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
Source: PubMed


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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    • "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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    • "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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