Bone speed of sound throughout lifetime assessed with quantitative ultrasound in a Mexican population

Calcium supplementation and body mass index modify associations between prenatal phthalate exposure and perinatal bone ultrasound measures among pregnant women

Phthalates have endocrine activity that may interfere with bone health, particularly during pregnancy and the early postpartum period, when bone resorption increases. We evaluated associations between prenatal phthalate exposure and perinatal bone health among 289 mothers in the ELEMENT birth cohort in Mexico City who were randomized upon recruitment to receive 1,200 mg daily calcium supplementation or placebo throughout pregnancy. Spot urine samples at up to three timepoints during pregnancy were assayed for 9 phthalate metabolites. Bone integrity was assessed by quantitative ultrasound speed of sound (SOS) measurements of the phalange and distal radius at 3, 6, and 8 months of pregnancy and 1, 3, 7, and 12 months postpartum. Geometric means of specific gravity-corrected phthalate concentrations were used as overall measures of prenatal exposure. Linear mixed effect models estimated associations between phthalate exposure and repeated perinatal bone SOS measures, adjusting for age, pre-pregnancy body mass index (BMI), education, parity, calcium supplementation, and month of pregnancy/postpartum. Effect modification by calcium supplementation and BMI were assessed in sensitivity analyses. An interquartile range increase in MEP and MiBP increased pregnancy phalange z-scores (β: 0.11; 95%CI: 0.003, 0.31 and β: 0.15; 95%CI: 0.00,0.42, respectively). Higher concentrations of several phthalate metabolites resulted in lower SOS measures among women who received calcium supplements (compared to placebo group) but higher SOS measures among women with a BMI≥25 (compared to BMI<25). These results suggest that phthalate exposure may interfere with bone remodeling during pregnancy, and that consideration of effect modifiers is paramount to fully understand the effects of environmental exposures on bone health.

Novel nomograms for predicting the risk of low distal bone strength: development and validation in a Chinese population-based observational study

BACKGROUND

This study aims to develop nomogram models based on the speed of sound (SOS) measurements results along with demographic information to predict the risk of low bone strength (LBS) of radius appropriate to the Chinese population of a broad age spectrum.

METHODS

A population-based cross-sectional study was conducted in 5 outpatient clinics located in Zhejiang, the southern part of China. A total of 38,699 participants from 2013 to 2017 were included. Baseline measurements included SOS of the distal radius and clinical risk factor evaluation. Logistic regression models were used to evaluate prognosis and identify independent predictive factors, which were then utilized to establish nomograms for predicting the low bone strength of radius. The discrimination and calibration of nomograms were validated using the calibration plots, the decision curve analysis (DCA), and the receiver operating characteristics curve (ROC).

RESULTS

A total of 19,845 of the 38,904 participants ranged in age from 10 to 88 years were selected in this process. LBP nomogram model 1 was constructed based on age, weight, height, BMI, and gender. LBP nomogram model 2 was constructed based on age, height, BMI, and gender. The AUCs for model 1 and model 2 were 0.838 (95% CI: 0.832-0.844) and 0.837 (95% CI: 0.831-0.843), respectively. High-quality calibration plots and DCA in nomogram models were noticed, indicated that the constructed nomogram models were clinically useful.

CONCLUSIONS

Our study demonstrates that the nomograms established in this study could effectively evaluate the high-risk population groups of distal radius fracture in China.

Diminished cortical bone density of long bones among children with haemophilic arthropathy

INTRODUCTION

Children with haemophilia (CwH) have lower bone mineral density in the spine (trabecular bone) than healthy children. There are few studies focusing on bone mineral density in long bones (cortical bone).

AIM

To evaluate bi-laterally the distal third of radius and midshaft tibias using quantitative ultrasound (QUS) and assess the speed of sound (SoS).

METHODS

A cross-sectional study where 91 CwH and 91 age-matched healthy boys were included. Joint evaluation was determined with the Haemophilia Joint Health Score 2.1 and SoS values. The Z scores were measured with the Sunlight Omnisense 8000 S equipment.

RESULTS

Ninety-one CwH (haemophilia A) were evaluated (26 mild form, 26 moderate, and 39 severe). Most patients were treated with on-demand factor replacement and had higher total HJHS scores according to severity (4.8, 14.8 and 14.1, respectively). Patients with moderate and severe disease showed a statistical difference in SoS values for both radius and tibias compared to controls. QUS Z-scores ≥-2 were more frequent in radius and tibias in CwH, but were statistically significant only in tibias when compared to controls (in 30% mild, 46% moderate, 28% severe, respectively).

CONCLUSIONS

There was diminished cortical bone density in radius and tibias of CwH compared to healthy controls. Changes predominated in tibias, more frequently affected according to the severity of haemophilia. Early intervention with factor replacement combined with physical activity are key aspects to promote bone health.

Long-Term Sex-Specific Effects of Cadmium Exposure on Osteoporosis and Bone Density: A 10-Year Community-Based Cohort Study

This study explored the long-term effects of cadmium (Cd) exposure on osteoporosis incidence and bone mineral density (BMD). This retrospective cohort study included men aged ≥50 years and post-menopausal women from the 2001−2002 Korea Genome and Epidemiology Study. Participants previously diagnosed with osteoporosis were excluded. Blood Cd concentrations were measured and categorized as <0.5, 0.5−1.0, and >1.0 μg/L. BMD was measured using quantitative ultrasound. Osteoporosis was diagnosed when the T-score was ≤−2.5. Confounders that affect exposure and outcome were controlled. Osteoporosis incidence and differences in BMD (ΔBMD) were assessed until 2012. The osteoporosis incidence among 243 participants who were followed up for an average of 6.3 years was 22.2%. In all the participants, a dose−response relationship was observed between blood Cd and incident osteoporosis and ΔBMD (both p-for-trend < 0.01). After adjusting for age, sex, smoking, physical activity, body mass index, creatinine, and baseline BMD, a blood Cd concentration of >1.0 μg/L was an independent risk factor for incident osteoporosis and decrements in ΔBMD. In women, blood Cd concentrations of >0.5 μg/L increased the risk for osteoporosis. Exposure to Cd prospectively increases the risk for osteoporosis and decrements of ΔBMD, particularly in women, even in lower doses of Cd.

Change in Quantitative Ultrasound-assessed Speed of Sound as a Function of Age in Women and Men and Association With the Use of Antiresorptive Agents: The Canadian Multicentre Osteoporosis Study

INTRODUCTION

Five-year changes in multisite quantitative ultrasound-assessed speed of sound (SOS in m/s) were studied in a cohort of women and men. The impacts of antiresorptive therapies and menopausal status on SOS were also assessed.

METHODOLOGY

Two SOS assessments, clinical assessments, and comprehensive questionnaires were completed 5 years apart on 509 women and 211 men. Age at first assessment was grouped into: <40 yr, 40-49 yr, 50-59 yr, 60-69 yr, 70-79 yr and 80+ yr. Mean rate of change in SOS at the distal radius and tibia were calculated for each age grouping by sex. SOS changes were stratified by antiresorptive use (yes, no) or menopausal status (premenopausal, postmenopausal, or bilateral oophorectomy).

RESULTS

Mean losses in SOS occurred over the 5 years in almost all age groupings. In women, mean losses in SOS for the <40 yr, 40-49 yr, 50-59 yr, 60-69 yr, 70-79 yr, and 80+ yr age groupings were -59, -83, -107, -92, -80 and -66 (p = 0.30; differences among age groupings) at the radius and -18, -16, -54, -1, -9 and 31 at the tibia (p < 0.05), respectively. In men, mean SOS losses were -101, -56, -69, -67, -83 and -127 at the radius (p = 0.61) and -46, -61, 0, -35, -29, and -26 at the tibia (p = 0.23). At the tibia, women prescribed antiresorptives had a mean increase in SOS (8.6 m/s) whereas untreated participants had a mean loss (-23.0; p < 0.001); there was no significant impact at the distal radius. There were no significant differences in change in SOS among menopausal groups (p > 0.26).

CONCLUSIONS

Mean SOS generally declined over 5 years in all age groupings of both sexes. The consistent mean losses in SOS over the age spans investigated are coincident with increasing fracture risk. Women on antiresorptive therapy had increased mean SOS over the 5-year assessment period at the tibia, whereas untreated women had mean losses in SOS.

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method

BACKGROUND

Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations.

OBJECTIVE

In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method.

METHOD

We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use.

RESULTS

We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults.

CONCLUSIONS

These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.

The ability of calcaneal and multisite quantitative ultrasound variables in the identification of osteoporosis in women and men

Objectives

The aim of this study was to assess the ability of calcaneal and multisite quantitative ultrasound (QUS) parameters in the identification of osteoporosis in women and men.

Patients and methods

A total of 131 women (mean age 53.7±11.9 years; range, 21 to 79 years) and 109 men (mean age 57.8±13.7 years; range, 24 to 85 years) whose bone mineral density (BMD) at the spine and proximal femur was measured between January 2010 and January 2012, using dual-energy X-ray absorptiometry (DXA) were included. Acoustic bone properties were also examined using both a calcaneal and a multisite QUS. The receiver operating characteristic analysis with the calculation of areas under the curve (AUCs) to evaluate the ability of both QUS devices for the identification of osteoporosis. We also calculated a lower and an upper threshold at a specificity of 90% and at a sensitivity of 90%, respectively, for the identification of osteoporosis along with a threshold/cut-off value with the best compromise between sensitivity and specificity.

Results

All calcaneal QUS parameters showed significant AUCs within the range of 0.712 (for Broadband Ultrasound Attenuation [BUA]) and 0.764 (for Speed of Sound [SOS]) in women and ranging from 0.661 (for BUA) to 0.735 (for SOS) in men, while only radial SOS of the multisite QUS demonstrated a significant AUC value of 0.661 for identifying osteoporosis in women. A Quantitative Ultrasound Index T-score of -1.53 for women and -1.68 for men showed sensitivity and specificities around 70%.

Conclusion

Based on the results of this study, all calcaneal QUS parameters in both women and men and possibly radial SOS measurements of the multisite QUS in women may be helpful for the identification of osteoporosis.

De vuelta a la clínica. Métodos I. Diseños de investigación. Mayor calidad de información, mayor certeza a la respuesta

Research designs refer to the way information is obtained and are limited by ethical, economic and temporal viability. Research designs are standardized strategies to reduce biases, which in the architectural model of research are identified in the baseline state, the maneuver and the outcome; hence, there are no specific designs for each question. The design with the lowest probability of bias is the clinical trial, followed by cohort and case-control studies and, finally, by cross-sectional surveys. Among the main characteristics that give merit to research designs are the following: population inquiry, which refers to the situation of the population in relation to the clinical course/natural history of the disease; the maneuver, or action that is expected to modify the baseline state, which can be observational or experimental; follow-up, or documented monitoring that is given to each subject, which can be longitudinal or cross-sectional; and directionality, which can prolective or retrolective and refers to the timing of data collection for research purposes. It will always be better having a valuable question, even when answered with a design with higher risk of bias, than a question that is irrelevant or has no applicability.

De vuelta a la clínica: sin justificación no existe pregunta de investigación que valga

A clinical research question requires the concurrence of clinical experience and knowledge on methodology and statistics in that who formulates it. Initially, a research question should have a structure that clearly establishes what is that which is being sought (consequence or outcome), in whom (baseline status), and by action of what (maneuver). Subsequently, its reasoning must explore four aspects: feasibility and reasonableness of the questioning, lack of a prior answer, relevance of the answer to be obtained, and applicability. Once these aspects are satisfactorily covered, the question can be regarded as being "clinically relevant", which is different from being statistically significant, which refers to the probability of the result being driven by chance, which does not reflect the relevance of the question or the outcome. One should never forget that every maneuver entails adverse events that, when serious, discredit good results. It is imperative to have the possible answer estimated from within the structure of the question. The function of clinical research is to corroborate or reject a hypothesis, rather than to empirically test to find out what the outcome is.

Reference data for ultrasound bone characteristics in Hungarian children aged 7-19 years

Backround: Osteoporosis is a common disease and physical activity (PA) has a favourable influence on bone status.

AIM

To establish normative data for calcaneal quantitative ultrasound (QUS) bone characteristics in children and to analyse the relationships between PA, anthropometric and bone parameters.

SUBJECTS AND METHODS

Hungarian children aged 7-19 (n = 2674; 1325 girls, 1349 boys) provided PA, anthropometric and bone data. QUS parameters were registered with Sonost3000 densitometer (speed of sound: SOS, m/s; broadband ultrasound attenuation: BUA, dB/MHz; bone quantity index (BQI = αSOS + βBUA). Reference centiles of QUS parameters were constructed by LMS method. Multivariate linear regression models were used to analyse the relationships.

RESULTS

QUS bone parameters increased with age. There were no gender differences, except in 11- and 19-year-old children, where boys showed higher values. SOS (1497.15 ± 15.72 vs 1494.05 ± 14.81 m/s) and BQI (65.31 ± 16.71 vs 62.26 ± 15.78) were higher in athletic children. The regression model revealed significant relations between SOS and age, relative muscle mass and PA; BUA correlated with gender, morphological age, BMI, relative muscle mass and PA.

CONCLUSIONS

Changes in the bone parameters among 7-19-year-old Hungarian children depended on age, anthropometric dimensions and the level of PA. The normative data could be used for monitoring QUS bone parameters in children, leading to more effective interventions for healthy bones.

Levels of serum estradiol and lifestyle factors related with bone mineral density in premenopausal Mexican women: a cross-sectional analysis

BACKGROUND

Many factors, such as heredity, ethnicity, nutrition and other lifestyle factors, have been related to bone mineral density in postmenopausal women. Additionally, bone mass has been significantly associated with decreased estrogen levels. However, fewstudies have been conducted on premenopausal women. The present study was designed to estimate the relationship between low bone mineral density and levels of serum estradiol and lifestyle factors in premenopausal Mexican women.

METHODS

A cross-sectional study was conducted in 270 women between 40 and 48 years of age who participate in the Health Workers Cohort Study. Information on socio-demographic and lifestyle factors were obtained through a self-administered questionnaire. Body mass index and serum estradiol were measured with standard procedures; bone mineral density was assessed using dual-energy X-ray absorptiometry. Multiple linear and logistic regression models were computed to evaluate the relationship between low bone mineral density and levels of serum estradiol and lifestyle factors.

RESULTS

In linear regression analysis levels of estradiol, body mass index, physical activity, and vitamin D intake were positively related to bone mineral density. Age, cigarette smoking and caffeine were inversely associated with BMD. Finally, the odds of low bone mineral density increase significantly when the premenopausal women had low levels of serum estradiol (OR = 4.93, 95 % CI: 2.14, 11.37).

CONCLUSION

These data support that low serum estradiol, advancing age, lower physical activity, lower vitamin D intake, cigarette smoking, and higher amount of caffeine intake are linked to low bone mineral density in premenopausal Mexican women.

Sex- and Maturity-Related Differences in Cortical Bone at the Distal Radius and Midshaft Tibia Evaluated by Quantitative Ultrasonography

Boys usually have higher values of bone mineral density measured by dual-energy X-ray absorptiometry than girls, but contradictorily also have a greater incidence of fractures during growth. The purpose of this study was to investigate sex- and maturity-related differences in bone speed of sound (SoS) at the radius and tibia in a sample of 625 healthy children aged 10-14 y and to analyze the contributions of physical activity (PA) to possible dissimilarities. Radial and tibial SoS was evaluated by quantitative ultrasound, maturity was estimated as the years of distance from the peak height velocity age, and PA was assessed by accelerometry. Comparisons between sexes and maturity groups (low: below average [<-2.5 y], high: average or above [≥-2.5 y]) were made by two-sample t-tests with unequal variances. Girls in the high-maturity group had higher SoS at the radius and tibia compared with girls in the low-maturity group (p < 0.001). There were no SoS differences at the radius or tibia between the high- and low-maturity groups in boys. Within high-maturity children, girls had higher SoS than boys at the radius and tibia (p < 0.001). There were no differences at the radius and tibia between girls and boys with low maturity. The results were not modified after controlling for PA. Regardless of PA, the results provide insight into sex- and maturity-related differences in bone SoS at the distal radius and midshaft tibia from maturity less than 2.5 y from the peak height velocity age, with boys having lower SoS.

Axial quantitative ultrasound assessment of pediatric bone quality in eastern Nepal

This study presents quantitative ultrasonography (QUS) bone quality data for an underrepresented, south Asian pediatric population from Nepal. Data were collected as part of a longitudinal study of growth and development. This study offers normative data and documents the effect of stunting, wasting, and underweight on the bone properties measured by QUS.

INTRODUCTION

The purpose of this study was to (1) examine the bone quality of a rural, non-Western pediatric population using QUS, (2) explore variation in the trajectory of bone quality development between males and females, and (3) examine the impact of growth disruption(s) on bone quality.

METHODS

A cross-sectional study of 860 children and adolescents aged 5-18 years from the Jirel ethnic group in eastern Nepal was performed. The Sunlight Omnisense 7000P was used to assess bone quality of the distal 1/3 radius and midshaft tibia. WHO reference standards were used to assess growth disruptions of height, weight, and BMI.

RESULTS

QUS bone quality data for an underrepresented, non-Western pediatric population are presented for the radius and tibia. A sizable portion of the study participants were classified as stunted, wasted, and/or underweight. Despite this prevalence of growth disruption in the study sample, bone quality data conform to other documented populations with less growth disruption. Thus, this study offers normative data and documents the minimal effect of stunting, wasting, and underweight on the bone properties measured by QUS.

CONCLUSIONS

Non-Western pediatric populations are significantly underserved with regard to simple, non-invasive screening tools that may help identify developmental disorders and assess bone health. The children and adolescents examined here represent normal growth and development for an underrepresented south Asian population. While this work demonstrates that stunting, wasting, or underweight status at time of QUS assessment is not associated with poor bone quality, we do suggest that further study is needed to examine possible cumulative effects of persistent disruptions that may lead to compromised bone quality in later adolescence.