），Ppxx（25％），ppxx（34．7％），未检测到ppXX及ppXx型。PvuⅡ多态性与绝经后妇女腰椎BMD相关，PP基因型腰椎BMD显著低于pp和Pp基因型（P〈0．05），ER基因P等位基因是一种有益于骨量的基因型。XbaⅠ多态性与绝经后妇女各部位BMD间无明显相关性（P〉0．05）。联合分析PvuⅡ和XbaⅠ多态性与绝经后妇女BMD相关性发现，有Px单倍型的妇女腰椎部位的BMD显著低于无此单倍型的妇女（P〈0．01）。结论ER基因PVuⅡ多态性与绝经后妇女腰椎BMD有相关性，PP基因型妇女腰椎BMD减低，而具有Px单倍型的ER基因可能对BMD有不利影响。     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

Bone mineral density in premenopausal women with major depression

AIM: To investigate the relationship between the major depression and bone mineral density (BMD) in premenopausal women. MATERIAL AND METHODS: We compared BMD, plasma cortisol level, osteocalcin and C-telopeptide levels of 35 premenopausal women with major depression with those of 30 healthy women who were matched for age and body mass index. Major depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria. Nineteen patients had mild and 16 patients had moderate severity of major depression as measured by Hamilton rating scale for depression. RESULTS: Women with any risk factor for osteoporosis were excluded from the study. All women underwent BMD measurement by DEXA at lumbar (L2-4) and femoral neck region. After an overnight fasting, plasma cortisol levels were measured at 08:00 h by using competitive immunoassay method. Osteocalcin and C-telopeptide were used for the evaluation of bone turnover. There were no significant differences in BMD, plasma cortisol level, osteocalcin and C-telopeptide levels between the patients and the control groups. There was also no correlation between the plasma cortisol level, the duration and the severity of disease, antidepressant drug use and BMD. CONCLUSION: Major depression had no significant effect on BMD and bone turnover markers in our patient group of mild to moderate severity of the disorder.     

Measurements of broadband ultrasonic attenuation in the calcaneus in premenopausal and postmenopausal women

We report a study of broadband ultrasonic attenuation (BUA) in the calcaneus in 248 women. Measurements were performed with a Walker-Sonix UBA-575 ultrasonic bone analyser. The populations studied were 15 healthy young volunteers (group 1, mean age 26 years), 200 healthy pre- and postmenopausal women (group 2, mean age 53 years) and 33 osteoporotic women with vertebral crush fractures (group 3, mean age 66 years). Subjects in group 1 each had 10 repeated measurements of their right heel. Duplicate BUA measurements in the right heel were performed in 96 subjects and bilateral scans in a further 87 women in group 2. The remaining 17 subjects in group 2 and those in group 3 had a single scan of the right heel. All women in groups 2 and 3 had dual X-ray absorptiometry (DXA) scans of the lumbar spine and femoral neck.The precision study on the women in group 1 gave a root mean square (RMS) coefficient of variation (CV) of 4.2%. Individual CV results showed statistically significant differences (range 1.3%–7.6%). Duplicate scans in subjects in group 2 gave a RMS CV of 4.6% while the bilateral measurements showed no significant difference between the two heels. Linear regression analysis gave the following relationship between BUA and age: BUA=87.1–0.76 (Age –40) dB/MHz (r=–0.31,p<0.001, SEE=14.0 dB/MHz). Multivariate regression analysis showed that, in addition to age, years since the menopause was also a significant factor in predicting BUA. In the first 5 years following the menopause BUA decreased by 2.5%/year, while in the next 5 years the decrease fell to 0.5%/year. The BUA measurements in the osteoporotic subjects in group 3 gave a mean T-score of –2.1 compared with 66 premenopausal normal women and a mean Z-score of –1.0 compared with 27 age-matched elderly normal women in group 2. In comparison the lumbar spine DXA measurements for the same women gave a mean T-score of –3.2 and a mean Z-score of –1.8. DXA therefore gave substantially better discrimination between osteoporotic and normal subjects than the BUA measurements.     

Leisure physical activity is associated with quantitative ultrasound measurements independently of bone mineral density in postmenopausal women

The purpose of this study was to assess the magnitude of the relationship between leisure physical activity and bone status as measured either by an Achilles^TM ultrasound bone densitometer (QUS) or dual-energy X-ray absorptiometry (DXA) in postmenopausal women. We studied 1162 French Canadian postmenopausal women, aged 33–84 years (mean age 58 years), for QUS parameters [broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI)] measured at the right calcaneus, and bone mineral density (BMD) measured at the lumbar spine and femoral neck. Multivariate regression analyses revealed that leisure physical activity level was an independent predictor of the heel QUS parameters and of femoral neck BMD. No such association was observed for BMD of the lumbar spine. Heel QUS parameters (BUA, SOS, SI) and femoral neck BMD adjusted for interfering covariables showed a statistically significant difference between sedentary (less than three sessions/month) and active women (three or more sessions/week) (P 0.001). Furthermore, after adjusting each heel QUS parameters for the mean lumbar spine BMD value, the association observed between leisure physical activity and QUS remained significant. These results suggest that regular leisure physical activity could influence QUS parameters, independently of BMD, and that quantitative ultrasound could be a suitable outcome measure in exercise studies in postmenopausal women.