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H K Genant

Publications and source records attributed to H K Genant.

At least 109 records · Page 6Linked to original sources
PubMed1999

Trabecular bone architecture in the distal radius using magnetic resonance imaging in subjects with fractures of the proximal femur. Magnetic Resonance Science Center and Osteoporosis and Arthritis Research Group.

To determine whether magnetic resonance (MR)-derived measures of trabecular bone architecture in the distal radius are predictive for prevalent hip fractures, 20 subjects with hip fractures and 19 age-matched postmenopausal controls were studied. Bone mineral density (BMD) measures at the hip (dual-energy X-ray absorptiometry, DXA) and the distal radius (peripheral quantitative computed tomography, pQCT) were also obtained. We compared the MR-based structural measures derived in the radius with those in the calcaneus of the same patients. In the radius, images were acquired at an in-plane resolution of 156 microm and a slice thickness of 0.5 mm. Stereologic measures such as the apparent trabecular thickness (app. Tb.Th), fractional trabecular bone volume (app. BV/TV), trabecular spacing (app. Tb.Sp) and trabecular number (app. Tb.N) were derived from the images. Measures of app. Tb.Sp and app. Tb.N in the distal radius showed significant (p<0.05) differences between the two groups, as did hip BMD measures. However, radial trabecular BMD measures showed only a marginal difference (p = 0.05). Receiver operating curve analysis was used to determine the diagnostic efficacy of BMD, structural measures and a combination of the two. The area under the curve (AUC) for total hip BMD was 0.73, and for radial trabecular BMD was 0.69. AUC for most of the measures of trabecular bone structure at the distal radius was lower than for hip BMD measures; however, AUC for app. Tb.N at the radius was 0.69, comparable to trabecular BMD using pQCT. The AUC for combined BMD (hip) and structure measures was higher (0.87) when radius and calcaneus structure was included. Measures of trabecular architecture derived from MR images combined with BMD measures improve the discrimination between subjects with hip fractures and normal age-matched controls.

Aged↗
PubMed1999

Factors affecting broadband ultrasound attenuation results of the calcaneus using a gel-coupled quantitative ultrasound scanning system.

This study aimed to assess the factors that may influence the distribution and description of broadband ultrasound attenuation (BUA) and to identify specific criteria for diagnostic consideration when collecting BUA reference data. Two hundred Caucasian women (aged 20-79 years) without a history of atraumatic fractures or medicines known to affect bone metabolism were selected for this study. Medical and menstrual history, medication usage, family history of osteoporosis (FHO), physical activity, activities of daily living (ADL), dietary calcium intake, as well as smoking and alcohol consumption were obtained. Broadband ultrasound attenuation (BUA, dB/MHz) was determined in the right foot using a new gel-coupled ultrasound system. BUA was significantly associated with age (p<0.001), body weight (p<0.001), level of physical activity (p = 0.024) and dietary calcium intake (p = 0.023). Smoking, alcohol and coffee consumption and ADL were not associated with BUA (p>0.05). There were no differences in BUA (p>0.05) between those women who reported taking medications or had diseases (known to not affect bone metabolism), were using contraceptives, taking vitamin/mineral supplements and/or had traumatic fractures and their counterparts who did not report these characteristics. Premenopausal women with a FHO had significantly lower BUA values compared with those without a FHO (p = 0.013). When those participants with a FHO were removed from the sample, the peak BUA value was 1.1-4.4% higher and the variability (SD) was reduced by about 3.3-9.3% depending on which age range was used to define the peak BUA value. Consequently, an additional 4.5% of the population were classified as having a T-score <-2. Our results suggest that the impact on BUA of risk factors such as a FHO, body weight, physical activity and dietary calcium intake is similar to that on bone mineral density obtained by dual-energy X-ray absorptiometry (DXA), and thus provides further information on the comparability of quantitative ultrasound and DXA for assessment of risk of fracture. The criteria for calculating the T-score need further study to determine whether young adults with FHO should be included and what cutoff age range should be used in collecting peak values of quantitative ultrasound parameters.

Adult↗
PubMed1999

Ultrasound velocity of trabecular cubes reflects mainly bone density and elasticity.

Studies have indicated that quantitative ultrasound (QUS) variables may be influenced by the mechanical properties of bone which in turn are determined by bone's material and structural properties. However, from these studies it is unclear what role density, elasticity, and structure play in determining velocity. Eighteen defatted, 12-mm cubic trabecular bone specimens were cut from cadaveric specimens. Amplitude-dependent speed of sound (SOS) using a single point QUS system was assessed in three orthogonal axes. Magnetic resonance images were obtained, from which measures of apparent trabeuclar structure were derived. The specimens were nondestructively tested in compression along three orthogonal axes defined by the sides of the cubes. The elastic modulus (in the three directions) and the strength (in one direction) were determined. Trabecular BMD was measured by quantitative computed tomography. SOS varied significantly with direction of measurement, with the highest value in the axial direction (axial:1715 m/s, sagittal: 1662 m/second, and coronal: 1676 m/s). SOS of each of the three axes was generally associated with the various mechanical (r = 0.30-0.87), density (r = 0.81-0.93), and bone structural variables (0.3-0.8). However, after adjusting the SOS correlations by density, only the correlation with elasticity remained significant in the coronal direction. BMD alone explained 88-93% of variance in SOS whereas in the multivariate model, BMD plus elasticity and/or anisotropic variables explained 96-98% of the variance in SOS. Variability of SOS is explained mostly by density and to a small extent by elasticity or anisotropy. Since only 2-6% of the variance of the QUS measurement is not explained by density and elasticity, one could conclude that the remaining variance reflects other properties of bone or perhaps simply measurement error. Evidence that these other properties may be structure related is only found in the anisotropy of QUS parameter.

Adult↗
PubMed1999

Chondrosarcoma of the foot: imaging, surgical and pathological correlation of three new cases.

The foot is an uncommon location for chondrosarcoma. The presentation, diagnosis, pathological findings, surgical treatment and follow-up of three patients with chondrosarcoma in this rare location are presented. Though nonspecific, MR imaging findings were of aid in the diagnosis and treatment planning of these patients. If the diagnosis of this tumor is rapidly made, a tumor excision instead of limb amputation may be sufficient treatment at surgery.

Adult↗
PubMed1999

Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation.

OBJECTIVE: To investigate the use of MR imaging in the characterization of denervated muscle of the shoulder correlated with electrophysiologic studies. DESIGN AND PATIENTS: We studied with MR imaging five patients who presented with shoulder weakness and pain and who underwent electrophysiologic studies. On MR imaging the distribution of muscle edema and fatty infiltration was recorded, as was the presence of masses impinging on a regional nerve. RESULTS: Acute/subacute denervation was best seen on T2-weighted fast spin-echo images with fat saturation, showing increased SI related to neurogenic edema. Chronic denervation was best seen on T1-weighted spin-echo images, demonstrating loss of muscle bulk and diffuse areas of increased signal intensity within the muscle. Three patients showed MR imaging and electrophysiologic findings of Parsonage Turner syndrome. One patient demonstrated an arteriovenous malformation within the spinoglenoid notch, impinging on the suprascapular nerve with associated atrophy of the infraspinatus muscle. The fifth patient demonstrated fatty atrophy of the teres minor muscle caused by compression by a cyst of the axillary nerve and electrophysiologic findings of an incomplete axillary nerve block. CONCLUSION: MR imaging is useful in detecting and characterizing denervation atrophy and neurogenic edema in shoulder muscles. MR imaging can provide additional information to electrophysiologic studies by estimating the age (acute/chronic) and identifying morphologic causes for shoulder pain and atrophy.

Adult↗
PubMed1999

Shoulder MRI after surgical treatment of instability.

OBJECTIVE: To analyze magnetic resonance imaging (MRI) findings of the shoulder after an instability operation. MATERIALS AND METHODS: Physical examinations, radiographs and MRI of 10 patients after anterior glenoid bone block insertion for ventral instability were compared. MRI included T1-weighted spin-echo (TR = 600, TE = 20 ms) and T2*-weighted gradient-echo sequences (TE = 600, TE = 18, Flip = 30 degrees) in the axial, oblique-coronal and oblique-sagittal planes. RESULTS: No patient suffered from recurrent subluxation. We found fusion of the bone block with the anterior glenoid in seven cases, dislocation of the bone block without contact to the glenoid in one case, and no visible bone block in two cases. On MRI, the bone block showed either signal intensity equivalent to fatty bone marrow (n = 4) or was devoid of signal consistent with cortical bone or bone sclerosis (n = 4). In all patients, a low signal intensity mass, 2-4 cm in diameter, was visible next to the glenoid insertion site. CONCLUSION: Insertion of a bone block onto the anterior glenoid induces formation of scar tissue, increasing the stability of the shoulder joint. This scar is well visible on MRI and forms independently of the behavior of the bone block itself. MRI is ideally suited for evaluating postoperative shoulder joints after bone-grafting procedures.

Adult↗
PubMed1999

MR imaging of the arthritic rabbit knee joint using albumin-(Gd-DTPA)30 with correlation to histopathology.

The purpose of this study was to demonstrate a technique, in a pilot study, for measuring abnormal capillary permeability in synovial tissue of rabbit arthritic knees using dynamic MRI with a gadolinium-based blood pool agent. Arthritis, simulating rheumatoid arthritis, was induced in knees of 8 rabbits by intra-articular injection of carrageenan (n = 4) or ovalbumin (n = 4). Sequential fat presaturated T1-weighted Spoiled Grass images were obtained before and up to 30 min after intravenous administration of albumin-(Gd-DTPA)30. Estimates of synovial tissue plasma-volume (PV), fractional-leak-rate (FLR), and permeability-surface-area-product (PS) were computed. Histologic correlation was obtained in the corresponding regions. Dynamic MRI showed extravasation of albumin-(Gd-DTPA)30 into hypertrophic synovium in six of the eight arthritic knees. Histologic examination of these six knees showed markedly inflamed synovium. The two knees that did not show abnormal vascular permeability contained non-hypertrophic synovium. None of the rabbits showed abnormal permeability in muscle. MRI derived microvascular characteristics (PV, FLR and PS) correlated positively (r2 = 0.51, 0.97 and 0.86) with the histology. Factors involving the structural and functional microvascular characteristics of synovial tissue can be estimated non-invasively using albumin-(Gd-DTPA)30. This technique may be useful for monitoring disease progression and treatment response in rheumatoid arthritis.

Albumins↗
PubMed1999

Radiation exposure in bone mineral density assessment.

Osteoporosis is a systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue which leads to diminished biomechanical competence of the skeleton and low-trauma or atraumatic fractures. Due to increased awareness of the impact of osteoporosis on the elderly population, the use of bone densitometric techniques is becoming more widespread. Considerable progress has been made in the development of non-invasive methods for the assessment of the skeleton. While DXA and QCT are commonly used techniques, the popularity of other approaches such as RA, SXA and QUS is gaining grounds. QCT has an advantage over the other techniques in its ability to measure the true volumetric density of trabecular or cortical bone. We therefore present an overview of these current techniques for bone mineral density (BMD) measurements. In the second section we discuss the radiation doses incurred in BMD measurements by patients and methods for reducing patient and staff radiation exposure are given. Studies of radiation dose to patient from DXA confirms that patient dose is small (0.08-4.6 muSv) compared to that given by many other investigations involving ionizing radiation. Fan beam technology with increased resolution has resulted in increase patient dose radiation dose (6.7-31 muSv) but this is still relatively small. Carrying vertebral morphometry using DXA also incurs less radiation dose (< 60 muSv) than standard lateral radiographs QCT has radiation dose (25-360 muSv) comparable to simple radiological examination such as chest X-ray but lower than imaging CT. Radiation dose from other techniques such as RA and SXA are in the same order of magnitude as pencil beam DXA. For pencil beam DXA and SXA systems the time average dose to staff from scatter is very low even with the operator sitting as close as 1 m from the patient during measurement. However the scatter dose from fan beam DXA systems is considerable higher and approaches limits set by regulator bodies for occupational exposure.

Absorptiometry, Photon↗
PubMed1999

Perspectives on bone mechanical properties and adaptive response to mechanical challenge.

The bones of the human skeleton serve a mechanical function besides providing a reservoir for calcium and hematopoietic homeostatis. When mechanically challenged, they usually respond and adapt; failure to do so can result in fracture. The mechanical behavior of bone is determined by bone mass and its material properties and by its geometry and architecture. Therefore, in vivo noninvasive measurements of bone mass, geometry, and structure can predict bone strength and are usually employed as a useful-if not always reliable-way to estimate bone fragility, whereas direct bone biomechanical testing in vitro can provide detailed information about mechanical strength. Because bone strains are likely to be regulators of bone mass and strength, exercise protocols designed to counteract the effects of osteoporosis should load the target bone with repeated high peak forces and high strain rates or high impacts on a long-term basis. Such a protocol creates varied strain distributions throughout the bone structure, producing short, repeated strains on the bone in directions to which it is unaccustomed. Exercise in this manner can maintain and perhaps increase bone mass and improve mechanical properties and neuromuscular competency, reducing skeletal fragility and the predisposition to falls.

Adaptation, Physiological↗
PubMed1999

An in vitro investigation of the dependence on sample thickness of the speed of sound along the specimen.

To measure the speed of sound (SOS), most quantitative ultrasound (QUS) devices use the transmission mode, whereby two transducers are placed on opposite sides of the sample. This mode is limited to a few specific skeletal sites because of the varying configuration of bone geometry and varying amounts of overlying soft tissue at most other sites. The aim of this study was to address the dependence of SOS measured along the sample on the thickness and composition of the bone sample. Bovine samples from mid-femur and trochanter, and perspex phantoms were used. We prepared the perspex samples in the shapes of blocks and cylinders to investigate the effect of wall thickness on SOS. The thickness of the blocks was decreased in decrements of 1 mm; a 22 mm diameter hole was drilled through the cylindrical samples and the hole size was gradually increased. The second configuration was also used with the bovine samples. For each experimental set-up five SOS measurements were acquired, with the probe aligned along the sample and a mean value computed. All measurements were taken with castor oil as the coupling agent, and in the cylindrical cases, the oil was used to fill the tube. The measurement precision determined as the root mean square coefficient of variation (RMSCV) was determined to be 0.14% and 0.65% for perspex and bovine samples respectively. The measured SOS on the perspex phantom (2760+/-4 m/s) was within the published values for bulk velocity. It was observed that for both perspex and bovine samples the SOS was independent of sample wall thickness greater than the wavelength (2.2 mm, 2.7 mm and 3.5 mm for perspex, trochanter and mid-femur respectively). The SOS decreased with sample wall thickness smaller than the wavelength in concordance with theoretical predictions. The SOS values obtained for bovine samples reflected either totally cortical (mid-femur) or a composite of cortical and cancellous bone (trochanter).

Animals↗
PubMed1999

Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group.

Vertebral fractures are the most common osteoporotic fracture and are associated with significant pain and disability. Prior vertebral fracture and low bone mineral density (BMD) are strong predictors of new vertebral fracture. Using data from 6082 women, ages 55-80 years, in the Fracture Intervention Trial (a randomized, placebo-controlled trial of the antiresorptive agent, alendronate), we explored the association of the number of prior vertebral fractures with the risk of new fractures and whether this association is influenced by the spinal location of fractures. The risk of future vertebral fractures increased with the number of prevalent fractures, independently of age and BMD; in the placebo group, more than half of the women with five or more fractures at baseline developed new vertebral fractures, compared to only 3.8% of women without prior vertebral fractures. The magnitude of association with an increased risk of future vertebral fractures was equal for prevalent fractures located in either the "lower" (T12-L4) (relative risk [RR] = 2.9; 95% CI = 1.9, 3.6) or "upper" (T4-10) spine (RR = 2.6; 95% CI = 1.9, 3.6). We found no evidence that the effectiveness of alendronate in reducing the risk of future vertebral fracture was attenuated in women with up to five or more prevalent fractures, or that it varied by the location of prevalent fractures. However, prevalent vertebral fractures in any location were more strongly associated with risk of new fractures in the upper (RR = 5.2; 95% CI = 3.2, 8.3) than in the lower spine (2.3; 1.6, 3.3). In addition, each 1 SD decrease in spinal BMD was associated with a 2.1 (1.7, 2.6) times greater odds of new fracture in the upper spine, compared with 1.5 (1.3, 1.8) for the lower spine. These findings suggest that, in older women, osteoporosis may be a stronger risk factor for new fractures in the upper (vs. lower) thoracolumbar spine, although we found no evidence that the location of prior fractures should influence treatment decisions. Physicians should recognize that prior vertebral fractures are a strong risk factor for future fractures, and consider treating such patients to reduce their risk of subsequent fractures.

Aged↗
PubMed1999

An evaluation of a new gel-coupled ultrasound device for the quantitative assessment of bone.

Quantitative ultrasound (QUS) is now being accepted as a tool in the assessment of bone status. Most QUS devices measure broadband ultrasound attenuation (BUA) and speed of sound (SOS). A newly introduced device, the Acoustic Osteo-Screener (AOS-100), measures both SOS and an attenuation related parameter called the transmission index (TI) and provides a derived parameter called osteo sono-assessment index (OSI). The purpose of this study was to examine the reproducibility of this new device, compare the results with the UBA 575+ and evaluate the effect of using two platforms to compensate for different foot sizes on the measured values. 83 subjects aged 21-89 years, who gave informed consent, were recruited. Subjects were assigned to three different groups determined by age and health status. The short-term measurement precision (expressed as root mean square coefficient of variation) of SOS (0.13-0.16%) and TI (1.18-1.96%) was similar to and better than that obtained for the UBA 575+. Significant negative correlations were found between the differences in SOS measured with the two platforms (adaptors to adjust the position of the foot relative to the foot plate) and foot length (p < 0.0001). This implies that small feet are more influenced by the differences of measured location. All QUS parameters measured with the small platform were found to be significantly smaller than those with the large platform (p < 0.0001). The mean percentage differences were 0.6% in SOS, 2.8% in TI and 4.3% in OSI with the large foot platform giving larger value results. Proper use of the platforms resulted in more reproducible SOS and TI. This study demonstrated that the newly developed AOS-100 parameters TI and OSI were highly reproducible. This study also demonstrated that the use of an inappropriate platform can cause discrepancies in QUS readings and poor reproducibility.

Adult↗
PubMed1999

Defining incident vertebral deformity: a prospective comparison of several approaches. The Study of Osteoporotic Fractures Research Group.

Vertebral deformities are common and important outcomes in clinical trials and epidemiologic studies of osteoporosis. While several different methods for defining new deformities have been proposed, it is not clear which is best. We used data from serial spine radiographs obtained an average of 3.7 years apart in 7238 women age >/=65 years from the Study of Osteoporotic Fractures to compare several approaches to defining new deformities by morphometry including a fixed percentage reduction in any vertebral height (FIXED%), a change in a summary spinal deformity index, a change in a vertebra from no prevalent deformity at baseline to a deformity at follow-up, as well as several variations of these methods. We compared results of each definition with several clinical correlates, including height loss, back pain, age, baseline bone mineral density, and the presence of a baseline deformity. We also estimated the sample size required for a clinical trial using various cut points. At a given level of incidence, all methods had similar relationships with each of the correlates. Given that similarity, the FIXED% method was simplest and needed no reference data. Using the FIXED% method, a 20-25% vertebral height reduction criterion for deformity maximized the power for a clinical trial. We conclude that all of the morphometric approaches to defining incident deformities have similar relationships to clinical correlates of vertebral deformity, but that use of a fixed percentage reduction in vertebral height is the simplest and most practical. For the FIXED% method, a 20-25% reduction in vertebral height minimizes the sample size required for clinical trials and epidemiologic studies.

Aged↗
PubMed1999

Does combining the results from multiple bone sites measured by a new quantitative ultrasound device improve discrimination of hip fracture?

There is a growing interest in the use of quantitative ultrasound (QUS) measurements as an alternative to current radiation-based bone densitometry techniques for the noninvasive assessment of fracture risk. While most of the commercialized ultrasound devices measure only single predefined peripheral skeletal sites, the Omnisense prototype (Sunlight Ltd., Israel) can be used on multiple bones, including the spinous processes. In this study, we examined the ability of speed of sound measured at the calcaneus, distal third and ultradistal radius, proximal third phalanx, metacarpal, capitate, patella, and the posterior process of the thoracic spine to differentiate subjects with hip fractures from normal controls. Seventy-nine postmenopausal Caucasian Israeli women who had sustained an atraumatic fracture of the proximal femur within the last 6 months were recruited from the local population (mean age 80 +/- 8.9 years). As controls, 295 postmenopausal Caucasian Israeli women without osteoporotic fractures were also included (mean age 70 +/- 8.7 years). Discrimination of hip fractures with QUS at all ultrasound sites was highly statistically significant (p < 0.01) (odds ratios [ORs] = 1.4-3.0; area under the ROC curve [AUC] 77-92%), except for the hand metacarpal. Distal radius and calcaneus measurements (ORs = 2.4 and 3.0) were the best discriminators of hip fracture patients from controls. Using a forward selective linear regression model, the discriminator values of combined assessment at two sites were investigated. There was moderate improvement in diagnostic value, but the best combination was the calcaneus with the distal radius, which improved the AUC by 3% and raised both the sensitivity and specificity to 94%. These data demonstrate the encouraging potential of improving discrimination of hip fracture by using multiple-site ultrasonic measurements.

Aged↗
PubMed1999

Biochemical markers of bone turnover and prediction of hip bone loss in older women: the study of osteoporotic fractures.

To examine the ability of commercially available biochemical markers of bone formation and resorption to predict hip bone loss, we prospectively obtained serum and timed 2-h urine specimens from 295 women age 67 years or older who were not receiving estrogen replacement therapy. Serum was assayed for two markers of bone formation: osteocalcin (OC) and bone-specific alkaline phosphatase (BALP). Urine specimens were assayed for four markers of bone resorption: N-telopeptides (NTX), free pyridinolines (Pyr), free deoxypyridinoline (Dpyr), and C-telopeptides (CTX). Measurements of hip bone mineral density were made at the time the samples were collected and then repeated an average of 3.8 years later. Higher levels of all four resorption markers were, on average, significantly associated with faster rates of bone loss at the total hip, but not at the femoral neck. Women with OC levels above the median had a significantly faster rate of bone loss than women with levels below the median, but there was no significant association between levels of BALP and hip bone loss. The sensitivity and specificity of higher marker levels for predicting rapid hip bone loss was limited, and there was considerable overlap in bone loss rates between women with high and low marker levels. We conclude that higher levels of urine NTX, CTX, Pyr, Dpyr, and serum OC are associated with faster bone loss at the hip in this population of elderly women not receiving estrogen replacement therapy, but these biochemical markers have limited value for predicting rapid hip bone loss in individuals.

Aged↗
PubMed1999

Comparison of ultrasound and bone mineral density assessment of the calcaneus with different regions of interest in healthy early menopausal women.

This study investigated the effect of different sized regions of interest (ROIs) on quantitative ultrasound (QUS) variables of the calcaneus. The effect on QUS of using a fixed ROI as opposed to an ROI adjusted for foot length was also assessed. Eighty Caucasian women, aged 50-57 yr (mean 53 +/- 2) who were healthy and within 0. 5-5 yr of the onset of menopause participated in this study. Using the QUS-1(trade mark) Ultrasonometer (Metra Biosystems, Mountain View, CA), we assessed broadband ultrasound attenuation ([BUA] and UBI-4, dB/MHz), the average transit time through the heel ([TTH], mus) and a multiple-factor index (UBI-4T = UBI-4/TTH, dB/[MHz. mus]). The QUS measurement results were calculated from three different sizes of ROI as well as one in a fixed location and one adjusted for foot size. Bone thickness, bone width, bone mineral content ([BMC], g/cm), bone mineral density area ([BMD(a)], g/cm(2)), and bone mineral density volume ([BMD(v)], g/cm(3)) were measured by single-energy photon absorptiometry. Lateral radiography of the foot was used to ensure the QUS scanning location in a subgroup. The results showed that there was a 1.4-5.9% difference in QUS parameters among different ROIs (p = 0.076-0.001). No significant differences between fixed and adjusted location were found regarding the mean values of QUS. The correlation between the fixed and adjusted locations was very strong, although there was a 12-42% unexplained variation. On the other hand, QUS in the size-adjusted ROI increased the correlation with BMC/BMD compared to the fixed QUS assessments. After controlling for body weight and height, a significant correlation between QUS and bone mass variables remained, and in some cases correlations became stronger. Lateral radiography showed that when using a fixed location to scan a large foot, the scanning area might be close to the bone edge, an area of higher BMD and potential acoustic artifacts. When scanning a small foot, the scanning area was confined to the middle of the calcaneus. Our results indicate that bone size has a modest effect on BUA. There is a better correlation with BMD when the measurement region is appropriately located in the calcaneus. This suggests that measurement location based on foot size may improve the accuracy of the measurements, resulting in good diagnostic sensitivity.

Bone Density↗