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PubMed2003

Evaluation of calcaneus bone densitometry against hip and spine for diagnosis of osteoporosis.

Dual X-ray absorptiometry (DXA) is now widely available as a method for assessing bone density. However, the place of peripheral bone densitometry in clinical practice for diagnosis of osteoporosis is not yet clear. To examine the potential use in our district general hospital setting, we compared calcaneus measurements with conventional DXA of the hip and spine in 100 patients referred for assessment following identification of risk factors for osteoporosis. Measurements were made on both heels and the results were found to be similar but not completely interchangeable. Use of receiver operating characteristic curves confirmed that a threshold T-score of -1.6 could be used to identify many of the high risk subjects. However, there was only moderate agreement between fracture risk classifications derived from heel T-scores, and diagnostic classification (osteoporosis/osteopenia/normal) derived from axial DXA. The specificity of heel measurements was high, but sensitivity was poorer. Heel measurements could therefore be valuable in some circumstances for finding patients for whom treatment of osteoporosis would be appropriate, such as in a population with a low prevalence of osteoporosis. They may also be of value in a population with a high prevalence of disease, particularly if there were no alternative means of bone densitometry. However, with an intermediate prevalence, the relatively high risk of false negative values would mean that false reassurance could be given to many of those classed as "low risk". This could be a major drawback in clinical practice if heel densitometry were used as the initial investigation and axial measurements were also available, since they would give conflicting results for a substantial proportion of these patients.

Absorptiometry, Photon↗
PubMed2000

[Bone mineral density of the calcaneus and related factors in men].

In this cross-sectional study, the bone mineral density of the calcaneus was investigated in healthy young (n = 35, 22-33 years) and middle-aged (n = 49, 45-59 years) men. The relationships among the bone mineral density, body fatness, physical fitness, physical activity in recent and past days, smoking, alcohol, and sex hormones (free testosterone, estradiol, and dehydroepiandrosterone-sulfate; DHEA-S) and sex hormone binding globulin were evaluated. The speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness were measured by ultrasonic measurement. There was no association between age and bone density in each group. In the young group, there was a positive correlation between the body mass index (BMI) and BUA and between the training time during junior high school and BUA, and an inverse correlation between alcohol consumption and SOS after adjustment for the confounding factors using partial correlation analysis. The level of DHEA-S was weakly but not significantly associated with BUA. In the middle-aged group, there was an inverse correlation between the waist to hip ratio and SOS, and between the height of jump and SOS after adjustment for the confounding factors using partial correlation analysis. These results suggest that different factors may affect bone density in the young and middle-aged men. In young men, the higher BMI and the longer training time during boyhood may have a positive effect, and heavy alcohol consumption may have a negative effect on bone density. In middle-aged men, abdominal fat accumulation has a negative effect and leg muscle power has a positive effect on bone density.

Adipose Tissue↗
PubMed1986

Prominence of the calcaneus: is operation justified?

Sixty-nine heels in 42 patients with prominence of the calcaneus sufficient to cause symptoms were operated upon after conservative treatment had failed. At review the overall results of operation were found to be poor.

Adolescent↗
PubMed1991

Calcaneus deformity in the ambulant patient with myelomeningocele.

We reviewed our experience of tibialis anterior transfer and anterior release for calcaneus deformity in 46 feet of 26 ambulant patients with myelomeningocele. At an average follow-up of 8.4 years (2 to 17.6) there were 89% who had satisfactory results; 64% of the patients having tibialis anterior transfers were able to stand on their toes. Hip abductor power was a good predictor of a functional transfer. Pre-operative trophic ulceration of the heel increased from 3.2% to 33% if surgery was delayed. Secondary deformities, two-thirds of them into valgus, developed in 76% of feet.

Calcaneus↗
PubMed2003

A genome-screen of a large twin cohort reveals linkage for quantitative ultrasound of the calcaneus to 2q33-37 and 4q12-21.

UNLABELLED: A genome-wide screen was performed on a large cohort of dizygous twin pairs to identify regions of the genome that contain QTL for QUS of bone. Suggestive linkage of QUS parameters to 2q33-37 and 4q12-21 highlighted these regions as potentially important for studies of genes that regulate bone. INTRODUCTION: The genetics of osteoporotic fracture is only partly explained by bone mineral density (BMD). Quantitative ultrasound (QUS) of the calcaneus can also be used for independent clinical assessment of osteoporotic fracture risk. Two specific indices are derived from this assessment: broadband ultrasound attenuation (BUA) and velocity of sound (VOS). Both parameters provide information on fracture risk; however, BUA has been studied more extensively and may be favored because it is thought to have a stronger predictive value for osteoporotic fracture and incorporates aspects of trabecular structure and bone quality as well as BMD. Studies of QUS in twins have shown that both derived parameters are under substantial genetic control, independent of BMD. MATERIALS AND METHODS: To identify regions of the genome that contain quantitative trait loci (QTL) for QUS of bone, we performed a genome-wide screen on a large cohort of dizygous twin pairs. Unselected female dizygous twins from 1067 pedigrees from the St Thomas' UK Adult Twin Registry were genome scanned (737 highly polymorphic microsatellite markers). Multipoint linkage analyses provided maximum evidence of linkage for BUA (LOD 2.1-5.1) to 2q33-37. Linkage for VOS (LOD 2.2-3.4) was maximal at 4q12-21. Potential evidence of linkage in the cohort indicated five other possible locations of QTL (LOD > 2.0) relevant to bone density or structure on chromosomes 1, 2, 13, 14, and X. RESULTS AND CONCLUSIONS: This study has identified eight genomic locations with linkage of LOD > 2.0. This data should be of value in assisting researchers to localize genes that regulate bone mass and microstructure. These results should complement genome screens of BMD and bone structure and serve to enable further targeted positional candidate and positional cloning studies to advance our understanding of genetic control of bone quality and risk of fracture.

Adolescent↗
PubMed1999

Direct three-dimensional morphometric analysis of human cancellous bone: microstructural data from spine, femur, iliac crest, and calcaneus.

The appearance of cancellous bone architecture is different for various skeletal sites and various disease states. During aging and disease, plates are perforated and connecting rods are dissolved. There is a continuous shift from one structural type to the other. So traditional histomorphometric procedures, which are based on a fixed model type, will lead to questionable results. The introduction of three-dimensional (3D) measuring techniques in bone research makes it possible to capture the actual architecture of cancellous bone without assumptions of the structure type. This requires, however, new methods that make direct use of the 3D information. Within the framework of a BIOMED I project of the European Union, we analyzed a total of 260 human bone biopsies taken from five different skeletal sites (femoral head, vertebral bodies L2 and L4, iliac crest, and calcaneus) from 52 donors. The samples were measured three-dimensionally with a microcomputed tomography scanner and subsequently evaluated with both traditional indirect histomorphometric methods and newly developed direct ones. The results show significant differences between the methods and in their relation to the bone volume fraction. Based on the direct 3D analysis of human bone biopsies, it appears that samples with a lower bone mass are primarily characterized by a smaller plate-to-rod ratio, and to a lesser extent by thinner trabecular elements.

Adult↗
PubMed2000

Reconciling quantitative ultrasound of the calcaneus with X-ray-based measurements of the central skeleton.

Osteoporosis is frequently undiagnosed before fracture because of the lack of availability of instruments to quantitate bone mass. To evaluate the utility of quantitative ultrasound (QUS) of the calcaneus to diagnose osteoporosis, we determined bone mineral density (BMD) of the posterior-arterior spine, total hip, and femoral neck by dual-energy X-ray absorptiometry (DXA) and QUS in 312 women aged 50 years and older. A risk factor assessment (simple calculated osteoporosis risk estimation [SCORE]) also was quantitated in all women. Ninety-four of the 312 women were diagnosed as osteoporotic based on T scores < or = -2.5 at the spine, total hip, and/or femoral neck. The sensitivity of the individual central sites for the diagnosis of osteoporosis was 49% at the spine (46 of 94 women), 32% at the total hip (30 of 94 women), and 81% at the femoral neck (76 of 94 women). At a QUS T score < or = -1, the peripheral technique had a sensitivity of 62% and a specificity of 72%. Combining a QUS T score of < or = -1 followed by a risk factor assessment of women with a QUS T score > or = -0.99 using a cut point of 11 increased sensitivity to 81% (comparable with femoral neck DXA) but decreased specificity to 58%. If peripheral QUS measurements and risk factor assessment are the only tools employed before initiation of therapy, the benefits of increased ease of diagnosis will need to be balanced against potentially unnecessary treatment in some normal patients and lack of treatment in some osteoporotic patients.

Absorptiometry, Photon↗
PubMed2001

Quantitative ultrasound and trabecular architecture in the human calcaneus.

Relationships between quantitative ultrasound (QUS), density (bone volume density [BV/TV]), and trabecular architecture were investigated in 69 calcaneal cancellous bone cubes. Ultrasound signal velocity, phase velocity, attenuation, and broadband ultrasonic attenuation (BUA) measurements were made along the mediolateral axis. Density and architectural parameters were measured using microcomputed tomography (microCT). Density yielded the best correlations with QUS (r2 = 73-77%). Of the individual architectural parameters, correlations with QUS were highest for the Structure Model Index (SMI), a parameter quantifying the relative proportion of rods and plates (r2 = 57-63%). After adjustment for density, significant associations with QUS remained for SMI, trabecular spacing (Tb.Sp), and trabecular number (Tb.N), although the variance in QUS attributable uniquely to individual architectural parameters was at best 4%. In multivariate regression models, combinations of density and architectural parameters explained 76-82% of the variance in QUS, representing an r2 increase of, at most, 8% compared with using density alone. However, multivariate models using combinations of architectural parameters alone (i.e., density excluded) also had a good predictive ability for QUS (r2 = 73-81%). Thus, although these data show modest but significant density-independent relationships between QUS and trabecular architecture in the human calcaneus for the first time, the causal relationships behind the variation in acoustic properties remain obscure. Given the relative weakness and complexity of the emerging associations between QUS and architecture, it is prudent to regard QUS measurements in calcaneal bone primarily as an indicator of bone density.

Adult↗
PubMed2001

Calcaneus ultrasound measurements in a convenience sample of healthy youth.

We examined age-related changes in quantitative ultrasound of the calcaneus in 311 healthy males and females ages 6.6-20 yr using the Lunar Achilles ultrasound device. This equipment has been adapted for pediatric use with the provision of shims designed to properly position smaller feet relative to the transducers. Broadband ultrasound attenuation (BUA) (decibels/megahertz), speed of sound (SOS) (meters/second), and stiffness index (SI) (percent) increased across the age range until a plateau was reached at 16-18 yr. BUA increased by 40%, SOS by 4%, and SI by 80% across this age range. There was no gender difference in age-related gains. Age, weight, height, and hours of weight-bearing physical activity were all significantly associated with BUA, SOS, and SI. After controlling for age and weight, hours of weight-bearing physical activity showed little to no additional effect on these parameters. Short-term in vivo precision using this device was similar in children to that observed in adults in our laboratory; coefficients of variation for between-day measurements were 1.8, 0.6, and 3.2% for BUA, SOS, and SI, respectively. These data support the feasibility of using the Lunar Achilles in evaluating pediatric bone mass. The ability of this technique to discriminate between osteopenic and normal children remains to be determined.

Adolescent↗
PubMed2003

Comparison of calcaneus ultrasound and dual X-ray absorptiometry in children at risk of osteopenia.

The optimal method to assess pediatric bone mass remains controversial. Dual X-ray absorptiometry (DXA) is used most commonly for clinical assessments in children, but calcaneus ultrasound (CUS) is less costly, is free of ionizing radiation, and predicts fracture as well as DXA in adults. This study was designed to compare CUS and DXA in 42 young patients (ages 9-21) with chronic disease and/or fragility fractures. Zscores for broadband ultrasound attenuation (BUA) and speed of sound (SOS) determined using the Lunar Achilles Plus ultrasonometer were compared with Z-scores for areal bone mineral density (BMD) and volumetric BMD using DXA (Hologic). Logistic regression was employed to predict low bone density measured by DXA (defined as spinal BMD Z-score < -2) from CUS measurements. Sensitivity/specificity analysis was performed to compare CUS and spinal DXA Z-scores as predictors of previous low-impact fracture. Correlations between CUS and DXA Z-scores were in the range of r = 0.3-0.6. Areas under the receiver operator characteristic (ROC) curves for BUA and SOS predicting low bone density by DXA were similar: 0.81 and 0.82, respectively. ROC curve areas for spinal DXA, BUA, and SOS predicting previous fracture were also similar: 0.85, 0.84, and 0.84, respectively. While CUS correlates only modestly with DXA, ROC curve areas indicate that CUS detects low bone mineral in children with fragility fractures as well as DXA and may be a viable initial screen for osteopenia.

Absorptiometry, Photon↗
PubMed2005

Pediatric reference data for bone mineral density in the calcaneus for healthy children 2, 4, and 7 years of age by dual-energy x-ray absorptiometry and laser.

Dual-energy X-ray absorptiometry and laser (DXL) Calscan measures bone mineral density (BMD) in the calcaneus. In the present study, the DXL Calscan device has been modified for use in pediatric practice. It includes a function for measuring calcaneal height, which makes it possible to calculate volumetric bone mineral apparent density (BMAD). The aims of the present study were to evaluate the method when used in children, to create pediatric reference values in healthy Swedish 2-, 4-, and 7-yr-old children for BMD, bone mineral content (BMC), and BMAD, and to study whether these parameters were related to auxological data. The method was well tolerated by all children. Intraindividual coefficients of variation for BMC and BMD decreased with increasing age. The mean BMD was 0.17+/-0.003 g/cm2 in 2-yr-old children, 0.22+/-0.003 g/cm2 in 4-yr-old children, and 0.30+/-0.005 g/cm2 in 7-yr-old children. This study provides normative data as percentile values for BMD, BMC, and BMAD in young children measured with DXL Calscan. BMD was significantly correlated with age (p<0.001), height (p=0.001), weight (p<0.001), and body mass index standard deviation score (p<0.001). Seven-year-old girls showed significantly higher BMD than boys.

Absorptiometry, Photon↗
PubMed1993

Late complications of fractures of the calcaneus.

We retrospectively reviewed the results of the operative treatment of forty-three fractures of the calcaneus in forty-two patients (thirty-six men and six women). The operations had been performed a mean of twenty-six months (range, six to seventy-two months) after the injury. An in situ subtalar arthrodesis had been performed in fifteen patients; a subtalar distraction bone-block arthrodesis, in fourteen; a triple arthrodesis, in five; a lateral calcaneal ostectomy, in seven; a transection and proximal transposition of the sural nerve, in seven; and a release of the tibial nerve, in five. The patients were examined at a mean of thirty-two months (range, twenty-six to fifty-two months) after the operation. The difference between the preoperative and postoperative rating scores was used to measure any improvement in function. Pain was partially relieved in thirty-eight (90 per cent) of the patients, function improved in thirty-five (83 per cent), and thirty-two (76 per cent) of the patients returned to work or to a pre-injury level of activity at a mean of eight months (range, four to sixteen months) after the operation. There was a trend (p = 0.07) that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. The most successful results were in the patients who had had a subtalar arthrodesis.

Activities of Daily Living↗
PubMed1994

Displaced intra-articular fractures of the calcaneus treated non-operatively. Clinical results and analysis of motion and ground-reaction and temporal forces.

Twenty-seven patients who had a unilateral displaced intra-articular fracture of the calcaneus were managed with a cast instead of with reduction or an operation. The clinical result after a mean of six years (range, two to ten years) was excellent in five patients, good in five, fair in seven, and poor in ten. The sixteen patients who were re-examined for this study and for whom the gait was analyzed demonstrated abnormalities in ground-reaction force with regard to vertical force (F3) and temporal force factors (T2, T3, T6, and T9). Analysis of temporal and distance factors showed a trend toward a decreased proportion of single-limb support on the involved side. Three-dimensional motion analysis of the ankle and hindfoot was performed with electrogoniometers as the subject walked on a level surface, on a 10-degree side-slope, and up and down stairs. Motion was decreased in the sagittal, coronal, and transverse planes during walking on level ground and on a side-sloping surface. Significant decreases in motion in these planes were also seen during walking up and down stairs. Although these patients did not have a subsequent reconstructive operation, most had a residual functional deficit.

Ankle Joint↗
PubMed1977

Chondroblastoma of the calcaneus: radiographic features with emphasis on location.

Fourteen cases of chondroblastoma of the calcaneus have been examined and the radiographic features described. Thirteen occured in males. In all but one case the location was either at the talocalcaneal articulation or adjacent to the posterior calcaneal cortex. A sclerotic margin was present in all instances. Occasionally calcifications and septations were seen.

Adolescent↗
PubMed1987

Stress fractures of the distal tibia and calcaneus subsequent to acute fractures of the tibia and fibula.

Stress fractures (two in the calcaneus and four in the distal tibia) occurring distal to the site of a healing fracture of the tibia or fibula were discovered in five patients. Three of these fractures were identified radiographically at the time of their occurrence, and three were identified only after retrospective review of the radiographs of 74 patients with previous tibial or fibular fractures. Three of the patients were less than 10 years old. All five patients had disuse osteopenia and recently had begun weight-bearing. Four patients had healing of their acute fractures with angulation or displacement. Stress fractures can easily be overlooked on radiographic studies in this setting and may be a source of pain that mistakenly can be attributed to malunion or nonunion. Stress fractures should be considered in patients with fractures of the lower extremity, particularly those who experience new or persistent pain or discomfort.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of intra-articular fractures of the calcaneus with dislocations].

Most calcaneal fractures occur in male industrial workers, having significant economic repercussions. Although current operative treatment has improved the outcome of the treatment in many patients, there is still no consensus on the classification, treatment, operative technique, or postoperative management. Computed tomographic scanning has improved our understanding of these fractures substantially, and has allowed the consistent analysis of the results of the treatment. The focus of current treatment is on the operative methods, internal fixation by leg-screw and plate through the lateral Kocher approach. Between April 1998 and July 2002, we treated operatively 6 displaced intraarticular fractures of the calcaneus. A lateral Kocher incision, leg-screw, and plate fixation were used. Neither infection, nor nonunion, or malunion occurred. All the patients presently have painless foot, use normal footwear, and are capable of normal activities.

Adolescent↗
PubMed1998

Broadband ultrasound attenuation of the calcaneus. A tool for assessing bone status in patients with chronic renal failure.

PURPOSE: To evaluate broadband ultrasound attenuation (BUA) for the assessment of bone status and to correlate this to dual-energy X-ray absorptiometry (DXA) in haemodialysis patients. MATERIAL AND METHODS: In 60 patients, BUA (dB/MHz) was determined for the calcaneus. The results were expressed as Z-scores and T-scores, i.e. units of standard deviations respectively from age- and sex-matched normal values and from sex-matched normal mean values in healthy young adults. Ultrasound data were correlated to relevant clinical, biochemical and DXA data (g/cm2), which were examined at the femoral neck and at the lumbar spine in 50 patients. RESULTS: The BUA Z-score was < -1 in 53% of the patients and < -2 in 22%. The BUA T-score was < -1 in 88% and < -2 in 62%. Moderate correlation was found for calcaneal BUA to DXA in men (r = 0.47-0.48, p < 0.01) and to DXA of the lumbar spine in women (r = 0.51, p < 0.05). The best correlation was observed for BUA to DXA of the femoral neck in women (r = 0.61, p < 0.01). CONCLUSION: Calcaneal BUA is an additional tool for the surveillance of bone density in haemodialysed patients.

Absorptiometry, Photon↗
PubMed1989

The calcaneus in ankylosing spondylitis. A radiographic study of 43 patients.

A prospective study analysing the radiological findings of calcaneus bone in ankylosing spondylitis is presented. It includes 43 patients with a relatively low mean age (33.5 years). The morphology of their lesions correlated with disease duration. Abnormal radiological findings were observed in 63% of the patients and in 58% of the radiographs, but in only 3 of 20 normal subjects. Erosive lesions were more frequently found in early stages, whereas sclerotic and proliferative lesions were typical of advanced stages of the disease. Only one patient suffered relevant local pain. No clinico-radiological correlation could be established.

Adult↗