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1.
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
2.
F. E. Alenfeld E. Diessel M. Brezger J. Sieper D. Felsenberg J. Braun 《Osteoporosis international》2000,11(5):400-407
Periarticular osteopenia is the earliest radiographic sign of rheumatoid arthritis (RA). Recent studies using dual-energy
X-ray absorptiometry (DXA) have indicated that the loss of periarticular BMD can be quantified by whole-hand bone mineral
density (BMD) measurements. The aim of this study was to analyze periarticular BMD in more detail by DXA and quantitative
ultrasound (QUS). In a cross-sectional study 23 women aged 30–76 years with early RA, mean disease duration 26 ± 19 months,
and 18 men aged 42–69 years, mean disease duration 24 ± 25 months, were examined. All patients received antirheumatic therapy.
The reference population consisted of 103 age-matched controls (68 females, 35 males) and young healthy controls. BMD measurements
were performed using a DXA Expert XL densitometer (Lunar). BMD of the whole-hand and two subregions was determined: two subchondral
regions of interest (S.CH.) were set within the trabecular bone, distal to the proximal interphalangeal joints of digits II
and III excluding the dense subchondral bone of the metacarpophalangeal (MCP) joint and two metacarpal regions of interest
(MCP) were set including the entire MCP joint of these fingers. QUS measurements at the proximal phalanges of digits II–V
were performed using a DBM Sonic (Igea); amplitude-dependent speed of sound (Ad-SoS) was determined. In comparison with whole-hand
BMD measurements, bone loss was pronounced in patients with a disease duration of 18–72 months at the subchondral regions
of interest in both genders compared with age-matched controls (women: mean BMD loss S.CH. −23%, p<0.001, whole-hand −16%, p<0.001; men: mean BMD loss S.CH. −19%, p<0.05, whole-hand −12%, p<0.05). The bone changes were also shown by QUS (women: Ad-SOS values of 1950 ± 90 m/s in RA vs 2137 ± 35 m/s in young healthy
controls (p<0.005); men AD-SOS 1956 ± 87 m/s in RA vs 2146 ± 41 m/s in young healthy controls (p<0.05)). These results show that BMD and Ad-SOS values are significantly lowered in patients with early RA and indicate that
periarticular osteoporosis in early RA might possibly be better detected using detailed hand scan analyses.
Received: 2 February 1999 / Accepted: 25 October 1999 相似文献
3.
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
4.
A. Dey E. V. McCloskey T. Taube R. Cox K. C. Pande R. U. Ashford M. Forster D. de Takats J. A. Kanis 《Osteoporosis international》2000,11(11):953-958
Metacarpal morphometry represents a potentially cheap and widely available non-invasive assessment of skeletal status. In
two cross-sectional studies, we compared the performance characteristics of a semi-automated technique (the Teijin Bonalyzer)
with an in-house manual measurement, and with measures of skeletal strength at other sites. The metacarpal cortical index
(mCI) was measured on hand radiographs of 178 osteoporotic women using both the Teijin Bonalyzer and a digitizing tablet.
Measurements on the latter were consistently lower than with the Bonalyzer except for mCI (0.443 ± 0.080 vs 0.364 ± 0.060,
p<0.001), although correlation coefficients between these two methods were highly significant (r= 0.62–0.83, p<0.001). The reproducibility errors of metacarpal bone mineral density (mBMD) were constant (1.1–1.2%) whilst those for mCI
showed a marked operator-dependency (2.0–7.9%). In 379 elderly community-dwelling women, Bonalyzer mCI and mBMD showed a significant
decline with age (r=−0.30 and −0.27 respectively, p<0.05). Both mCI and mBMD correlated significantly with forearm BMD (r= 0.50 and 0.57 respectively, p<0.001) and hip BMD (r= 0.48 and 0.53 respectively, p<0.001). After adjustment for age and weight, hip BMD demonstrated the best discrimination for prevalent vertebral fractures
as judged by the gradient of risk for a 1 SD decrease in measurement (odds ratio (OR) 2.17, 95% CI 1.56–3.01). Similar but
smaller gradients of risk were shown by Bonalyzer mCI (OR 1.32, 95% CI 1.00–1.75), mBMD (OR 1.35, 95% CI 1.02–1.78) and forearm
BMD (OR 1.39, 95% CI 1.08–1.80). MCI, and in particular mBMD, may be useful assessments of bone mass and fracture risk. In
our study, it is comparable to peripheral assessment of skeletal status by forearm densitometry.
Received: 22 February 2000 / Accepted: 6 June 2000 相似文献
5.
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
6.
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
7.
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
8.
Quantitative Ultrasound Assessment of Acute Bone Loss Following Spinal Cord Injury: A Longitudinal Pilot Study 总被引:14,自引:3,他引:11
S. J. Warden K. L. Bennell B. Matthews D. J. Brown J. M. McMeeken J. D. Wark J. D. Wark 《Osteoporosis international》2002,13(7):586-592
Spinal cord injury (SCI) results in substantial and rapid osteoporosis. Given its rapid onset, assessment of bone changes
in the early stages (first 6 months) following SCI is important. This is particularly pertinent if intervention is to be implemented.
Quantitative ultrasound (QUS) represents a potential assessment tool for the evaluation of skeletal changes in the early stages
following SCI. This longitudinal pilot study assessed changes in QUS measures of calcaneal broadband ultrasound attenuation
(BUA) and speed of sound (SOS) in 15 male subjects (age 23.9 ± 7.3 years) over a 6-week period. Their mean time since SCI
was 110.3 ± 34.5 days. Also assessed were bone mineral density of the calcaneus (BMDc) and proximal tibia (BMDt) using dual-energy
X-ray absorptiometry (DXA). Confirming the rapid onset of bone loss following SCI, BMDc and BMDt decreased by 7.5 ± 3.0% (p<0.001) and 5.3 ± 4.2% (p<0.001), respectively. QUS was sensitive to these changes. BUA decreased by 8.5 ± 6.9% (p<0.001), whilst SOS decreased by 1.5 ± 1.3% (p<0.001). Suggesting an influence of the material properties of bone on BUA, BUA was correlated with BMDc at both the initial
(r= 0.68, p<0.01) and final (r = 0.62, p<0.01) assessments. There were no significant correlations in the magnitude of change over the 6-week assessment period between
any of the skeletal measures (all p>0.05). This suggests that skeletal qualities other than material properties also influence QUS measures. Overall, this study
confirmed the rapid onset of bone loss following SCI and showed QUS to be a useful portable measure of acute bone changes.
This may allow assessment of bone loss and the efficacy of intervention on this loss in the early stages following injury,
a period where traditional axial DXA assessment is limited by practical constraints.
Received: 14 February 2001 / Accepted: 18 January 2002 相似文献
9.
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
10.
The aim of this study was to determine possible associations between bone mineral density (BMD), 25-hydroxyvitamin D (25(OH)D)
and intact parathyroid hormone (PTH). In a retrospective study we examined the case notes of free-living postmenopausal women
living in our city (34° S). We also report a low prevalence of vitamin D deficiency (25(OH)D <25 nmol/l, 5.6%) and of secondary
hyperparathyroidism (intact PTH >65 pg/ml, 7.5%). Age was correlated with BMD at the lumbar spine (r=−0.25, p = 0.00038) and femoral neck (r=−0.252, p = 0.0003). Body mass index (BMI) was correlated with BMD at the femoral neck (r= 0.177, p = 0.021) but not at the lumbar spine. 25(OH)D was positively correlated with BMD at the femoral neck (r = 0.149, p=0.036) but not at the lumbar spine. PTH was positively correlated with age (r= 0.279, p = 0.012) and negatively correlated with 25(OH)D (r=−0.322, p = 0.0036). PTH was also negatively correlated with BMD at the lumbar spine (r=−0.258, p=0.02) and the femoral neck (r=−0.282, p = 0.011). Forward stepwise multiple regression showed that BMI, age and 25(OH)D made significant contributions to BMD at
the femoral neck. PTH also showed a significant contribution to BMD at both sites. In conclusion, weak correlations found
between PTH and 25(OH)D and BMD suggest these biochemical variables, among other factors, contribute to lumbar spine and femoral
neck BMD.
Received: 19 February 2000 / Accepted: 20 June 2000 相似文献
11.
A. Montagnani S. Gonnelli C. Cepollaro D. Bruni M. B. Franci B. Lucani C. Gennari 《Osteoporosis international》2002,13(3):222-227
Bone loss characterizes both primary hyperparathyroidism (PHPT) and osteoporosis (OP) but with a different histologic pattern,
and this could partially explain the different fracture incidence in these two populations. Quantitative ultrasound (QUS),
influenced by bone structural parameters other than bone mineral density (BMD), could evidence these differences, opening
new perspectives in the evaluation of patients with metabolic bone diseases. The aim of the present study was to investigate
the usefulness of QUS graphic trace parameters, assessed at the phalanx, in discriminating between PHPT bone disease and osteoporosis.
We studied 34 patients with PHPT (mean age 59.7 ± 12.7 years), 35 patients with OP (mean age 60.6 ± 7.1 years) and 34 healthy
subjects as controls (mean age 59.1 ± 9.4 years). In all subjects QUS measurements were performed at the phalanx with a Bone
Profiler (IGEA, Italy), obtaining the amplitude-dependent speed of sound (AD-SoS), fast wave amplitude (FWA), signal dynamic
(SDy), bone transmission time (BTT) and ultrasound bone profile index (UBPI). Moreover, serum calcium, phosphorus, parathyroid
hormone (PTH), bone isoenzyme of alkaline phosphatase (B-ALP) and ionized calcium were measured in all subjects in the morning
under fasting conditions. In PHPT patients BTT was correlated with PTH, ionized calcium and B-ALP levels (r=–0.47, –0.57 and –0.44, respectively; p <0.01), whereas FWA, SDy and UBPI correlated only with B-ALP (r=–0.43, –0.46 and –0.50, respectively; p <0.01). Moreover, FWA, SDY and UBPI were significantly (p<0.01) lower and BTT significantly (p<0.001) higher in OP than in PHPT patients. UBPI, BTT, FWA and the BTT/FWA ratio, but not SDy, were able to discriminate between
the two groups (area under the curve =0.66, 0.69, 0.67 and 0.81, respectively).
Our findings show that ultrasound signal parameters are differently influenced by bone changes characterizing primary hyperparathyroidism
or osteoporosis. This suggests that the QUS signal could be a useful instrument in discriminating and studying some of the
bone alterations typical of metabolic bone diseases.
Received: 15 February 2001 / Accepted: 27 August 2001 相似文献
12.
J. M. Le Parc P. Plantin G. Jondeau M. Goldschild M. Albert C. Boileau 《Osteoporosis international》1999,10(6):475-479
Sixty adult patients (40 women, 20 men) with Marfan syndrome (MFS) according to the Berlin criteria had a full clinical examination
and bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry of the hip and nondominant forearm. BMD was
expressed as a Z-score and compared with the reference population of the Hologic database. In MFS men, BMD (g/cm2) was compared with the BMD of 45 normal tall Caucasian adults. Osteocalcin was measured by radioimmunoassay. In patients
with MFS, BMD was compared between patients with and without previous fractures and according to the phenotypic severity of
MFS. The mean age of the patients was 32.9 ± 9.3 years (women 32.5 ± 9.7, men 33.4 ± 8.6), mean height was 180.3 ± 10.3 cm
(women 176.3 ± 9.2, men 188.1 ± 7.5) and mean body mass index 20.9 ± 3.6 kg/m2 (women 20.8 ± 3.4, men 20.95 ± 3.97). Hyperlaxity score (Beighton criteria) was 6.9 ± 1.1. Six patients (10%) had a previous
fracture. Thirty per cent of patients had had at least one previous operation for scoliosis, aortic dilatation or eye problems.
BMD values in the 60 patients were as follows: Z-score of the hip, −1.26 ± 0.93, p<10−9 (neck, −0.93 ± 1.09, p<10−9; trochanter, −1.31 ± 0.85, p<10−9; intertrochanter, −1.39 ± 0.99, p<10−9; Ward’s triangle, −0.93 ± 1.88, p<10−9); Z-score of the radius: −1.6 ± 1.06, p<10−9 (1/3 proximal, −1.29 ± 1.03; mid-radius, −1.94 ± 1.04; ultradistal, −0.68 ± 1.1, p<10−9). The decrease in BMD was similar in men and women at both the hip and the radius. BMD in MFS patients was significantly
decreased at cortical compared with trabecular sites (radius 1/3 proximal vs ultradistal, p<0.0001; total femur vs Ward’s triangle, p<0.0005). No difference in BMD was found between MFS patients with or without previous fractures and those with severe or
less severe phenotypic expression of MFS. An influence of height and weight in MFS on BMD is suspected. Osteocalcin was not
increased in our group of MFS patients. Thus both men and women with MFS have a significant deficit of BMD at the hip and
radius. The decrease in BMD is present equally in both sexes and is more pronounced at predominantly cortical sites. In our
group of patients we found no increase in fractures and no relation between decreased BMD and phenotypic expression of the
syndrome.
Received: 30 October 1998 / Accepted: 26 May 1999 相似文献
13.
Alendronate significantly increases bone mass and reduces hip and spine fractures in postmenopausal women. To determine whether
forearm densitometry could be used to monitor the efficacy of alendronate, we examined changes in bone mineral density (BMD)
at the forearm (one-third distal, mid-distal, ultradistal radius) versus changes at the hip (femoral neck, total hip) and
spine (posteroanterior and lateral) in a double-masked, randomized, placebo-controlled clinical trial of 120 elderly women
(mean age 70 ± 4 years) treated with alendronate for 2.5 years. We found that among women in the treatment group, BMD increased
by 4.0–12.2% at the hip and spine sites (all p<0.001), whereas BMD increased only nominally at the one-third distal radius (1.3%, p<0.001) and mid-radius (0.8%, p<0.05), and remained stable at the ultradistal radius. At baseline, forearm BMD correlated with that of the hip (r= 0.55–0.64, p<0.001), femoral neck (r= 0.54–0.61, p<0.001) and posteroanterior spine (r= 0.56–0.63, p<0.001). Changes in radial BMD after 1 year of therapy were not correlated with changes in hip and spine BMD after 2.5 years
of therapy. In contrast, short-term changes in total hip and spine BMD were generally positively associated with long-term
changes in total hip, femoral neck and spine BMD (r= 0.30–0.71, p<0.05). Furthermore, long-term BMD changes at the forearm did not correlate with long-term hip and spine BMD changes, in contrast
to the moderate correlations seen between spine and hip BMD at 2.5 years (r= 0.38–0.45, p<0.01). We conclude that neither short- nor long-term changes in forearm BMD predict long-term changes in overall BMD for
elderly women on alendronate therapy, suggesting that measurements of clinically relevant central sites (hip and spine) are
necessary to assess therapeutic efficacy.
Received: 18 February 1999 / Accepted: 20 May 1999 相似文献
14.
G. Martínez Díaz-Guerra F. Hawkins A. Rapado M. A. Ruiz Díaz M. Díaz-Curiel 《Osteoporosis international》2001,12(3):178-184
Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although
osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone
mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible
for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 ± 7 years) were investigated
in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral
sites (femoral neck, Ward’s triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained
including: weight, height, body mass index (BMI), waist–hip ratio and testicular volume. Hormonal data measures were total,
free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth
factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed
a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score ≤−2.5). All BMD sites were positively correlated with body weight (r= 0.29–0.48, p<0.001) and BMI (r= 0.24–0.47, p<0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r=−0.24 and r=−0.22, p<0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r=−0.33, p<0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels.
The best predictive model accounted for 24–40% of the observed variability of BMD. However, most of the BMD variability was
explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy
elderly men.
Received: 9 June 2000 / Accepted: 27 September 2000 相似文献
15.
J. P. W. van den Bergh C. Noordam A. Özyilmaz A. R. M. M. Hermus A. G. H. Smals B. J. Otten 《Osteoporosis international》2000,11(11):967-976
We investigated the quantitative ultrasound (QUS) parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS)
measured in the posterior part of the calcaneus at the region of interest (ROI) with the lowest attenuation, using an ultrasound
imaging device (UBIS 3000) in 491 healthy Caucasian children and adolescents (262 girls, 229 boys) between 6 and 21 years
old. The relation of age, body weight, height, foot dimensions and pubertal stage to BUA and SOS was assessed. BUA increased
nonlinearly with age in boys and girls, r
2 being 0.44 (p<0.001) and 0.57 (p<0.001), respectively. SOS increased linearly with age in girls (r
2= 0.04, p<0.001). There was no significant increase in SOS in boys (r
2= 0.01, p>0.05). Heel width was significantly correlated with BUA (r= 0.20, p<0.005 in boys; r= 0.27, p<0.05 in girls) and with SOS (r=−0.19, p<0.005 in boys; r=−0.08, p<0.05 in girls). After downward adjustment of the ROI size according to foot length quartiles, significantly lower BUA and
SOS values were found compared with those with the standard ROI size of 14 mm. After correction for heel width and adjustment
of the ROI size based on foot length, BUA and SOS were significantly associated with age in boys (r
2= 0.36, p<0.001 and 0.06, p<0.05) and in girls (r
2= 0.53 and 0.06, both p<0.001). Tanner stage was significantly correlated with BUA (r= 0.62, p<0.001 in boys; r= 0.73, p<0.001 in girls) but not with SOS. BUA but not SOS increased significantly with the number of years since menarche (p<0.001). In a multiple stepwise regression analysis in boys, age, weight and foot length were independent predictors for BUA,
and age and foot length for SOS. In girls, age and weight were independent predictors for BUA and age was the only independent
predictor for SOS. After correction for age, pubertal stages and heel width were no longer determinants for QUS parameters
in either boys or girls. In conclusion, BUA increased significantly with age in both sexes. SOS increased with age in both
boys and girls, but the increase was small and not statistically significant in boys. SOS, as measured with the UBIS 3000
device, may therefore not be appropriate to assess skeletal status in healthy children. Whether SOS and BUA are affected in
children with skeletal disorders has yet to be determined. In boys, age, weight and foot length were independent predictors
for BUA and age and foot length for SOS. In girls, age and weight were independent predictors for BUA and age was the only
independent predictor for SOS. In our opinion, children with small feet should be measured with a smaller ROI diameter than
those with larger feet.
Received: 28 October 1999 / Accepted: 19 June 2000 相似文献
16.
Y. V. Ho E. M. Briganti Y. Duan R. Buchanan S. Hall E. Seeman 《Osteoporosis international》1999,9(2):134-138
Corticosteroid therapy (CST) is associated with reduced intestinal calcium absorption, bone loss and increased fracture risk.
As polymorphisms of the vitamin D receptor (VDR) gene may be associated with bone mineral density (BMD) and intestinal calcium
absorption, we asked whether patients with a given VDR genotype receiving CST may be at increased or decreased risk for corticosteroid-related
bone loss and osteoporosis. We measured areal BMD (g/cm2) by dual-energy X-ray absorptiometry in 193 women (50 premenopausal, 143 postmenopausal) and 70 men with rheumatoid arthritis
(n= 44), obstructive airway diseases (n= 128) and other corticosteroid-treated diseases (n= 91). All patients received a cumulative dose greater than 1.8 g per year or a minimum of 5 mg daily of prednisolone or equivalent
for at least 1 year. VDR alleles were typed by polymerase chain reaction assay based on the polymorphic BsmI and TaqI restriction sites. BMD in patients was expressed as a Z-score (mean ± SEM) derived from age- and gender-matched controls. BMD was reduced in patients at the lumbar spine (bb, −0.52
± 0.12; Bb, −0.47 ± 0.11; BB, −0.65 ± 0.18 SD; p<0.01), femoral neck (bb, −0.46 ± 0.10; Bb, −0.34 ± 0.10; BB, −0.54 ± 0.14 SD; p<0.01), Ward’s triangle (bb, −0.44 ± 0.10; Bb, −0.31 ± 0.10; BB, −0.45 ± 0.13 SD; p<0.01), and trochanter (bb, −0.50 ± 0.10; Bb, −0.30 ± 0.10; BB, −0.44 ± 0.14 SD; p<0.01). However, there was no significant difference in the deficit in BMD in any of the genotypes, either before or after
adjusting for age, sex, body mass index, disease type, age at onset of disease, disease duration, cumulative steroid dosage,
smoking status and dietary calcium intake. Similarly, there were no detectable differences between the BsmI genotypes and the rate of bone loss in 79 patients with repeated BMD measurements at an interval of 4–48 months. The data
suggest that the VDR genotypes may not be a means of identifying patients at greater risk of corticosteroid-related bone loss.
Received: 23 December 1997 / Accepted: 26 May 1998 相似文献
17.
H. Hoshino K. Kushida M. Takahashi K. Yamazaki M. Denda K. Atsumi M. Oikawa O. Toyoyama K. Kawana T. Inoue 《Osteoporosis international》2000,11(2):128-133
The aim of this longitudinal study was to investigate the changes in the levels of biochemical markers and ultrasound indices
of os calcis across the menopausal transition. One hundred and ten healthy women (age 35–59 years at the 1992 baseline) participated
in this 4-year population-based longitudinal study. Serum intact osteocalcin (IOC), urinary pyridinoline (Pyr), urinary deoxypyridinoline
(Dpyr) and ultrasound indices were measured at baseline and after 4 years. The percentage changes in biochemical markers (%DIOC,
%DPyr and %DDpyr) and the percentage decreases in the ultrasound indices (%DSOS, %DBUA and %DStiffness) were calculated. The
values of %DIOC and %DDpyr in the perimenopausal subgroup (−4 to−3 years since menopause) and the values of %DSOS and %DStiffness
in the perimenopausal subgroup (−2 to 0 years since menopause) were significantly higher than those in other groups. Pyr was
significantly correlated with %DSOS (r=−0.467, p<0.01) and %DStiffness (r = −0.330, p<0.05) and Dpyr was significantly correlated with %DSOS (r=−0.390, p<0.05), %DBUA (r=−0.353, p<0.05) and %DStiffness (r = −0.454, p<0.05), while %DIOC was significantly correlated with %DSOS (r=−0.278, p<0.05), %DBUA (r=−0.369, p<0.01) and %DStiffness (r = −0.383, p<0.01) in the peri- and postmenopausal groups. These results indicate that the increase in bone turnover occurs 4 years before
menopause. However, the correlations between biochemical markers and ultrasound indices were too low to allow prediction of
bone change in the individual patient.
Received: 12 October 1999 / Accepted: 30 June 1999 相似文献
18.
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
19.
In Vivo MRI Measurements of Bone Quality in the Calcaneus: A Comparison with DXA and Ultrasound 总被引:5,自引:0,他引:5
Magnetic resonance imaging (MRI) has shown promise in the assessment of bone architecture. The precision and feasibility
of MRI measurements in osteoporosis in vivo have been assessed in this study. T2′ was calculated from measurements of T2 and
T2* in the calcaneus of 32 postmenopausal women using a gradient-echo sequence PRIME (Partially Refocused Interleaved Multiple
Echo). This sequence allows the measurement of T2 and T2* in one acquisition. In vivo measurements of bone mineral density
(BMD) by dual-energy X-ray absorptiometry (DXA) were made in the calcaneus, spine and femoral neck. The ultrasound parameters
broadband ultrasound attenuation (BUA) and speed of sound (SOS) were also measured in the calcaneus. These three techniques
have not previously been compared in the same study population. The precision of the MRI technique was poor relative to the
DXA and ultrasound techniques, with a CV of 6.9%± 4.4% for T2′ and 5.5%± 3.6% for T2*. Approximately 4% of this is due to
system error as determined by phantom measurements. The postmenopausal women were classified as having low BMD if they had
a lumbar spine (L2–4) BMD of less than 0.96 g/cm2 (more than 2 standard deviations below normal peak bone mass). Calcaneal T2′ was significantly correlated with calcaneal
BMD (r = –0.79, p <0.0001), BUA (r = –0.59, p = 0.0004) and SOS (r = –0.58, p = 0.0006). T2′ was significantly different in postmenopausal women with normal BMD and those with low BMD (p <0.01). However, the difference was of only borderline significance (p <0.06) after adjustment for age and years since menopause.
Received: 8 July 1997 / Accepted: 29 April 1998 相似文献
20.
Evaluation of Finger Ultrasound in the Assessment of Bone Status with Application of Rheumatoid Arthritis 总被引:5,自引:0,他引:5
C. F. Njeh C. M. Boivin A. Gough D. Hans S. K. Srivastav N. Bulmer J. Devlin P. Emery 《Osteoporosis international》1999,9(1):82-90
Osteoporosis associated with active rheumatoid arthritis (RA) has been demonstrated in both the axial and peripheral skeleton,
especially the periarticular regions more directly affected by the disease. Quantitative ultrasound (QUS) is a recently accepted
tool for the assessment of bone status, and therefore could be used to monitor bone changes in RA patients. In a cross-sectional
study we measured ultrasound velocity (Ad-SOS) through the proximal phalanges in three groups of female subjects. These included:
51 patients with rheumatoid arthritis (group 1), 44 general practitioner (GP)-referred patients for osteopenia (group 2) and
52 young healthy volunteers (group 3). For groups 1 and 2 bone mineral density (BMD) of the lumbar spine and proximal femur
were also measured. For the RA patients BMD of the hand, measurement of hand function (HAQ and grip strength) and disease
activity (ESR and CRP) were also assessed. The precision of long-term Ad-SOS measurements on volunteers gave a root mean square
coefficient of variation (CV) of 0.7% and standardized CV of 3.6%. No statistically significant effect of dominance was observed
in the measured Ad-SOS between the dominant and non-dominant hand (r= 0.96, p<0.001). Ad-SOS was found to be significantly different in the three groups (p<0.0001). Ad-SOS was highly dependent on age (r=−0.67), with a gradual reduction (−5.2 m/s per year) after the age of 30 years for female patients in both group 1 and group
2. Ad-SOS was significantly correlated with lumbar spine, femoral neck and hand BMD, with correlation coefficients of 0.49,
0.51 and 0.72 respectively for RA patients. Finger ultrasound was moderately correlated with measures of hand function, with
coefficients of 0.37 and 0.39 for HAQ and grip strength respectively. Hand BMD also correlated to the same power with these
parameters. Neither finger ultrasound nor BMD was significantly correlated with ESR and CRP (measures of disease activity).
We have demonstrated that bone status can be assessed quickly and cheaply using a portable QUS device. Ad-SOS relates to the
measure of hand function in RA patients. Longitudinal studies are required to determine the usefulness of finger ultrasound
for monitoring disease progression or the effect of treatment in RA.
Received: 1 July 1998 / Accepted: 5 November 1998 相似文献