Phalangeal Osteosonogrammetry Study: Age‐Related Changes, Diagnostic Sensitivity, and Discrimination Power

Department of Internal Medicine I, Endocrinology and Metabolism, University of Heidelberg, Germany.
Journal of Bone and Mineral Research (Impact Factor: 6.83). 08/2000; 15(8):1603-14. DOI: 10.1359/jbmr.2000.15.8.1603
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Phalangeal osteosonogrammetry was introduced as a method for bone tissue investigation in 1992. It is based on the measure of the velocity of ultrasound (amplitude-dependent speed of sound [AD-SoS]) and on the interpretation of the characteristics of the ultrasound signal. In this study we have collected a database of 10,115 subjects to evaluate the performance of AD-SoS and to develop a parameter that is able to quantify the signal characteristics: ultrasound bone profile index (UBPI). The database only includes females of which 4.5% had documented vertebral osteoporotic fractures, 16% lumbar spine dual X-ray absorptiometry (DXA), and 6% hip DXA. The analysis of the ultrasound signal has shown that with aging the UBPI, first wave amplitude (FWA), and signal dynamics (SDy) follow a trend that is different from the one observed for AD-SoS; that is, there is no increase during childhood. In the whole population, the risk of fracture per SD decrease for AD-SOS was odds ratio (OR) 1.71 (CI, 1.58-1.84). The AD-SoS in fractured subjects was significantly lower than in a group of age-matched nonfractured subjects (p < 0.0001). In a small cohort of hip-fractured patients UBPI proved to be lower than in a control age-matched group (p < 0.0001). When the World Health Organization (WHO) working group criteria were applied to this population to identify the T score value for osteoporosis, for AD-SoS we found a T score of -3.2 and for UBPI we found a T score of -3.14. Sixty-six percent of vertebral fractures were below the AD-SoS -3.2 T score and 62% were below UBPI -3.14. We observed the highest incidence of fractures (63.6%) among subjects with AD-SoS who had both DXA T score values below the threshold. We conclude from this study that ultrasound investigation at the hand phalanges is a valid methodology for osteoporosis assessment. It has been possible to quantify signal changes by means of UBPI, a parameter that will improve the possibility of investigating bone structure.

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    • "It is believed that QUS could assist in the follow-up analysis of bone mass parameters of patients with CAH- 21 OHD. QUS can also be a good choice for the screening and diagnosing of osteoporosis (Albanese et al. 2011; Wuster et al. 2000). However, the effectiveness of QUS remains to be proven in the CAH-21 OHD population and it is not known how it compares with reference methods such as DXA. "
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    ABSTRACT: The purpose of this study was to verify the performance of quantitative ultrasound (QUS) parameters of proximal phalanges in the evaluation of reduced bone mineral density (BMD) in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21 OHD). Seventy patients with 21 OHD (41 females and 29 males), aged between 6-27 y were assessed. The QUS measurements, amplitude-dependent speed of sound (AD-SoS), bone transmission time (BTT), and ultrasound bone profile index (UBPI) were obtained using the BMD Sonic device (IGEA, Carpi, Italy) on the last four proximal phalanges in the non-dominant hand. BMD was determined by dual energy X-ray (DXA) across the total body and lumbar spine (LS). Total body and LS BMD were positively correlated to UBPI, BTT and AD-SoS (correlation coefficients ranged from 0.59-0.72, p < 0.001). In contrast, when comparing patients with normal and low (Z-score < -2) BMD, no differences were found in the QUS parameters. Furthermore, UBPI, BTT and AD-SoS measurements were not effective for diagnosing patients with reduced BMD by receiver operator characteristic curve parameters. Although the AD-SoS, BTT and UBPI showed significant correlations with the data obtained by DXA, they were not effective for diagnosing reduced bone mass in patients with 21 OHD.
    Ultrasound in medicine & biology 04/2014; 40(7). DOI:10.1016/j.ultrasmedbio.2013.12.027 · 2.21 Impact Factor
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    • "For the DXA method, osteoporosis and osteopenia were defined according to the World Health Organization definitions (osteoporosis: T score <−2.5; osteopenia: T score between >−2.5 and <−1; normal: T score >−1).13 For QUS of the phalanx, different cutoff values have been directly provided by the manufacturer (osteoporosis: T score <−3.2; osteopenia: T score between >−3.2 and <−1; normal: T score >−1).14 Calibration of QUS densitometer was carried out daily using manufacturer’s verification phantom for quality control and assurance. "
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    ABSTRACT: Background: Osteoporosis is a leading cause of morbidity in patients affected by β-thalassemia major or intermediate; we aimed to assess the association between demineralization observed in young thalassemic patients. Methods: A total of 88 patients with β-thalassemia were recruited at Microcitemia Center of Taranto Hospital under the Prevention Osteoporosis and Fractures research project from 2008 to 2010. All the patients were screened with both dual energy x-ray absorptiometry (DXA) and quantitative ultrasound (QUS). T score and Z score values were obtained for each subject. Results: The overall prevalence of demineralization was 84% with DXA and 70% with QUS, whereas normality was found in 16% of patients screened with DXA and in 30% of cases with QUS. Hypogonadism, hypothyroidism, diabetes mellitus, hepatitis-B, and the presence of previous fragility fractures were significantly associated with the demineralization status (lower T scores values) both with DXA and QUS. Conclusion: Our data confirm that DXA and QUS examinations are both useful for detecting bone demineralization in thalassemic patients.
    Journal of Pediatric Hematology/Oncology 05/2013; 35(6). DOI:10.1097/MPH.0b013e31828e6cab · 0.90 Impact Factor
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    • "Quantitative ultrasound (QUS) is a safe and inexpensive new technique used in the determination of bone age in youth by measuring the speed of sound passing through the distal ulna and radius (Mentzel et al. 2005). QUS was shown to strongly correlate with traditional radiographic methods that typically require ionizing radiation and specialized interpretation (Wüster et al. 2000; Mentzel et al. 2005). Age of peak height velocity (aPHV), an indicator of somatic maturity, is one of the most commonly used methods of assessing somatic maturity in adolescents (Mirwald et al. 2002; Malina et al. 2004). "
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    ABSTRACT: Background: Although the relation between body fatness and maturation has been the subject of much research, somatic maturity as assessed by sex-specific regression equations, has yet to be investigated in a population of overweight and obese children. Aim: To examine whether adiposity affects the relationship between somatic and skeletal maturity in peri-pubertal children and if increased adiposity is related to earlier maturation. Subjects and methods: A total of 172 girls and boys (12.8 ± 0.9 years of age) participated in the study. Participants were categorized as normal weight (NW, < 85(th) percentile) or overweight/obese (OW/OB, ≥ 85(th) percentile) based on body mass index and matched for chronological and skeletal age. Skeletal age was assessed across the radial and ulnar epiphyses using quantitative ultrasound. Somatic maturity was assessed as years from age of peak height velocity (aPHV), estimated using prediction equations. Peripheral adiposity was determined by the sum of two skin-folds. Results: Years from aPHV was significantly higher (p < 0.001) in OW/OB girls, but not in OW/OB boys. Skeletal age was associated with years from aPHV in NW and OW/OB boys (r = 0.87 vs 0.86, p < 0.001) and girls (r = 0.83 vs 0.72, p < 0.001). Among peri-pubertal youth of similar chronological and skeletal age, OW/OB girls were more somatically mature than their NW peers. Conclusion: It is concluded that excess peripheral adiposity in girls may affect the estimated somatic maturity, as reflected in years from aPHV.
    Annals of Human Biology 11/2012; 40(1). DOI:10.3109/03014460.2012.744095 · 1.27 Impact Factor
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