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PubMed1997

[Too long antero-medial process of the calcaneus. A study of 59 cases in 37 children and adolescents].

PURPOSE OF THE STUDY: In 1983, we reported 5 cases of a type of tarsal abnormality which often went unrecognized in children and adolescents, the so-called "too long antero-medial process of the calcaneus" (TLAP). This report analyzes 59 such abnormalities observed in 37 children and adolescents. Treatment of the 48 symptomatic cases is presented. MATERIAL: A retrospective study was done on the files of all patients in whom oblique foot radiographs, CT scan or MRI of the foot showed an abnormal antero-medial process of the calcaneus. Of this group, patients were re-examined and radiographs of both feet (AP, lateral and oblique views) were obtained. METHODS: Gender, age at occurrence of symptoms, diagnosis and follow-up, patient complaints and successive treatment were assessed. Final clinical results were graded according to patient's complaints of pain and functional limitation as well as clinical evaluation of subtalar motion. RESULTS: Fifty-nine TLAPs have been found in 37 patients, 30 girls and 7 boys of 11.6 years on average at the first symptoms. Delay of diagnosis from onset of symptoms to final diagnosis averaged 2 years. First symptoms were so-called ankle sprains in 19 patients, ankle instability with tarsal pain in 17, pain and tarsal stiffness in 11, spastic flat foot in 1. In 11 patients, the abnormality was found on the opposite foot. In 2 patients, the TLAP was combined to a calcaneo-navicular bridge of the other foot. Eleven strapping managements resulted in 11 failures, 36 plaster immobilizations led to 12 good, 2 fair and 22 poor results; 25 resections gave 23 good, 1 fair and 1 poor result at a 4.6 years follow-up on average. DISCUSSION: In some people, the antero-medial process of the calcaneus is elongated and becomes interposed between the head of the talus and the cuboïd, far enough to cause impingement on the navicular. Because of the elongation, supination produces a "nutcracker" phenomenon with compression of the process between the talus and the cuboïd; this may result in a chondral injury of the talus head at its inferior and lateral part which faced the TLAP. Authors suggest that calcaneo-navicular coalition and TLAP represent a spectrum of types of errors in embryologie mesenchymal formation with lack of normal joint formation of the tarsal ossicles during fetal life. Immobilization treatment as primary management was particularly unsuccessful in the group with recurrent ankle sprains and persistent pain. Process resection proved a highly successful technique in management of those patients who failed to achieve good results with plaster immobilization. CONCLUSION: The "too long antero-medial process of the calcaneus" should be considered when assessing possible causes of recurrent ankle sprain or persistent tarsal pain in adolescents. An oblique X-ray is usually satisfactory for diagnosis. In patients who failed a conservative management, resection of the process produced good results and painless, supple feet.

Adolescent↗

PubMed1998

[In vitro study of ultrasonic bone densitometry using dissected calcaneus].

Quantitative ultrasound (QUS) of the calcaneus is a widely utilized method for bone densitometry. However, the meaning of measured parameters, such as speed of sound (SOS) and broadband attenuation (BUA), is not well established. We performed in vitro measurement of dissected human calcaneus (n = 60; male 29, female 31; mean age 81 years) using two QUS machines and also measured bone densities using SXA, DXA and pQCT. Finally, we investigated breaking strength of the calcaneus and studied the correlation with QUS parameters and other assessed parameters. The two QUS measurements were in good agreement in most experiments. SOS correlated most closely with bone mineral densities assessed by pQCT and did not correlate with factors related to bone size, while BUA showed the highest correlation with BMC and association with parameters related with bone size such as bone area and bone width. With maximal breaking stress of the calcaneus, correlations were almost equal among QUS parameters and bone mineral density. We conclude that SOS is the parameter most closely associated with true bone mineral density (g/cm3), whereas BUA represents both bone mineral density and bone size, mimicing BMD assessed by DXA or SXA.

Aged↗

PubMedDate not supplied

Ossification of the calcaneus in the normal fetal foot and in clubfoot.

The ossification of the fetal calcaneus was studied in a series of plastinated sections of 44 normal feet and three clubfeet. The results documented a precise sequence of perichondral and endochondral ossification in the normal calcaneus characterized by ossification grooves and associated cartilage canals. Within the clubfoot calcaneus, the coordination of perichondral and endochondral ossification is disturbed, ossification grooves and associated cartilage canals are not found in regular positions, and the process of endochondral ossification obviously is disturbed. The findings in the clubfoot specimens point to grave irregularities of the extracellular matrix within or outside the calcaneus.

Calcaneus↗

PubMed1996

Heterogeneity of the skeleton: comparison of the trabecular microarchitecture of the spine, the iliac crest, the femur, and the calcaneus.

The objective of this study was to elucidate the structure of cancellous bone and its age-related changes at different skeletal sites. Therefore, the lumbar spine, iliac crest, femur, and calcaneus of 12 age- and sex-matched skeletal healthy autopsy cases (6 females, 6 males, aged 28-84 years, mean 54 years) were removed. The following analysis includes an evaluation of the trabecular bone volume (BV/TV, %) and the trabecular interconnection (TBPf, mm-1) as well as a qualitative investigation of the structure of trabecular bone. BV/TV shows the following mean values: lumbar spine, 8.3% (+/- 0.8%); iliac crest, 11.5% (+/- 1.6%); intertrochanteric, 10.2% (+/- 1.2%); femoral neck, 15.8% (+/- 1.6%); and calcaneus, 15.4% (+/- 2.0%). There are significant differences between the BV/TV of the femoral neck and that of the lumbar spine as well as between that of the calcaneus and the lumbar spine (p < 0.01). However, a positive correlation can be seen between the bone mass of the spine and that of all other investigated sites (r = 0.67 to r = 0.80; pr < 0.1). The trabecular interconnection of the lumbar spine (2.7 mm-1, SEM +/- 0.2 mm-1) and the femoral neck (0.3 mm-1, SEM +/- 0.3 mm-1) differs significantly. Only these two sites show a significant positive correlation of TBPf (r = 0.60; pr < 0.1). Age-dependent alteration of the spine and the femoral neck in bone mass and bone structure is nearly the same. The trabecular microarchitecture of the iliac crest varies systematically. A region 4-10 cm behind and 1-3 cm below the anterior superior iliac spine turns out to be the most suitable biopsy site because of its closest relation to the lumbar bone mass. However, drawing information about the trabecular interconnection within the lumbar spine by measurement of the iliac crest at any site seems to be impossible. The horizontal specimens reveal a vertical running tubular spongiosa pattern that is arranged in concentric rings starting from the dorsal shell like a honeycomb. The comparison of TBPf in horizontal and vertical planes and its age-related changes indicates the age-related bone loss to be predominantly a loss of horizontal trabeculae. Thus, the presented data provide further information about the skeletal distribution and heterogeneity of the trabecular microarchitecture.

Adult↗

PubMed2004

Relationships of loading history and structural and material characteristics of bone: development of the mule deer calcaneus.

If a bone's morphologic organization exhibits the accumulated effects of its strain history, then the relative contributions of a given strain stimulus to a bone's development may be inferred from a bone's hierarchical organization. The artiodactyl calcaneus is a short cantilever, loaded habitually in bending, with prevalent compression in the cranial (Cr) cortex, tension in the caudal (Cd) cortex, and shear in the medial and lateral cortices (i.e., neutral axis). Artiodactyl calcanei demonstrate unusually heterogeneous structural and material organization between these cortices. This study examines potential relationships between developmental morphologic variations and the functional strain distribution of the deer calcaneus. One calcaneus was obtained from each of 36 (fetus to adult) wild deer. Predominant collagen fiber orientation (CFO), microstructural characteristics, mineral content (% ash), and geometric parameters were determined from transversely cut segments. Radiographs were examined for arched trabeculae, which may reflect tension/compression stress trajectories. Results showed that cross-sectional shape changes with age from quasi-circular to quasi-elliptical, with the long axis in the cranial-caudal direction of habitual bending. Cranial ("compression") cortical thickness increased at a greater rate than the Cd ("tension") cortex. Fetal bones exhibited arched trabeculae. Percent ash was not uniform (Cr > Cd), and this disparity increased with age (absolute differences: 2.5% fetuses, 4.3% adults). Subadult bones showed progressively more secondary osteons and osteocyte lacunae in the Cr cortex, but the Cd cortex tended to have more active remodeling in the subadult and adult bones. Nonuniform Cr:Cd CFO patterns first consistently appear in the subadults, and are correlated with secondary bone formation and habitual strain mode. Medial and lateral cortices in these groups exhibited elongated secondary osteons. These variations may represent "strain-mode-specific" (i.e., tension, compression, shear) adaptations. The heterogeneous organization may also be influenced by variations in longitudinal strain magnitude (highest in the Cr cortex) and principal strain direction-oblique in medial-lateral cortices (where shear strains also predominate). Other factors such as local reductions in longitudinal strain may influence the increased remodeling activity of the Cd cortex. Some structural variations, such as arched trabeculae, that are established early in ontogeny may be strongly influenced by genetic- or epigenetic-derived processes. Material variations, such as secondary osteon population densities and CFO, which appear later, may be products of extragenetic factors, including microdamage.

Age Factors↗

PubMed1992

The relationship between ultrasound and densitometric measurements of bone mass at the calcaneus in women.

Broadband ultrasound attenuation (BUA) of the calcaneus predicts axial density in women and is decreased in women who sustain hip fractures. To determine the relationship between ultrasonic and densitometric assessments of bone mass at the same site, BUA and velocity of sound (VOS) were correlated with bone density as measured by dual energy x-ray absorptiometry (DXA) at the calcaneus in 64 Caucasian women aged 35-83 years. BUA, VOS, and bone density in these women decreased annually as a function of age by 1.0%, 0.3%, and 0.9%, respectively. Holding age, years since menopause, height and weight constant, BUA correlated with VOS (r = 0.74, P < 0.001), and calcaneal density correlated with BUA (r = 0.73, P < 0.001) and with VOS (r = 0.66, P < 0.01). The results indicate that both BUA and VOS measurements reflect density at the calcaneus, but suggest that they measure properties of bone other than density and different from each other. The assessment of these additional properties may be useful in the prediction of fracture risk.

Absorptiometry, Photon↗

PubMed1976

The onset of ossification in the human calcaneus.

A (silver) radiographic and microscopic study of the onset of ossification in the calcaneus of 177 human fetuses between 49 and 150 mm C.-R. length has revealed the presence of two independent and developmentally different ossific sites. A lateral locus, intramembranous (parachondral) in origin and precocious in appearance, was observed in slightly over 16% of the fetuses examined between 93 mm (the first appearance of this bone) and 150 mm C.-R. It occupied the vascular connective tissue within the anterior portion of a distinct groove on the inferolateral wall of the cartilaginous calcaneus between the retrotrochlear eminence anterosuperiorly, and the lateral process of the tuber posteroinferiorly. A centrally situated, primary ossific centre, endochondral in origin, was detected in only 11% of the fetuses between 118 mm (the initial appearance of this centre) and 150 mm C.-R. It was situated in the centre of the anterior third of the cartilaginous calcaneus in relation to the sustenaculum tali medially and to a distinct cartilaginous prominence on its lateral surface. Only four fetuses possessed both ossific sites (lateral and central): at 122, 143, 145, and 150 mm C.-R., and in only one of these was continuity established between them. One fetus (122 mm) possessed two independent endochondral centres (superior and inferior).

Calcaneus↗

PubMed1977

[The importance of the radiological angle between talus and calcaneus in patients with congenital clubfoot (author's transl)].

A reduction of the angle between the longitudinal axes of talus and calcaneus in the lateral X-ray view of a clubfoot is a sign of persistent supination of the subtalar joint and not due to anatomical changes of the bone. Correction of this deformity by closed manipulation produces a normal angle between talus and calcaneus. The angle between talus and calcaneus can thus be used as a guide for adequate correction of the subtalar deformity.

Anthropometry↗

PubMed1997

Quantitative ultrasound imaging at the calcaneus using an automatic region of interest.

A new approach to measuring bone properties at the calcaneus using ultrasound parametric imaging has recently emerged. However, an additional source of observer-related error is the substantial regional variations in the pattern of ultrasound parameters. The contribution of intra-observer and inter-observer variability to the coefficient of variation can be eliminated using an algorithm which selects the region of interest (ROI) completely automatically. The objective of the present study was the clinical assessment of an automatic ROI for both broadband ultrasonic attenuation (BUA) and speed of sound (SOS) measurement using ultrasound parametric imaging. The automatic ROI was defined as the circular region of lowest attenuation in the posterior tuberosity of the calcaneus. We have tested this algorithm using clinical images of the calcaneus from 265 women. Mean coefficients of variation were 1.6% (95% confidence interval 1.4%-1.9%) and 0.26% (95% confidence interval 0.23%-0.32%) for BUA and SOS respectively (standardized CV was 2.1% for BUA and 2.6% for SOS). Z-scores in an osteoporotic group were -0.61 and -0.52 for BUA and SOS respectively. In healthy women, the age-related decline was -0.50 dB/ MHz per year (0.7%/year) for BUA and -1.2 m/s per year (0.08%/year) for SOS. In the subgroup of healthy postmenopausal women, using stepwise multiple regression, we found that BUA was predicted best by years since menopause (YSM) and weight, with overall model r2 = 0.28; SOS was predicted best by YSM only (r2 = 0.21). Neither the range of biological variation of ultrasound parameters nor the clinical value were affected by the choice of the region of lowest attenuation for measurement. The automatic procedure was totally independent of operator interaction, therefore excluding loss of precision due to intra- or inter-observer variability. The results showed the high precision and robustness of the procedure. These factors make this approach viable for routine clinical use.

Aged↗

PubMed1991

Ultrasound attenuation of the calcaneus: a sensitive and specific discriminator of osteopenia in postmenopausal women.

Recent studies have evaluated techniques for estimating bone mass without radiation. The present study compares broadband ultrasound attenuation of the calcaneus and bone densities of the femoral neck and the lumbar spine in 17 normal women and 41 women with osteoporosis. Twenty of the osteoporotic women had spine (n = 16) or femoral neck (n = 4) fractures. There was a significant decrease in the broadband ultrasound attenuation (P less than 0.001) in women with osteoporosis compared with normal women. The osteoporotic women also showed a decrease in vertebral (P less than 0.0001) and femoral neck (P less than 0.0001) densities compared with normal women. At 63 dB/MHz, the sensitivity and specificity of broadband ultrasound attenuation for decreased bone mineral density with or without fractures were 76%. All women with fractures had a broadband ultrasound attenuation less than 72 dB/MHz. This corresponded to a specificity of 41%. To determine whether broadband ultrasound attenuation correlated with trabecular bone volume, samples of cadaver calcaneus were analyzed. The histologic determination showed a significant correlation between broadband ultrasound attenuation and trabecular bone volume (r = 0.992, P = 0.008). These results suggest broadband ultrasound attenuation of the calcaneus reflects bone mass and can be used as a safe and sensitive indicator for decreased axial bone density.

Absorptiometry, Photon↗

PubMed2006

Calcaneus ultrasound in males: normative data in the Croatian population (ECUM study).

Limited number of dual X-ray absorptiometry (DXA) devices in Croatia makes this diagnostic technique unavailable to the majority of the population. Quantitative ultrasound (QUS) of the calcaneus could be an alternative tool for assessing fracture risk. However, age-specific normative data should be obtained before using the QUS in everyday clinical practice. The aim of our Epidemiology of Calcaneus Ultrasound in Males (ECUM) study is to establish the normative QUS data in a healthy sample of Croatian males. A total of 1002 male participants, aged 20-99, recruited in different Croatian counties, were included in the study. In each subject broadband ultrasound attenuation (BUA), speed of sound (SOS) and quantitative ultrasound index (QUI) of the left calcaneus were measured using the Sahara ultrasound device (Hologic). The coefficients of variation were 2.85 for BUA, 0.37 for SOS and 2.49 for QUI. Significant declining with age was found for all three parameters, BUA (p<0.001), SOS (p<0.001) and QUI (p<0.001), with respective r values 0.14, 0.27 and 0.23. The peak SOS (1,562.8+/-28.5 m/sec) and QUI (103.6+/-16.5) values were observed in the third decade, whereas the peak BUA value (86.2+/-19.2 db/MHz) was observed in the fourth decade. A subgroup of 103 participants, aged 20-29, was used to estimate young adult mean and SD for QUI and calculate the T-scores. Using the World Health Organization diagnostic criteria the rates of osteoporosis (T-score<-2.5) in the males aged 50 and older was 5.8%. However, when we used the cut-off value of the T-score<-1.8, as previously suggested, prevalence of osteoporosis in Croatian males >50 yr was 16.2%. Although further studies might improve our understanding of the QUS role in the fracture prediction, we hope that the results presented here will improve the clinical management of osteoporosis in males.

Absorptiometry, Photon↗

PubMed2005

[Fracture of the calcaneus].

Although screw or plate fixation of the fractured calcaneus was first described in the 1920s, surgical treatment using open anatomical reduction and stable internal fixation only commenced at the start of the 1980s. This treatment was made possible by the introduction of new imaging methods such as CT which allowed better detection of the fracture pathology and provided the basis for new surgical strategies. New procedures, including modified surgical approaches related to vascular anatomy, arthroscopic control of the subtalar joint during open or closed reduction, early free flap coverage in severe open or closed fractures with full-thickness skin necrosis, increasingly available (3)D intraoperative radiographic monitoring, and the use of interlocking calcaneus plates, have significantly improved the functional outcome in the treatment of fractures of the calcaneus.

Ankle Injuries↗

PubMed2000

[Calcaneus pseudarthrosis: a clinical rarity].

The calcaneus pseudoathrosis is rarely seen in clinical workday and we couldn't find any case be reported. In two cases the authors present the diagnosis and therapy of a non-union after a calcaneus fracture. The authors point especially at anatomical characteristics and biomechanical reasons and their meaning for aetiology of pseudoathrosis after a calcaneus fracture.

Adolescent↗

PubMed2000

Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study.

The aim of this study was to assess the ability of serum bone-specific alkaline phosphatase (bone ALP), creatinine-corrected urinary collagen crosslinks (CTx) and calcaneus bone mineral density (BMD) to identify postmenopausal women who have an increased risk of osteoporotic fractures. Calcaneus BMD and biochemical markers of bone turnover (serum bone ALP and urinary CTx) were measured in 512 community-dwelling postmenopausal women (mean age at baseline 69 years) participating in the Hawaii Osteoporosis Study. New spine and nonspine fractures subsequent to the BMD and biochemical bone markers measurements were recorded over an average of 2.7 years. Lateral spinal radiographs were used to identify spine fractures. Nonspine fractures were identified by self-report at the time of each examination. During the 2.7-year follow-up, at least one osteoporotic fracture occurred in 55 (10.7%) of the 512 women. Mean baseline serum bone ALP and urinary CTx were significantly higher among women who experienced an osteoporotic fracture compared with those women who did not fracture. In separate age-adjusted logistic regression models, serum bone ALP, urinary CTx and calcaneus BMD were each significantly associated with new fractures (odds ratios of 1.53, 1.54 and 1.61 per SD, respectively). Multiple variable logistic regression analysis identified BMD and serum bone ALP as significant predictors of fracture (p = 0.002 and 0.017, respectively). The results from this investigation indicate that increased bone turnover is significantly associated with an increased risk of osteoporotic fracture in postmenopausal women. This association is similar in magnitude and independent of that observed for BMD.

Aged↗

PubMed1999

In vivo MRI measurements of bone quality in the calcaneus: a comparison with DXA and ultrasound.

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.

Absorptiometry, Photon↗

PubMed1999

Ultrasound measurements at the calcaneus in men: differences between healthy and fractured persons and the influence of age and anthropometric features on ultrasound parameters.

The aim of this cross-sectional study was to assess the ability of quantitative ultrasound at the calcaneus to discriminate between fractured and unfractured men, fracture probability, and the relationship of ultrasonic parameters to age and body size. The study included 224 men (age range 36-86 years) with no history of diseases or therapy affecting bone metabolism. The subjects were divided into two groups (unfractured, n = 148; fractured, n = 76) matched for age and body size. Bone status was assessed by ultrasound measurements at the calcaneus. Long-term in vitro CV% values were 0.88% for speed of sound (SOS) and 0.54% for broadband ultrasound attenuation (BUA). In vivo CV% values were 0.33% for SOS and 2.48% for BUA, while sCV% values were 4.66% and 6.58%, respectively. The following SOS/BUA values were obtained: in unfractured men, SOS = 1517.5 +/- 35.3 m/s and BUA = 114.0 +/- 13.3 dB/MHz; in fractured men, SOS = 1492.6 +/- 24.6 m/s and BUA = 106.1 +/- 11.6 dB/MHz. The differences were significant (p<0.0001). The odds ratio for BUA for all fractures was 1.05 (95% CI, 0.03-2.07) and for SOS 2.13 (95% CI, 0.77-3.49). Only the age-related decrease in SOS in unfractured men was significant (r = -0.17, p<0.05). In fractured men, weight and body mass index (BMI) were found to correlate significantly with BUA (r = 0.31, p = 0.007, r = 0.31, p = 0.007, respectively). The areas under receiver operating characteristics (ROC) curves were 0.706 for SOS and 0.665 for BUA. Ultrasound measurements at the calcaneus thus enable discrimination between fractured and healthy males. Different patterns of the relationship between age and body size in the two groups suggest the presence of other, unknown factors affecting bone status. Their identification requires further prospective studies.

Aged↗

PubMed2002

Fractal analysis of trabecular bone texture on calcaneus radiographs: effects of age, time since menopause and hormone replacement therapy.

An analysis of trabecular bone texture based on fractal mathematics, when applied to trabecular bone images on plain radiographs, can be considered as a reflection of trabecular bone microarchitecture. It has been shown to be able to distinguish postmenopausal osteoporosis cases from controls. This cross-sectional study was carried out to investigate the influence of age, time since menopause and hormone replacement therapy (HRT) on the fractal dimension of trabecular bone texture at the calcaneus in a sample of 537 healthy women. Fractal analysis of texture was performed on calcaneus radiographs and the result expressed as the Hmean parameter (H = 2-fractal dimension). Total hip, femoral neck and lumbar spine bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. There was a statistically significant Hmean parameter decrease with age (p<0.0001) but the degree of correlation was low (r = -0.2) compared with the correlation between age and BMD (r = -0.36 to -0.61 according to the BMD site). We found a weak but statistically significant correlation between time since menopause and Hmean (r = -0.14, p = 0.03) in the 241 postmenopausal women included in the study. Hmean was significantly lower in a group of postmenopausal women without HRT (n = 110) compared with a group of age-matched postmenopausal women with HRT (n = 110): respectively 0.683 +/- 0.043 and 0.695 +/- 0.038 (p = 0.03). In conclusion, this study suggests that there is a menopause- and age-related decrease in the Hmean parameter and that HRT interferes with the results of the fractal analysis of trabecular bone texture on calcaneus radiographs.

Absorptiometry, Photon↗

PubMed2000

Calcaneus bone mineral density is lower among men and women with lower physical performance.

Fracture risk is influenced by both bone strength and by falls. Measures of physical function and performance are predictors of falls. However, the interrelationships among bone mineral density (BMD), regular physical activity, and measures of physical performance are not well known. We studied 447 community-dwelling Japanese people aged 40 years and over (96 men and 351 women) to examine the association of calcaneus BMD with measures of physical performance (grip strength, walking speed, chair stand, and functional reach) and regular physical activity. Calcaneus BMD decreased with age by approximately 25% in men and 42% in women. Measures of physical performance decreased with age by approximately 30% in both genders, however, performance on the chair stand test declined by approximately 60%. There were only minimal differences in performance measures and calcaneus BMD between people with and those without regular physical activity in both genders, and most differences were not significant. However, there were significant BMD increases of 3-6% per standard deviation (SD) increase in all performance measures for women and a 7% increase in BMD per SD increase in grip strength for men, after adjusting for age. These associations remained after additional adjustment for body mass index and regular physical activity. These findings suggest that bone density and physical function decline markedly in both men and women with age, and that low BMD and poor function tend to occur together, which would increase fracture risk more than either risk factor alone.

Absorptiometry, Photon↗