Comparison of International Reference Values for Bone Speed of Sound in Pediatric Populations: Meta-analysis

Predictive factors of bone strength variation in adolescent girls according to body composition

PURPOSE

This study examined correlations among anthropometric parameters, body composition, bone parameters and predictive factors of bone mass in adolescent girls with different body fat percentages (%fat).

METHODS

A total of 129 females aged 15-18 years were categorized into 3 groups using %fat-for-age at the 50th and 95th percentiles as cutoff points (normal, over, and excess %fat groups). We recorded anthropometric data and measured the speed of sound at the tibia and radius using quantitative ultrasound. Dual-energy x-ray absorptiometry (DXA) was used to measure body composition and bone parameters, including bone mineral density (BMD), bone mineral content (BMC), and the BMD-z-score (z-score) in the lumbar spine (LS) and whole body (WB). These parameters were compared among the 3 groups using bivariate and multivariate correlation analyses.

RESULTS

There were strong correlations among all anthropometric parameters, body composition, and DXA in the over %fat group. Lean parameters strongly correlated with LS and WB in the normal %fat group, whereas both lean mass (LM) and fat mass (FM) were positively correlated with BMC in the excess %fat group. The predictive factors of bone mass differed among the groups, as follows: lean body mass was predictive of BMD and BMC at both sites in the normal and over %fat groups; LM and body weight were predictive of LS-BMC and WB-bones, respectively, in the over %fat group; and FM was predictive of WB-bones in the excess %fat group. Body fat and waist circumference were negative predictors of bone mass.

CONCLUSION

Predictive factors of bone strength appear to depend on the amount of body fat in adolescent girls.

Evaluation of cortical bone strength using a quantitative ultrasound measurement device in dogs

This study was performed to evaluate cortical bone strength in dogs using a quantitative ultrasound measurement device. In this study, 16 clinically healthy dogs with no lameness underwent measurement of the ultrasound propagation velocity of cortical bone (namely, speed of sound [SOS]) at the radius and tibia. Additionally, computed tomography examination with a calibration phantom was performed in 10 dogs. We calculated the bone mineral density (BMD) and Young's modulus from the computed tomography data using bone strength evaluation software. SOS, BMD, and Young's modulus were statistically compared between the radius and tibia. In addition, we examined the correlation between SOS and BMD and between SOS and Young's modulus. We also examined the correlation between SOS and age in the 13 dogs whose age was known. BMD and Young's modulus were not significantly different between the radius and tibia, but SOS was significantly different (P<0.05). Moreover, SOS and BMD showed a positive correlation in both radius and tibia. Similarly, SOS and Young's modulus showed a positive correlation. In addition, SOS and age showed a strong positive correlation (radius: r=0.77, P<0.05, tibia: r=0.83, P<0.05). Our finding that SOS of the radius and tibia cortical bone was correlated with BMD and Young's modulus indicates that quantitative ultrasound can be useful for evaluating cortical bone strength in dogs.

Ultrasound reference values for the calcaneus of children and adolescents at moderate altitudes in Peru

OBJECTIVE

a) Establish reference values for bone parameters by using the speed of sound (SOS, m/s) of broadband ultrasound attenuation (BUA, dB/MHz) and establish a bone quality index (BQI=αSOS+βBUA) for children and adolescents living in a region of moderate altitude, b) compare bone parameters with an international standard (with different ethnic, socio-economic, and lifestyle backgrounds) by using ultrasound of the calcaneus (heel bone) (QUS).

METHODS

A descriptive cross-sectional study was carried out with children and adolescents between the ages of 6.0 and 16.9 years old. The sample was selected randomly. A total of 1322 subjects were studied. Weight, height, and bone parameters, using ultrasound of the calcaneus, were evaluated SOS, BUA, and BQI. Body Mass Index BMI was calculated.

RESULTS

The average age of males was 11.44±0.35 years old, and for females, it was 11.43±0.35 years old. The students in this research showed slightly higher values of SOS, BUA, and BQI for both sexes when compared with the international reference (the 50th percentile). Percentiles were generated (P3, P10, P25, P50, P75, P90, and P97) using the LMS method [median (M), standard deviation (S), and power of the Box-Cox transformation (L)] by age and sex.

CONCLUSION

The students living at a moderate altitude showed slightly higher values in bone parameters in relation to the international reference. This pattern depicted a population with a better state of bone health. The proposed percentiles may be used to categorize adequate to at risk bone parameters based on age and sex.

The first step in an investigation of quantitative ultrasound as a technique for evaluating infant bone strength

This study's purpose is to evaluate whether bone speed of sound (SOS) data, a parameter of quantitative ultrasound, collected from an infant autopsy sample are comparable to data collected from healthy, living infants. We hypothesize that SOS values obtained from deceased term-born infants will fall within the normal range for healthy, living infants. The study sample consists of 351 deceased infants between the ages of 30 weeks gestation at birth to 1 year postnatal at the time of death receiving autopsies at the Harris County Institute of Forensic Sciences or Texas Children's Hospital in Houston, TX. Various multivariate and univariate statistics were used to examine the relationship between SOS and age, prematurity, and chronic illness. The results of an ANOVA comparing the study sample data to published data from healthy, living infants indicate the SOS data are comparable. Additionally, a MANOVA indicated significant differences in SOS related to prematurity (p = 0.001) and age (p < 0.001). Mean SOS was significantly greater among term-born infants (M = 3065.66, SD =165.05) than premature infants (M = 2969.71, SD =192.72). Age had a significant polynomial (cubic) relationship with SOS for both the premature and term groups (p < 0.001). Results suggest that bone from an infant autopsy sample is an appropriate surrogate to examine the relationship between SOS and determinants of bone strength. Therefore, future research will use this study sample to investigate the relationship between SOS and determinants of bone strength in infants.

Shedding "LIGHT" on the Link between Bone and Fat in Obese Children and Adolescents

Obesity may affect bone health, but literature reports are contradictory about the correlation of body mass index (BMI) and bone markers. LIGHT, one of the immunostimulatory cytokines regulating the homeostasis of bone and adipose tissue, could be involved in obesity. The study involved 111 obese subjects (12.21 ± 3.71 years) and 45 controls. Patients underwent the evaluation of bone status by quantitative ultrasonography (QUS). LIGHT amounts were evaluated in sera by ELISA, whereas its expression on peripheral blood cells was evaluated by flow cytometry. Osteoclastogenesis was performed by culturing peripheral blood mononuclear cells (PBMCs) with or without anti-LIGHT antibodies. Obese patients showed significant high BMI-standard deviation score (SDS), weight-SDS, and Homeostatic model assessment for insulin resistance (HOMA-IR) that negatively correlated with the reduced Amplitude Dependent Speed of Sound (AD-SoS)-Z-score and Bone Transmission Time (BTT-Z)-score. They displayed significantly higher serum levels of LIGHT compared with controls (497.30 ± 363.45 pg/mL vs. 186.06 ± 101.41 pg/mL, p < 0.001). LIGHT expression on monocytes, CD3+-T-cells, and neutrophils was also higher in obese patients than in the controls. Finally, in PBMC cultures, the addition of anti-LIGHT antibodies induced a significant osteoclastogenesis inhibition. Our study highlighted the high serum levels of LIGHT in obese children and adolescents, and its relationship with both the grade of obesity and bone impairment.

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 Bones of Children With Obesity

Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in children with obesity support this fear. On the other hand, there is also evidence suggesting that bone mineral content is higher in obese children than in normal weight peers. Both adipocytes and osteoblasts derive from multipotent mesenchymal stem cells (MSCs) and obesity drives the differentiation of MSCs toward adipocytes at the expense of osteoblast differentiation. Furthermore, adipocytes in bone marrow microenvironment release a number of pro-inflammatory and immunomodulatory molecules that up-regulate formation and activation of osteoclasts, thus favoring bone frailty. On the other hand, body adiposity represents a mechanical load, which is beneficial for bone accrual. In this frame, bone quality, and structure result from the balance of inflammatory and mechanical stimuli. Diet, physical activity and the hormonal milieu at puberty play a pivotal role on this balance. In this review, we will address the question whether the bone of obese children and adolescents is unhealthy in comparison with normal-weight peers and discuss mechanisms underlying the differences in bone quality and structure. We anticipate that many biases and confounders affect the clinical studies conducted so far and preclude us from achieving robust conclusions. Sample-size, lack of adequate controls, heterogeneity of study designs are the major drawbacks of the existing reports. Due to the increased body size of children with obesity, dual energy absorptiometry might overestimate bone mineral density in these individuals. Magnetic resonance imaging, peripheral quantitative CT (pQCT) scanning and high-resolution pQCT are promising techniques for the accurate estimate of bone mineral content in obese children. Moreover, no longitudinal study on the risk of incident osteoporosis in early adulthood of children and adolescents with obesity is available. Finally, we will address emerging dietary issues (i.e., the likely benefits for the bone health of polyunsaturated fatty acids and polyphenols) since an healthy diet (i.e., the Mediterranean diet) with balanced intake of certain nutrients associated with physical activity remain the cornerstones for achieving an adequate bone accrual in young individuals regardless of their adiposity degree.

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.

Laser-ultrasonic delivery of agents into articular cartilage

Research is ongoing to develop drug therapies to manage osteoarthritis (OA) and articular cartilage (AC) injuries. However, means to deliver drug to localized AC lesions are highly limited and not clinically available. This study investigates the capability of laser ultrasound (laser-induced plasma sound source) to deliver agents (methylene blue, MB, in PBS) into bovine AC. Treatment samples (n = 10) were immersed in MB solution simultaneously with LU exposure, while adjacent control 1 tissue (n = 10) was pre-treated with LU followed by immersion in MB and adjacent control 2 tissue (n = 10) was only immersed in MB. AC exposed (n = 22) or not exposed (n = 27) to LU were characterized for anomalies in structure, composition, viability or RNA expression. Optically detected MB content was significantly (p < 0.01) higher in treatment samples up to a depth of 500 µm from AC surface as compared to controls. No major unwanted short-term effects on AC structure, proteoglycan or collagen contents, chondrocyte viability or RNA expression levels were detected. In conclusion, LU can deliver agents into AC without major short-term concerns on safety. LU could reveal new strategies for the development of localized drug therapies in AC.

Normative data for calcaneal broadband ultrasound attenuation among children and adolescents from Colombia: the FUPRECOL Study

Quantitative ultrasound (QUS) has been found to be a safe and reliable method for evaluating bone mineral density (BMD). Using calcaneal QUS techniques, the current study contributes to remedying this gap in the literature by establishing normative data among children and adolescents from Colombia.

INTRODUCTION

Minimal data on BMD changes are available from populations in developing countries. BMD reference values for children and adolescents have not been published for a Latin-American population. The aim of this study was to establish a normal reference range of calcaneal broadband ultrasound attenuation (BUA) in Colombian children and adolescents with ages ranging from 9 to 17.9 years.

METHODS

A sample of 1001 healthy Colombian youth (boys n = 445 and girls n = 556), children, and adolescents (9-17.9 years old) participated in the study. A calcaneus QUS parameter (BUA) was obtained for boys and girls, stratified by age group. Furthermore, height, weight, fat mass percentage, and body mass index were measured. Centile smoothed curves for the third, tenth, 25th, 50th, 75th, 90th, and 97th percentiles were calculated using the LMS method (L [curve Box-Cox], M [curve median], and S [curve coefficient of variation]).

RESULTS

Mean (± SD) values for the participants' anthropometric data were 12.9 ± 2.3 years of age, 45.2 ± 11.5 kg weight, 1.51 ± 0.1 m height, 19.5 ± 3.1 kg/m(2) BMI, and 69.5 ± 17.1 dB/MHz BUA. Overall, all variables were significantly higher in boys except in BMI and body fat percentage. Girls generally had higher mean calcaneal BUA (dB/MHz) values than the boys, except in the age ranges 16 and 17.9, p > 0.05. In addition, the BUA (dB/MHz) increased with age throughout childhood and adolescence and reached a plateau by age 15-17.9 for girls.

CONCLUSIONS

For the first time, our results provide sex- and age-specific BUA reference values for Colombian children and adolescents aged 9-17.9 years. A more specific set of reference values is useful for clinicians and researchers and informs clinical practice to monitor bone mineral status.