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MUSCULOSKELETAL RADIOLOGY Table of Contents   
Year : 2000  |  Volume : 10  |  Issue : 4  |  Page : 229-231
Quantitative ultrasound as a tool for assessment of bone status: An initial experience


Mandakini Imaging Centre, Pancholi Hops Building, Mumbai - 400 077, India

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   Abstract 

Objectives: To determine the incidence of osteopenia and osteoporosis in the general population using broadband ultrasound bone densitometer. Material and Methods: Heel bone mineral densitometry was performed in 1713 patients with the help of a broadband ultrasond bone densitometer. The broadband ultrasound attenuation (BUA) and ultrasonic speed of sound (SOS) of the calcaneus were measured to obtain quantitative ultrasound index (QUI), bone mineral density (BMD), T-score and Z-score. Fracture risk was also estimated. Results: Out of the 1713 patients, 685 (39.9%) were found to have osteopenia and 190 (11%) had osteoporosis. The incidence of osteopenia and osteoporosis in women (41.6% and 14.2% respectively) was found to be higher than the values in men (37.1% and 5.5 % respectively). The incidence of osteopenia in the 31-39 years age group was found to be comparable in men and women (30.1% and 26.4% respectively). However, after the age of 40, the incidence of osteopenia and osteoporosis in women rose rapidly and was higher than that in men. Discussion: Bone formation is at it's peak in the mid 20's and continues till the age of 30-35 years after which the bone resorption gradually becomes faster than the formation of new bone. Bone density at any age would depend on peak bone density and the subsequent rate of bone loss. It is therefore important to determine the BMD in this age group to prevent osteoporosis and related complications later. Similarly it is important to subject women to assessment of BMD routinely after the age of 40 years as they are definitely at a higher risk of developing osteoporosis with advancing age.

Keywords: Bone densitometry, Bone mineral density, Ultrasound

How to cite this article:
Parihar AL, Dialani VM, Mashankar AS, Salkade PS, Varma MS. Quantitative ultrasound as a tool for assessment of bone status: An initial experience. Indian J Radiol Imaging 2000;10:229-31

How to cite this URL:
Parihar AL, Dialani VM, Mashankar AS, Salkade PS, Varma MS. Quantitative ultrasound as a tool for assessment of bone status: An initial experience. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Jun 19];10:229-31. Available from: http://www.ijri.org/text.asp?2000/10/4/229/30567
Quantitative ultrasound is a cost effective and reliable method of determining bone-mineral-density and risk of fractures. It is very important to determine the risk of developing osteoporosis and take correct preventive measures.

Osteoporosis is characterized by extensive loss of trabecular bone. This leads to formation of wide spaces between the remaining trabeculae [1].

The peak bone formation occurs in mid 20's and continues till the age of 30-35 years. Thereafter, bone resorption gradually overtakes new bone formation.


   Materials and Methods Top


Bone mineral density (BMD) of the calcaneus was obtained in 1713 patients (age range 25-75 years) with a commercially available ultrasound bone densitometer (SAHARA clinical bone sonometer, Hologic Inc, Waltham, MA, USA) during a nine month period from September 98 to May 99. The patients were from all socio-economic strata of the general population. The system incorporates two ultrasound transducers positioned opposite each other. The heel is placed in between the two transducers and the data is acquired.

SAHARA measures the speed of sound (SOS) and broad band ultrasonic attenuation (BUA) in dB/Mhz, of an ultrasound beam passed in between the two transducers. The quantitative ultrasound index (QUI), bone mineral density (BMD), T-Score and Z Score are estimated from this data by the system software.

The results of BMD estimation were compared with those of white Caucasian women, to determine fracture risk. Fracture risk estimation is based on comparison of SAHARA results with those of Walker - Sonix UBA - 575 system [2].

The T score quantifies the differences between the patient's BMD and the mean value for young adults from the reference group. The Z score is used to compare the patient's BMD with the mean value for individuals of the same age. A low Z score indicates etiology other than age related bone loss. According to a WHO report, the normal value for T Score is within one standard deviation of the mean value for young adults (-1 to +1). Osteopenia is present when the T score lies between -1 and -2.5. Osteoporosis is present when T score is less than -2.5 [3]. Severe osteoporosis is considered to be present when the value for BMD is more than 2.5 standard deviation below the mean for young adults and there is at least one so-called fragility fracture. Fragility fractures are fractures assumed to be associated with osteoporosis because they occur as a result of slight trauma.


   Results Top


BMD of 1713 men and women of 25 and more years of age from the general population was obtained from September 98 to May 99.

Of these, 838 patients (48.9%) were found to have bone mineral density within normal limits, 685 (39.9%) were found to have osteopenia and 190 (11%) were found to have osteoporosis [Figure - 1] 1).

Out of 620 men, 356 (57.4%) had normal bone density, 230 (37.1%) had osteopenia and 34 (5.5%) had osteoporosis [Figure - 2].

Of the 1093 women, 482 (44.0%) had normal bone density, 455 (41.6%) had osteopenia whereas 156 (14.2%) had osteoporosis [Figure - 3].

The incidence of osteopenia in the 30-39 age group was comparable in men (30.1%) and women (26.4%) [Figure - 2],[Figure - 3]. The incidence rose steadily in the same proportion upto the 40-59 age group.

However, it was observed that the incidence of osteoporosis in the 50-59 and 60-75 and above age group in women (12.4% and 35% respectively) surpassed that in the men (4.5% and 14% respectively).


   Discussion Top


The resorption and formation of bone continues throughout life. At a young age the bone formation is rapid. Peak bone mass is reached in the mid-twenties. This process of bone building continues till the age of 30-35. After this as a part of natural process, bone resorption is greater than bone formation.

In the present study, the incidence of osteopenia in the 30-39 age group was significant and comparable in men and women (30.1% and 26.4% respectively).

Women are more prone to develop osteopenia and osteoporosis than men of the same age group. In our study the overall incidence of normal BMD among women (44.0%) was lower than that in men (57.4%). In women, bone loss accelerates after menopause when their ovaries stop producing estrogens, the hormone that protects against bone loss. Bone loss is most rapid in the first few years after menopause but persists into the menopausal years. It is suggested that women should undergo BMD routinely after the age of forty.

The bone resorption increases rapidly after the age of 50 years. Thus the risk of fractures is significantly enhanced in this age group, more so for the patients who have had osteopenia at the relatively younger age of 31-40 years. Equal incidence of osteopenia in young men and women can possibly be attributed to the newer social lifestyles. It is therefore important to determine the bone mineral density in this young age group to treat correctable disease conditions. Similarly it is recommended that patients undergoing treatment for osteoporosis should undergo BMD yearly to monitor the progress.

 
   References Top

1.Parfitt AM, Mathews CH, Villanueve AR, Khereloper M, Frane B, Rao DS. Relationship between surface, volume and thickness of iliac trabecular bone in aging and in osteoporosis: implications for the microanatomic and cellular mechanisms of bone loss. J Clin Invest 1983; 72: 1396-1409.   Back to cited text no. 1    
2.Bauer DC, Gluer CC, Cauley JA et al . Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. Archives of Internal Medicine 1997; 157: 629-633.   Back to cited text no. 2    
3.Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. Osteoporosis Int 1994; 4: 368-381.   Back to cited text no. 3  [PUBMED]  

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Correspondence Address:
Anand L Parihar
Mandakini Imaging Centre, Pancholi Hops Building, 90 Feet Road, Ghatkopar (E) Mumbai - 400 077
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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[Pubmed]



 

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