Three-year prospective study on fracture risk in postmenopausal women by quantitative ultrasound at the phalanges

Osteoporosis Diagnostic Model Using a Multichannel Convolutional Neural Network Based on Quantitative Ultrasound Radiofrequency Signal

Quantitative ultrasound (QUS) is a promising screening method for osteoporosis. In this study, a new method to improve the diagnostic accuracy of QUS was established in which a multichannel convolutional neural network (MCNN) processes the raw radiofrequency (RF) signal of QUS. The improvement in the diagnostic accuracy of osteoporosis using this new method was evaluated by comparison with the conventional speed of sound (SOS) method. Dual-energy X-ray absorptiometry was used as the diagnostic standard. After being trained, validated and tested in a data set consisting of 274 participants, the MCNN model could significantly raise the accuracy of osteoporosis diagnosis compared with the SOS method. The adjusted MCNN model performed even better when adjusted by age, height and weight data. The sensitivity, specificity and accuracy of the adjusted MCNN method for osteoporosis diagnosis were 80.86%, 84.23% and 83.05%, respectively; the corresponding values for SOS were 50.60%, 73.68% and 66.67%. The area under the receiver operating characteristic curve of the adjusted MCNN method was also higher than that of SOS (0.846 vs. 0.679). In conclusion, our study indicates that the MCNN method may be more accurate than the conventional SOS method. The MCNN tool and ultrasound RF signal analysis are promising future developmental directions for QUS in screening for osteoporosis.

Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors

PURPOSE

Aromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users.

METHODS

Sixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.64 ± 8.33 years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated.

RESULTS

After 18 months, changes of TBS vs baseline were significantly different between AIs group and controls [Δ TBS - 2.2% vs - 0.4%, respectively, p = 0.001]. AD-SoS, BTT and UBPI values decreased only in AIs' group (- 3.7%, - 6.45%, -8.5%, vs baseline, respectively, p_all < 0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs' group, ΔTBS was associated with ΔAD-SoS (r = 0.58, p < 0.001) and ΔUBPI (r = 0.415, p = 0.001), but not with ΔBMD. Moreover, ΔTBS was independently predicted by ΔAD-SoS, after correcting for BMD, CTX and BSAP level changes (β = 0.37, SE = 2.44, p < 0.001).

CONCLUSIONS

TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.

Skeletal Status in Women With Carpal Tunnel Syndrome-A 1-Yr Prospective Study

Functional deterioration due to carpal tunnel syndrome (CTS) may influence the bone status of the forearm and hand. The aim of this prospective study was to establish whether CTS has an impact on bone status at distal parts of the upper limb and to monitor the longitudinal changes of that status during a 1-yr follow-up after surgical treatment. Fifteen women with CTS at mean age of 55.13 ± 9.3 yr, mean weight of 79.18 ± 20.37 kg, and mean height of 157.8 ± 6.17 cm were enrolled into the study. All women had unilateral CTS that negatively affected upper limb function and were qualified to surgical treatment. Functional status was established at baseline using Levine's scale, motor latency, and nerve conduction velocity in electrophysiologic examinations. Bone status was established using densitometric measurements (Hologic Explorer, Bedford, MA) at the forearm, spine, and hip (bone mineral density [BMD], g/cm²) and with quantitative ultrasound measurements (amplitude-dependent speed of sound, m/s) at hand phalanges (DBM Sonic, IGEA, Carpi, Italy). Longitudinal changes were established for Levine's scale score and for forearm and phalanges measurements at 3, 6, and 12 mo after surgery. Levine's scale results improved significantly over a period of observation (p < 0.0001). Longitudinal BMD measurements for ultradistal forearm have shown a decrease only for measurement at 6 mo vs baseline result (0.386 ± 0.08 g/cm² vs 0.375 ± 0.08 g/cm², p < 0.05) with onward increase. Amplitude-dependent speed of sound did not differ over the period of observation. Correlation analysis has shown that functional status expressed by Levine's scale was most strongly related to the longitudinal BMD measurements for ultradistal forearm at 6 mo (r = -0.52, p < 0.05). Successful surgery in patients with CTS does not lead to permanent deterioration in bone status within the affected upper limb in a 1-yr longitudinal observation.

Brazilian pediatric reference data for quantitative ultrasound of phalanges according to gender, age, height and weight

Aims

To establish normative data for phalangeal quantitative ultrasound (QUS) measures in Brazilian students.

Methods

The sample was composed of 6870 students (3688 females and 3182 males), aged 6 to 17 years. The bone status parameter, Amplitude Dependent Speed of Sound (AD-SoS) was assessed by QUS of the phalanges using DBM Sonic BP (IGEA, Carpi, Italy) equipment. Skin color was obtained by self-evaluation. The LMS method was used to derive smoothed percentiles reference charts for AD-SoS according to sex, age, height and weight and to generate the L, M, and S parameters.

Results

Girls showed higher AD-SoS values than boys in the age groups 7–16 (p<0.001). There were no differences on AD-SoS Z-scores according to skin color. In both sexes, the obese group showed lower values of AD-SoS Z-scores compared with subjects classified as thin or normal weight. Age (r² = 0.48) and height (r² = 0.35) were independent predictors of AD-SoS in females and males, respectively.

Conclusion

AD-SoS values in Brazilian children and adolescents were influenced by sex, age and weight status, but not by skin color. Our normative data could be used for monitoring AD-SoS in children or adolescents aged 6–17 years.