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PubMed2002

Quantitative ultrasound calcaneus measurements: normative data and precision in the spanish population.

Quantitative ultrasound (QUS) assessment at the calcaneus has been found to be a safe and reliable method for evaluating skeletal status. In this study we have determined the normative QUS data in the Spanish population for the Sahara Clinical Sonometer (Hologic). Broadband ultrasound attenuation (BUA), speed of sound (SOS), quantitative ultrasound index (QUI) and estimated bone mineral density (BMD) were determined. We also studied the precision in vivo and in vitro. The short-term in vivo precision (CV) was 4.88% for BUA, 0.36% for SOS, 3.45% for QUI and 4.15% for BMD, while in vitro precision was 0.40% for SOS and 2.67% for BUA. Our results are comparable to reference population data previously published in other countries and may serve as reference normative data for both genders in Spain.

Adolescent↗
PubMed2002

Quantitative ultrasound of the calcaneus and falls risk in the institutionalized elderly: sex differences and relationship to vitamin D status.

Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men (mean age 81.2 years, range 65-102 years) and 899 women (mean age 86.7 years, range 65-104 years). Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively ( p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women ( p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex. There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8-4.7% per decade and VOS by 1% per decade (both p<0.001). Mean BUA T-scores were -1.55 and -2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either sex.

Accidental Falls↗
PubMed2002

Effect of temperature on ultrasonic properties of the calcaneus in situ.

To assess the dependence of calcaneal quantitative ultrasound (QUS) on foot temperature, a series of acoustic measurements were made in five cadaver feet in situ (all soft tissues retained) over a temperature range of 25 degrees C to 40 degrees C in steps of 5 degrees C. An implanted probe was used to measured temperature directly in the calcaneus itself. Ultrasound velocity decreased linearly with increasing temperature, with a mean thermal coefficient of -2.2 m/s/ degrees C. In contrast, broadband ultrasonic attenuation (BUA) increased with temperature with a mean thermal coefficient of +0.75 dB/MHz/ degrees C. We argue that the temperature trends in velocity are likely to be due to the influence of fat, present in the bone marrow and in the soft tissues, which has a negative thermal coefficient for acoustic velocity. The attenuation trends may arise, in part, from greater scattering losses inside the cancellous bone due to an increased acoustic impedance mismatch between trabeculae and fatty marrow at higher temperatures. These considerations suggest that the greatest temperature effects may be expected in patients with a high proportion of fat within the measured volume and/or low calcaneal bone density. Given the magnitude of the thermal coefficients observed, the clinical impact of temperature-related QUS errors is likely to be modest for diagnostic purposes but of greater significance in follow-up studies.

Aged↗
PubMed2002

Age-specific values and cutoff levels for the diagnosis of osteoporosis in quantitative ultrasound measurements at the calcaneus with SAHARA in healthy Japanese women: Japanese population-based osteoporosis (JPOS) study.

To establish the reference values of the quantitative ultrasound (QUS) indices in healthy Japanese women and to propose a diagnostic criterion for osteoporosis by means of the QUS indices, 659 healthy women aged 20-79 years recruited from a larger cohort study (JPOS study), were examined for bone mass measurements by QUS at the calcaneus (SAHARA, Hologic Inc., USA) and by dual-energy X-ray absorptiometry at the spine, hip, and distal forearm. We presented 10-year age-specific mean values and T-scores of the QUS indices. The pattern of decrease in the T-score appeared to be linear in the QUS indices and total hip BMD but not in BMD at the spine. The T-score of the QUS of indices of the subjects in their 70s were significantly higher than that of BMD at the spine. The prevalence rates of osteoporosis in the subjects aged 50 and older diagnosed by QUS (8.7% for SOS, 10.7% for BUA) were similar to that diagnosed by total hip BMD (11.5%) and significantly lower than that by the spine BMD (36.1%) when the WHO criteria were applied. We performed receiver-operating characteristic analysis to set a cutoff level of the QUS indices for the diagnosis of osteoporosis to accurately identify the subjects diagnosed by either the spine or total hip BMD. The highest likelihood ratios for SOS and BUA were obtained at the cutoff levels of 1,517.7 m/sec (T-score: -1.58) with the sensitivity of 0.65 and the specificity of 0.65 and 59.5 dB/MHz (T-score: -1.52) with 0.66 and 0.69, respectively. The diagnostic accuracy of QUS indices for osteoporosis was not superior to that of age. However, the QUS indices showed a significant contribution to forming the diagnosis of osteoporosis independently of age and body size in multivariate diagnostic models developed by the logistic regression analysis. Therefore, the cutoff values presented in this study may be used as a tentative criterion until the cutoff levels for the QUS indices are set according to the fracture risk.

Adult↗
PubMed2004

Relationship between computed tomographic image analysis and histomorphometry for microarchitectural characterization of human calcaneus.

The present study aimed to characterize the relationships between several variables reflecting bone microarchitecture assessed by both computed tomographic (CT) image analysis and histomorphometry (conventional CT system) at the calcaneus. A total of 24 cadaveric specimens were studied. The mean age at death was 78 +/- 10 years (range, 53-93 years). A total of 15 sagittal sections (1 mm in width and spaced 2 mm apart) were selected for CT analysis; 6 undecalcified sections (7 microm) were analyzed for histomorphometry. The histomorphometric analysis was performed on a Leica Quantimet Q570 image analyzer. Features measured by both methods were: bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), interconnectivity index (ICI), number of nodes (N Nd), number of terminus (N Tm), node-to-node strut count (NNS), node-to-terminus strut count (NTS), terminus-to-terminus strut count (TTS), marrow space star volume (SV), Euler number (EN), and fractal dimension (FD). The coefficient of correlations' values (simple linear regression) between histomorphometry and CT image analysis varied according to the parameters selected. R values were high for BV/TV, Tb.N, and Tb.Sp (range, 0.69-0.90; P < 0.01). R values were less significant for some variables also obtained from the binary image: SV (0.5, P < 0.05) and EN (0.43, P < 0.05). Finally R values were also significant for (two) variables obtained from skeletonized images, i.e., N Nd (0.4, P < 0.05) and N Tm (0.61, P < 0.01). Other correlations were not statistically significant. Moreover, for some variables the relationships between the two methods (CT analysis and histomorphometry) seemed best-described by using nonlinear models. For example, a logarithmic model was more appropriate for SV (r = 0.71, P < 0.01), N Nd (r = 0.52, P < 0.01). Finally the relationship between apparent (App) N Tm and N Tm was most satisfying when using an exponential model (r = 0.64, P < 0.01). In conclusion, trabecular bone structure measures determined on CT images show highly significant correlations with those determined using histomorphometry. The level of correlation varies according to the type of method used for characterizing bone structure, however, and the strongest correlations were found for the most basic features (Parfitt's parameters). Finally, for some variables, nonlinear models seem more appropriate.

Absorptiometry, Photon↗
PubMed2000

Imaging ultrasonometry of the calcaneus: dependence on calcaneal area.

The purpose of this study was (1) to investigate the dependence of broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured in a circular region of interest (ROI) having a fixed size on calcaneal area and (2) to examine whether the normalization of ultrasonic variables for the area of the calcaneus provides better differentiation of diseased subjects from healthy individuals. Ultrasound variables were estimated in 169 healthy postmenopausal women (mean age 66.5 years, range 42-87 years) and 39 women with vertebral fractures (mean age 72.9 years, range 51-86 years). A minimum attenuation ROI, 15 mm in diameter, with a commercial imaging ultrasonometer was used. Significant relationships were found between both ultrasonic variables and calcaneal area (r2 = 0.06, P < 0.001 for BUA, r2 = 0.12, P < 0.0001 for SOS). Normalization of ultrasound variables (BUAn and SOSn) was based on the regression equations of the relationships among BUA, SOS, and calcaneal area. In a precision study, nine women were examined five times each to determine the errors arising from both the repositioning of the foot and selection of the calcaneal area. The reproducibility errors of BUA, SOS, BUAn, SOSn, and area were 0.87%, 0.20%, 1.07%, 0.27%, and 3.72%, respectively. Significant differences were found between the areas under the ROC curve for BUAn and BUA (area under the curve = 0.93 for BUAn versus 0.90 for BUA, P = 0.003) as well as for SOSn and SOS (area under the curve = 0.85 for SOSn versus 0.79 for SOS, P = 0.003). Normalization of ultrasound variables for calcaneal area improves the discrimination of clinical studies.

Adult↗
PubMed2002

The collagen Ia1 SP1 polymorphism is associated with differences in ultrasound transmission velocity in the calcaneus in postmenopausal women.

Bone mineral density (BMD) and fracture risk are under genetic control. An association of a G to T polymorphism in the Sp1 binding site of the collagen Ia1 (COLIa1) gene with the risk for fractures has been previously reported. This association is only partly explained by differences in BMD. Thus, we analyzed the relationship between the COLIa1 Sp1 polymorphism and ultrasound (US) transmission velocity (speed of sound; SOS) in bone. In a population-based sample of 740 women (aged 55-80 years) we determined COLIa1 genotype and US parameters in the calcaneus. SOS in the "GG" genotype group was 1522 +/- 31 m/sec, in the "GT" group, 1519 +/- 30 m/sec, and in the "TT" group 1508 +/- 30 m/sec (P = 0.01). While the difference between the GG and TT genotype groups corresponds to 0.5 SD or 1%, we observed an allele-dose-effect of 4.3 m/sec decrease in SOS per each copy of the "T" allele (P = 0.01). The differences remained significant after adjustment for BMD measured at the femoral neck. When we analysed 45 incident nonvertebral fractures in this group of women, we found the risk for fracture by COLIA1 Sp1 genotype to be partly explained by SOS differences as well as by BMD differences. Linear regression analysis showed a progressive negative slope of the regression line of SOS over age from "GG" over "GT" to "TT" genotype. These data indicate that the collagen Ia1 Sp1 polymorphism is associated with the modulus of elasticity of bone as determined in vivo by acoustical measurement. The relationship is independent of BMD and increases with age, contributing to an explanation of the increased fracture risk observed for this polymorphism.

Aged↗
PubMed2001

Imaging ultrasonometry of the calcaneus: optimum T-score thresholds for the identification of osteoporotic subjects.

The purpose of the present study was to (1) examine the age dependence of T-score results for calcaneal imaging ultrasonometry and dual X-ray absorptiometry of the axial skeleton and (2) determine the optimum T-score thresholds appropriate for broadband ultrasound attenuation (BUA) and speed of sound (SOS) measurements. A total of 453 healthy women aged 20-9 years were included in the study. All study participants underwent bone mineral density (BMD) measurements of the lumbar spine, femoral neck, total hip and calcaneal measurements of the BUA and SOS. An imaging ultrasound device (UBIS, DMS, France) was used for the ultrasound measurements. T-scores were calculated using a subgroup of 71 healthy women aged 20-35 years to estimate the mean value of young normals and SD for BUA, SOS, and BMD. The age-related decline in both BUA and SOS T-scores was slower than that in the equivalent figures obtained by BMD measurements. The optimum T-score thresholds estimated by receiver operating characteristic (ROC) analysis were 1.3 for BUA and 1.5 for SOS. Using the optimum threshold, the sensitivity and specificity for BUA was 68% and 83%, respectively. Corresponding values for SOS were 63% and 79%. Utilizing calculated optimum T score thresholds for BUA and SOS, the agreement among BUA, SOS, and BMD at the femoral neck was improved compared with that found using the T-score of < or = -2.5 criterion. In conclusion, the definition of osteoporosis by a T-score of , or = -2.5 was not applicable to imaging ultrasonometry of the calcaneus. Optimum T-score thresholds were determined for both BUA and SOS suitable to Ubis QUS device.

Absorptiometry, Photon↗
PubMed2000

Lifestyle factors affecting bone ultrasonometry of the calcaneus in Japanese women.

Ultrasonometry is increasingly used to assess bone characteristics. A group of 1412 women with a mean age of 57 years attended a screening examination in a Japanese city. Seventy-four percent of participants were postmenopausal. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and Stiffness index (SI) of the calcaneus were measured; subjects also completed a questionnaire examining lifestyle factors; anthropometric data were recorded. Analysis showed that the strongest predictors of decreased BUA, SOS, and SI were increased age and menopausal status. Higher body mass index and current participation in exercise or sports were significant predictors of increased BUA, SOS, and SI in a multivariate model. Higher calcium intake predicted increased BUA (P = 0.004) and missing meals predicted a lower SOS (P = 0.019). This study suggests that dietary factors as well as physical activity influence bone characteristics assessed by QUS. QUS may be a suitable technique to assess the effect of lifestyle changes on bone.

Adult↗
PubMed1996

Sex and age patterns of quantitative ultrasound densitometry of the calcaneus in normal Japanese subjects.

: The speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (stiffness), which was derived from SOS and BUA, were measured on the calcaneus using the Achilles ultrasound densitometer (Lunar) in normal Japanese woman (n = 473) and men (n = 218). Sex differences and age-related changes in these variables were investigated. In addition, the bone mineral density (BMD) of the lumbar vertebrae measured by dual X-ray absorptiometry (QDR-2000, Hologic) was compared with SOS, BUA, and stiffness. There were some decreases of ultrasound variables in both young adult men and women. BMD values were similar in young adults of both sexes. BMD was relatively stable in women from 20 to 49 years, then decreased at about 1.5%/year. Ultrasound variables were higher in males than females at all ages, and they decreased from age 20 onward in both sexes with an annual loss of about 0.6%. Age-related changes in SOS, BUA, and stiffness were different from those in BMD in normal Japanese subjects. The correlations between BMD and SOS and BUA and stiffness were higher in women (r = 0.51-0.64) than in men (r = 0. 43-0.49).

Absorptiometry, Photon↗
PubMed1996

Primary lymphoma of the calcaneus.

Primary non-Hodgkin's lymphoma (NHL) of bone is a rare condition. Presented herein is a case of primary NHL of the calcaneus illustrating many of the classic features of the disease. Emphasized in this report are the nonspecific clinical and conventional radiographic features of primary NHL of bone, which may mimic inflammatory, neuropathic, infectious, or other neoplastic conditions of the extremities. The importance of early cross-sectional radiologic studies, such as magnetic resonance imaging, lies in the early characterization of the mass-like features and local extent of such lesions, helping to raise the suspicion of neoplastic disease.

Aged↗
PubMed1997

Malignant hemangioendothelioma of the left calcaneus associated with fever and hematological abnormalities.

A case of malignant hemangioendothelioma of the left calcaneus associated with unique system manifestations is reported here. The severe toxic manifestations included: high fever, anemia, leukocytosis, coagulation abnormalities, and other signs. Because of poor response to many antibiotic regimens, the confusion of diagnosis, and severe coagulation abnormalities with clinical signs that the life of the patient was endangered, below the knee amputation was performed. Pathological studies revealed a malignant hemangioendothelioma. A review of the case suggests that the signs and symptoms were possibly due to an immune response to the tumor rather than to secondary infection, although the latter possibility cannot be completely excluded.

Adult↗
PubMed1999

Intra-articular displaced fractures of the calcaneus. Operative vs non-operative treatment.

Twenty-eight patients with displaced intra-articular fractures of the calcaneus treated by open reduction and fixation were compared with 30 patients with similar fractures treated conservatively. Judged by the clinical and radiographic criteria results were more satisfactory in the surgical group than in the nonoperative group, although high rates of poor results were encountered in both groups.

Calcaneus↗
PubMed1998

Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture.

Fracture of the anterior superior process of the calcaneus has been considered an unusual injury. Following a sudden twist there is immediate pain on the outer aspect of the mid-portion of the foot and discomfort on weight-bearing. Three mechanisms of injury have been reported to cause the fracture. The diagnosis is often missed, and prolonged disability and local pain at the calcaneocuboid joint deserve further consideration. Oblique X-rays of the foot are helpful to visualize the fracture. Type III fractures may cause cartilage lesions and arthrosis; therefore, one should not wait long before excision or refixation of the fragment.

Adult↗
PubMed2004

Quantitative ultrasound measurements of the calcaneus in the prediction of lumbar spine degeneration.

A cross-sectional study was conducted to evaluate the possible use of a low-cost radiation-free technique in the prediction of degenerative changes in the lumbar spine. Although an inverse correlation between osteoporosis and degenerative changes in the lumbar spine has been reported, no previous studies have asked whether there is a correlation between calcaneal quantitative ultrasound results and degenerative findings in the lumbar spine. In 117 patients with low back pain or pain in the lower limb, ultrasonographic parameters (speed of sound, broadband ultrasound attenuation, stiffness) of the calcaneus were correlated with evidence of degenerative changes and stenosis on magnetic resonance scans of the lumbar spine. Linear and logistic regression, as well as receiver operator characteristic curve analyses, were used to evaluate the correlation. Lumbar spine stenosis was associated with elevated calcaneal ultrasonographic parameters, particularly speed of sound. For the identification of a narrowing of the lumbar spinal canal below 100 mm(2) of dural sac cross-sectional area, speed of sound showed 89% sensitivity and 75% specificity in males older than 60 years. In male patients, we also found a significant positive correlation between ultrasonographic parameters and scores on a degenerative scale that primarily reflects intervertebral disc degeneration ( P=0.019 for speed of sound; P=0.039 for stiffness). In conclusion, calcaneal quantitative ultrasound is frequently used in elderly patients with low back pain as a diagnostic test for osteoporosis. The incidental finding of high values on ultrasonographic parameters in these subjects, particularly in males, is highly correlated with lumbar spine degeneration and stenosis, and can help to identify those symptomatic patients needing more extensive diagnostic testing.

Adult↗
PubMed2004

Ultrasound bone densitometry of the calcaneus, determined with Sahara, in healthy Japanese adolescents: Japanese Population-based Osteoporosis (JPOS) Study.

To establish the reference values for quantitative ultrasound (QUS) indices (speed of sound [SOS]), and broadband ultrasonic attenuation [BUA]) in healthy Japanese adolescents, and to evaluate the effects of age and body size on QUS in comparison with their effects on bone mineral density (BMD), 632 healthy adolescents aged 12 through 17 years recruited from a larger cohort study (Japanese Population-based Osteoporosis [JPOS] Study), were examined in terms of bone mass measurements by QUS at the calcaneus (Sahara; Hologic) and by dual-energy X-ray absorptiometry at the distal one-third radius and ultradistal forearm. We present sex- and age-specific mean values of the QUS and BMD indices. BMD increased significantly up to 17 years of age in males and up to 16 years in females. However, the age-related change in the QUS indices in males was not as clear as that seen for BMD and no age-related change in the QUS indices was observed in females. Significant positive correlation coefficients between BMD and body size were observed in both sexes even after adjusting for the effect of age. SOS showed no correlation with body size and BUA showed a positive but weak correlation with body size in both sexes. Thus, the relationships of age and body size to BMD and QUS were different from each other, even though the QUS indices had significant positive correlations with BMD, allowing for the effect of age.

Absorptiometry, Photon↗