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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 597-601
Assessment of quantitative ultrasound densitometry in 100 persons with fractures due to osteoporosis


Department of Orthopaedics, Govt. Medical College & Rajindra Hospital, Patiala, Punjab, India

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Date of Submission15-Jun-2006
Date of Acceptance10-Oct-2006
 

   Abstract 

To assess the role of quantitative ultrasound densitometry on person with osteoporosis fracture. We measure BUA T-score of Os-calis in a sample of 100 persons (Male 54, Female46), aged 45-99 years at Rajindra Hospital, Patiala. We observed that none of the patient in our study had normal BUA T Score measured by quantitative ultrasound densitometry. All patient had BUA T-Score range -5.5 to -1.2, mean with SD -2.60 1.07. Thus quantitative ultrasound densitometry seems to be a good predictor of fracture risks due to osteoporosis. We also observed that in osteoporotic patient with age 45 years or over there was age related decline BUA T. Score. This was higher in women compared with men. We conclude that all patients with fractures due to osteoporosis had poor bone quality. Thus quantitative ultrasound densitometry may be mandatory for a person with osteoporosis facture.

Keywords: Densitometry, Ultrasound, Osteoporosis

How to cite this article:
Walia J, Singh A, Gupta A C, Singh B, Walia A K, Kumar D. Assessment of quantitative ultrasound densitometry in 100 persons with fractures due to osteoporosis. Indian J Radiol Imaging 2006;16:597-601

How to cite this URL:
Walia J, Singh A, Gupta A C, Singh B, Walia A K, Kumar D. Assessment of quantitative ultrasound densitometry in 100 persons with fractures due to osteoporosis. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 22];16:597-601. Available from: http://www.ijri.org/text.asp?2006/16/4/597/32278

   Introduction Top


Osteoporosis is the most common metabolic bone disorder and remains an increasingly significant problem affecting millions individuals world wide. Osteoporosis is often under recognized, in part because it is a clinically silent disease until it manifests in the form of fracture (Lin, 2004).

Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue with a resultant increase in bone fragility and susceptibility to bone fracture.

Osteoporosis is a silent risk factor for fracture, just as hypertension is for brain stroke. Clinically osteoporosis usually recognized by occurrence of low trauma, fracture commonly associated with osteoporosis include crush fracture of vertebral bodies (dorsolumbar vertebrae), fracture wrist (Colles' fracture) and fracture hip (fracture neck femur and intertrochantric fracture of femur).

Bone mass density study is the most accurate method available for diagnosing osteoporosis and also helps to assess individual risk for fracture and re-fracture in patients with fracture (Krane and Holic 1998). Bone densitometry is quick and painless procedure to measure the bone loss and predict risk for fracture.

DEXA: - (Dual Energy X-ray Absorptiomtry) is most accurate test available and is generally considered to be gold standard for bone density measurement. It is used to measure bone mass density at both peripheral and axial sites. In DEXA regions usually measured on the proximal femur & vertebral bodies. Although the technique is fast and requires only limited exposure to radiation, high cost and limited assess may restricts its wide spread use. (Stephen, 1998)

QCT: - (Quantitative computerized tomography) QCT scan provides detailed three dimensional images and take into account the effect of other factors such as age and diseases of bone, besides osteoporosis. The disadvantages of QCT scanners are higher radiation dose, lower precision accuracy and low speed. QCT gives true volumetric assessment of bone (Ibanez, 2003).

QUS: - (Quantitative ultrasound densitometry) QUS is based on differential reflections and attenuation of sound waves as they traverse bones. QUS measured broadband ultrasound attenuation (BUA). Measurement of BUA involves sending a broadband ultrasound pulse through the bone and measuring the reduction of intensity at different frequencies. Sending a voltage spike into the transducer generates a sound wave with a wide frequency spectrum. This board frequency spectrum allows measurements of attenuation to occur over a range of frequencies. Subtracting the values in this spectrum from a spectrum obtained by transmitting a sound wave through a weakly attenuating reference medium, such as water, provides the net attenuation at each frequency. A regression line is then drawn through the points on the net attenuation curve to obtain the attenuation slope (dB/MHz). The slope of the regression line is the BUA value.

BUA T-Score is Number of Standard Deviation above or below the mean of BUA for young adult healthy population.

Usually calcaneal measurements are taken. It takes less than a minute and is more cost effective than DEXA. It has advantage of portability, easy accessibility, lack of ionizing radiations and relatively inexpensive. Its disadvantages are that it cannot measure bone mass density at axial sites, with significant rate of false negatives and high degree of variability (Jean, Hodson, 2003).


   Material & Methods Top


The present study was conducted on 50 patients, which includes 27 males and 23 females. They had radiologically proven osteoporotic fracture due to a trivial trauma. It was a cross-sectional study conducted in the department of Orthopedics, Rajindra Hospital Patiala (Punjab) India during the period of Aug 2003-2005

Inclusion Criteria
" Patients of both sexes with age above 45 years.
" Patients had radiologically proven primary osteoporosis

Exclusion Criteria
" Individuals less than 45 years of age
" Individuals taking hormonal theraphy, anticonvulsant drugs, sterioids, etc.
" Who is having chronic debilitating illness (Cancer, CHF, CRF, COPD, Endocrinological diseases).
" Individuals with metabolic bone diseases

Quantitative ultrasound densitometry (CUBA Clinical) was used to measure bone mass density. Osteoprotic fracture risks estimated by using BUA T- Score. International Osteoporosis is Foundation recommended that QUS can be used only for fracture risk assessment.

Following definition is used to assess the fracture risks as per recommended by CUBA Clinical

BUT-Score Fracture Risk

> 1.0 SD Low

>-1 SD but <-2 SD Moderate

<-2 SD High

Observed data was analysed statistically by using range, mean SD, and 2 Text.


   Observations Top


Patients were divided into four age groups with comparable age and sex distribution. The range of age was 45-99 years with mean ± SD as 62.14±11.40 years. The observations were depicted in following tables.

This table shows the number and distribution of patients into four groups according to age. Maximum numbers of patients were in the group III. As evident from the above table, the range of age was from 45-99 years with mean ± SD as 62.14 ± 11.40 years.[Table - 1]

This table shows that the study was carried out in 100 patients. Out of these, 54 were male and 46 were female patients. No statistically significant relationship was found between the number of male and female patients.[Table - 2]

[Table - 3] shows that BUA T-score in 100 patients were in range of -5.5 to - 1.2 with mean ±SD as -2.60 ± 1.07.

Above [Table - 4] shows BUA T-score grouping according to risk of osteoporotic fracture based upon bone mass density determined by QUS.

According to BUA T-score determined by QUS, 30 patients had BUA T-score values from -1 to -2 and 70 patients had BUA T-score below -2. According to BUA T-score, 30 patients showed below average bone mass and had moderately increased fracture risk.

70 patients showed low bone mass and had high osteoporotic fracture risk.

None of the patients in study had normal BUA T-score value.

This table shows the BUA T-score levels according to gender.

Out of 54 male patients, 12 (28.57%) had BUA T-score within -1 to -2 and 42 (71.43%) had BUA T-score below -2.

Out of 46 female patients, 18 (39.13%) had BUA T-score within -1 to -2 and 28 (60.67%) had BUA T-score below -2.

According to above table, mean ± SD values of BUA T-score in age Group I were -2.18 ± 0.52, in Group II -2.29±0.41, in Group III -2.56 ± 1.29 and in Group IV were -4.11 ± 0.86.

BUA T-score level of all patients decreased with age.

According to above table mean ± SD values of BUA T-score in male and female patients decreased with age, but female patients had more decreased values of BUA T-score.


   Discussion Top


In the present study bone mass density in 100 patients (54 male, 46 Female) was estimated. Range of bone mass measured by QUS was markedly decreased (Range -5.5 to -1.2).

It was observed that all patients had mean ±SD BUA T-score -2.6. According to BUA T-score level 30 patients had moderately increased risk for osteoporotic fracture and 70 patients had high increased risk of osteoporotic fracture. BUA T-score below -1 signify increased risk of osteoporotic fracture. It means that all patients had decreased bone strength. Weak bone strength reflects the integration of decreased bone density and poor bone quality.

According to age and gender, BUA T-score measured in present study decreased with age and this decrease was more in female patients.

Low et al (2000) studied the normative data of the calcaneus using QUS in male and female Chinese population. 237 female and 122 male patient had broad band ultrasound attenuation (BUA) of the left calcaneum measured using a Paris ultrasound system. Their results showed that calcaneal BUA T.score decreased with age in both sexes and was lower in osteoporotic subjects than in normal individuals. There was overall decline of 11.7% of BUA T.score in females between the ages of 50 to 80 years which was double the rate of loss in males (6.4%).

Van Daele et al (1994) reported a study in which QUS parameters of os calcis were measured in 1405 persons (628 males and 777 females) with age range of 55-93 years. They studied the effect of age on QUS parameter. They found significant decline with age in Speed of Sound and BUA T score in men (-0.4 and 0.1%/year) and in women (-1.3 and 0.4%/year) respectively. They conculded that in person of age above 55 years , there was significant age related decline of BUA T-score and SOS, which was about three times higher in women compared with men.

Njeh et al (2000) evaluated BUA T-Score and speed of sound on 215 healthy Caucasian pre- menopausal (n=126) and post- menopausal (n=89) females aged 20-89 years. Their study showed that QUS T-score was significantly dependent on age. There was an increase in annual change after 45 years, normally -0.187 dB/MHz/yr for BUA and -1.15m/s/yr for SOS.

Oral (2000) study reported a preliminary normative data of quantitative ultrasound values in total of 515 Turkish women aged between 20-80 years. Their study showed a significant inverse correlation of age of BUA T-score. BUA T-score significantly declined after the age of 50. BUA T-score decreased by 33% between the age of 20-80 years.

Present study findings are in agreement with the studies conducted by Low (2000), Van Daele (1984), Njeh(2000), and Oral(2000).


   Conclusion Top


  1. None of the patient in our study had normal BUA T Score measured by quantitative ultrasound densitometry. All patient had BUA T-Score range -5.5 to -1.2, mean with SD -2.60 1.07. Thus quantitative ultrasound densitometry seems to be a good predictor of osteoporotic fracture risks.
  2. We observed that in osteoporotic patient with age 45 years or over there was age related decline BUA T. Score. This was higher in women compared with men.
  3. It is concluded that all patients with osteoporotic fractures had poor bone quality. Thus quantitative ultrasound densitometry may be mandatory for a person with osteoporosis facture.[8]


 
   References Top

1.Ibanez R. Bone mineral density measurement techniques. An Sist Sanit Navar 2003; 26(3):19-27.  Back to cited text no. 1    
2.Jean Hodson and Jen Marsh. Quantitative ultrasound and risk factor enquiry as predictors of postmenopausal osteoporosis: comparative study in primary care. BMJ 2003; 326:1250-51.  Back to cited text no. 2    
3.Krane SM and Holick MF. Metabolic bone disease. In : Harrison's Principles of Internal Medicine. McGraw Hill Publisher. 14th edn, Vol.2; 1998:2247-2253.  Back to cited text no. 3    
4.Lin JT and Lane JM. Osteoporosis: a review. Clin Orthop Relat Res 2004; 425:126-34.  Back to cited text no. 4    
5.Low SL, Goh JCH, DasDe S et al. Calcaneal ultrasound in males and females: Normative data and relationship to DXA. Osteoporos Int 2000; 2:S-57-209.  Back to cited text no. 5    
6.Njeh CF, Fan B, Grigorian M et al. Normative data of a water-coupled quantitative ultrasound device. Osteoporos Int 2000; 2:S-57-209.  Back to cited text no. 6    
7.Stephen M. Krane, Mickael F Holick. Metabolic bone disease, Osteoporess. Harrison's Principal of internal medicine. Dr. Anthony S Fauci, editor; McGraw Hill Publication, 14th ed, 365: 2247-2248, 2260  Back to cited text no. 7    
8.Van Daele PL Burger H. Algra D, Hofman A, Grobbee DE, Birkenhager JC, Pols HA. Age associated changes in ultrasound measurements of the calcaneus in men and women: the Rotterdam Study. J Bone Miners Res 1994 Nov; 9(11): 1751-7:  Back to cited text no. 8    

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Correspondence Address:
JPS Walia
70-E, Police Lines, Patiala - 147001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32278

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    Figures

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

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]



 

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    Abstract
    Introduction
    Material & Methods
    Observations
    Discussion
    Conclusion
    References
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