Bone elasticity and ultrasound velocity are affected by subtle changes in the organic matrix

Establishing density-dependent longitudinal sound speed in the vertebral lamina

Focused ultrasound treatments of the spinal cord may be facilitated using a phased array transducer and beamforming to correct spine-induced focal aberrations. Simulations can non-invasively calculate aberration corrections using x-ray computed tomography (CT) data that are correlated to density (ρ) and longitudinal sound speed (c_L). We aimed to optimize vertebral lamina-specific c_L(ρ) functions at a physiological temperature (37 °C) to maximize time domain simulation accuracy. Odd-numbered ex vivo human thoracic vertebrae were imaged with a clinical CT-scanner (0.511 × 0.511 × 0.5 mm), then sonicated with a transducer (514 kHz) focused on the canal via the vertebral lamina. Vertebra-induced signal time shifts were extracted from pressure waveforms recorded within the canals. Measurements were repeated 5× per vertebra, with 2.5 mm vertical vertebra shifts between measurements. Linear functions relating c_L with CT-derived density were optimized. The optimized function was c_L(ρ)=0.35(ρ-ρ_w)+ c_L,w m/s, where w denotes water, giving the tested laminae a mean bulk density of 1600 ± 30 kg/m³ and a mean bulk c_L of 1670 ± 60 m/s. The optimized lamina c_L(ρ) function was accurate to λ/16 when implemented in a multi-layered ray acoustics model. This modelling accuracy will improve trans-spine ultrasound beamforming.

Assessment of Osteoporosis in Lumbar Spine: In Vivo Quantitative MR Imaging of Collagen Bound Water in Trabecular Bone

AIM

Bone collagen matrix makes a crucial contribution to the mechanical properties of bone by imparting tensile strength and elasticity. The collagen content of bone is accessible via quantification of collagen bound water (CBW) indirectly. We prospectively study the performance of the CBW proton density (CBWPD) measured by a 3D short repetition time adiabatic inversion recovery prepared ultrashort echo time (STAIR-UTE) magnetic resonance imaging (MRI) sequence in the diagnosis of osteoporosis in human lumbar spine.

METHODS

A total of 189 participants with a mean age of 56 (ranged from 50 to 86) years old were underwent MRI, quantitative computed tomography (QCT), and dual-energy X-ray absorptiometry (DXA) in lumbar spine. Major fracture risk was also evaluated for all participants using Fracture Risk Assessment Tool (FRAX). Lumbar CBWPD, bone marrow fat fraction (BMFF), bone mineral density (BMD) and T score values were calculated in three vertebrae (L2-L4) for each subject. Both the CBWPD and BMFF were correlated with BMD, T score, and FRAX score for comparison. The abilities of the CBWPD and BMFF to discriminate between three different cohorts, which included normal subjects, patients with osteopenia, and patients with osteoporosis, were also evaluated and compared using receiver operator characteristic (ROC) analysis.

RESULTS

The CBWPD showed strong correlation with standard BMD (R² = 0.75, P < 0.001) and T score (R² = 0.59, P < 0.001), as well as a moderate correlation with FRAX score (R² = 0.48, P < 0.001). High area under the curve (AUC) values (≥ 0.84 using QCT as reference; ≥ 0.76 using DXA as reference) obtained from ROC analysis demonstrated that the CBWPD was capable of well differentiating between the three different subject cohorts. Moreover, the CBWPD had better correlations with BMD, T score, and FRAX score than BMFF, and also performed better in cohort discrimination.

CONCLUSION

The STAIR-UTE-measured CBWPD is a promising biomarker in the assessment of bone quality and fracture risk.

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.

Trabecular bone imaging using a 3D adiabatic inversion recovery prepared ultrashort TE Cones sequence at 3T

PURPOSE

To investigate direct imaging of trabecular bone using a 3D adiabatic inversion recovery prepared ultrashort TE cones (3D IR-UTE-Cones) sequence.

METHODS

The proposed 3D IR-UTE-Cones sequence used a broadband adiabatic inversion pulse together with a short TR/TI combination to suppress signals from long T2 tissues such as muscle and marrow fat, followed by multispoke UTE acquisition to detect signal from short T2 water components in trabecular bone. The feasibility of this technique for robust suppression of long T2 tissues was first demonstrated through numerical simulations. The proposed IR-UTE-Cones sequence was applied to a hip agarose bone phantom and to 6 healthy volunteers for morphologic and quantitative T 2 ∗ and proton density mapping of trabecular bone.

RESULTS

Numeric simulation suggests that the IR technique with a short TR/TI combination provides sufficient suppression of long T2 tissues with a wide range of T1 s. High contrast imaging of trabecular bone can be achieved ex vivo and in vivo, with fitted T 2 ∗ values of 0.3-0.45 ms and proton densities of 5-9 mol/L.

CONCLUSION

The 3D IR-UTE-Cones sequence with a short TR/TI combination provides robust suppression of long T2 tissues and allows both selective imaging and quantitative ( T 2 ∗ and proton density) assessment of short T2 water components in trabecular bone in vivo.

Pulsed vibro-acoustic method for assessment of osteoporosis & osteopenia: A feasibility study on human subjects

In this paper we propose a new non-invasive ultrasound method, pulsed vibro-acoustic, for evaluating osteoporotic and osteopenic bone in humans. Vibro-acoustic method uses acoustic radiation force (ARF) to stimulate bone and the resulting acoustic signal can be used to characterize bone. The resulting acoustic signal is collected by a hydrophone at the skin surface. Wave velocity and numbers of intrinsic modes are used for analysis. Wave velocity is estimated using the received signal and maximum power mode of the decomposed signal is estimated using variational mode composition from different push points of ARF based on the cross-correlation method. A total of 27 adult volunteers, including healthy and those diagnosed with osteopenia and osteoporosis, were tested. Results of pulsed vibro-acoustic test on tibia of volunteers showed that healthy group could be differentiated from osteoporosis or osteopenia (p < 2 × 10^-5). The results of our study support the feasibility of pulsed vibro-acoustic method for measuring mechanical properties of bone and the potential clinical utility of the proposed method for assessment of bone health.

Ultrasound Characterization of Bone Demineralization Using a Support Vector Machine

We propose an ultrasound-guided remote measurement technique, utilizing an acoustic radiation force beam as our excitation source and a receiving hydrophone, to assess non-invasively a bone's mechanical properties. Features, such as velocity, were extracted from the acoustic pressure received from the bone surface. The typical velocity of an intact bone (3540 m/s) was higher in comparison to that of a demineralized bone (2231 m/s). According to the receiver operating characteristic curve, the optimal velocity cutoff value of ≥3096 m/s yields 80% sensitivity and 82.61% specificity between intact and demineralized bone. Utilizing a support vector machine, the hours of bone demineralization were successfully classified with maximum accuracy >80% using 18% training data. The results indicate the potential application of our proposed technique and support vector machine for monitoring bone mechanical properties.

A Surrogate Measure of Cortical Bone Matrix Density by Long T2 -Suppressed MRI

Magnetic resonance has the potential to image and quantify two pools of water within bone: free water within the Haversian pore system (transverse relaxation time, T2 > 1 ms), and water hydrogen-bonded to matrix collagen (T2 ∼ 300 to 400 μs). Although total bone water concentration quantified by MRI has been shown to scale with porosity, greater insight into bone matrix density and porosity may be gained by relaxation-based separation of bound and pore water fractions. The objective of this study was to evaluate a recently developed surrogate measurement for matrix density, single adiabatic inversion recovery (SIR) zero echo-time (ZTE) MRI, in human bone. Specimens of tibial cortical bone from 15 donors (aged 27 to 97 years; 8 female and 7 male) were examined at 9.4T field strength using two methods: (1) (1)H ZTE MRI, to capture total (1)H signal, and (2) (1)H SIR-ZTE MRI, to selectively image matrix-associated (1)H signal. Total water, bone matrix, and bone mineral densities were also quantified gravimetrically, and porosity was measured by micro-CT. ZTE apparent total water (1)H concentration was 32.7 ± 3.2 M (range 28.5 to 40.3 M), and was correlated positively with porosity (R(2) = 0.80) and negatively with matrix and mineral densities (R(2) =  0.90 and 0.82, respectively). SIR-ZTE apparent bound water (1)H concentration was 32.9 ± 3.9 M (range 24.4 to 39.8 M), and its correlations were opposite to those of apparent total water: negative with porosity (R(2) = 0.73) and positive with matrix density (R(2) = 0.74) and mineral density (R(2) = 0.72). Porosity was strongly correlated with gravimetric matrix density (R(2) = 0.91, negative) and total water density (R(2) = 0.92, positive). The strong correlations of SIR-ZTE-derived apparent bound water (1)H concentration with ground-truth measurements suggest that this quantitative solid-state MRI method provides a nondestructive surrogate measure of bone matrix density.

Quantitative ultrasound measurements of bone quality in female adolescents with idiopathic scoliosis compared to normal controls

OBJECTIVE

The aims of this study were to compare the speed-of-sound (SOS) between adolescent idiopathic scoliosis (AIS) patients and controls using quantitative ultrasound examination and to further analyze the relationship between the SOS and curve type, curve magnitude, maturation status and Risser's sign in AIS patients compared to controls.

METHODS

Seventy-eight female AIS patients and 58 healthy female controls 10 to 16 years of age were recruited to participate. Quantitative ultrasound measurements were performed at the non-dominant distal end of the radius. The standard method for estimating the SOS and z-score was used. Comparisons were made between the SOS values and z-score in AIS patients and age-matched Asian adolescents.

RESULTS

The SOS values of the patients were significantly lower than the controls (P < .01). The percentage of cases with low bone quality was 25% in the entire AIS sample. The prevalence of low bone quality in AIS patients was 20.5%. However, there were no correlations between the SOS and types of scoliosis (P > .05). The SOS values among different severity groups were significant, particularly between the 10° to 19° and 20° to 39° groups as well as between 10° to 19° and ≥40° groups. However, there was no significant correlation between the SOS and Cobb angles. Significant correlations were also found between the pre- and post-menarchy status in patients. There was a significant difference in the SOS values for different Rissers' signs (P < .05).

CONCLUSIONS

Compared to nonscoliotic controls, subjects with AIS had a generally lower SOS, indicating lower bone quality. The age, Risser's sign, or maturation status, may have an effect on the bone quality; however, the curve type and magnitude do not affect the bone quality. The results of this study indicate that slower bone maturation may affect the bone quality in adolescents with AIS.

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

The purpose of this study was to assess the bone speed of sound (SoS) through lifetime of a large Mexican population sample by determining the SoS from the radius and tibia using quantitative ultrasound (QUS). This is a cross-sectional evaluation of participants in the Mexican Health Workers Cohort Study. QUS measurements were performed using Sunlight Omnisense 8000P; Z- and T-scores were calculated for both sexes at the distal third of the radius and midshaft tibia, both on the nondominant side. A locally weighted regression smoothing scatterplot model was used to identify different phases of bone accretion and loss. A total of 9128 participants aged 1-75 yr were measured with QUS. Bone SoS accretion began 5 yr earlier in girls than boys (p<0.05). Maximal SoS or peak bone SoS was noted at 28 yr in the radius and at 22 yr in the tibia. Postmenopausal women (45-50 yr) showed significant SOS decrease at both sites (p<0.05) compared with men. Using the locally weighted regression smoothing scatterplot model, we found 5 different phases that constitute the biological development of bone over the life course, from ages 1-6, 7-12, 12-25, 25-50, and 50-75 yr (p<0.05). Our study shows the age- and sex-dependent changes and different phases of bone development expressed by SoS measurements of the radius and tibia. The values reported in this study can be used as a reference for urban Mexican population.

Bone mineral (31)P and matrix-bound water densities measured by solid-state (31)P and (1)H MRI

Bone is a composite material consisting of mineral and hydrated collagen fractions. MRI of bone is challenging because of extremely short transverse relaxation times, but solid-state imaging sequences exist that can acquire the short-lived signal from bone tissue. Previous work to quantify bone density via MRI used powerful experimental scanners. This work seeks to establish the feasibility of MRI-based measurement on clinical scanners of bone mineral and collagen-bound water densities, the latter as a surrogate of matrix density, and to examine the associations of these parameters with porosity and donors' age. Mineral and matrix-bound water images of reference phantoms and cortical bone from 16 human donors, aged 27-97 years, were acquired by zero-echo-time 31-phosphorus ((31)P) and 1-hydrogen ((1)H) MRI on whole body 7T and 3T scanners, respectively. Images were corrected for relaxation and RF inhomogeneity to obtain density maps. Cortical porosity was measured by micro-computed tomography (μCT), and apparent mineral density by peripheral quantitative CT (pQCT). MRI-derived densities were compared to X-ray-based measurements by least-squares regression. Mean bone mineral (31)P density was 6.74 ± 1.22 mol/l (corresponding to 1129 ± 204 mg/cc mineral), and mean bound water (1)H density was 31.3 ± 4.2 mol/l (corresponding to 28.3 ± 3.7 %v/v). Both (31)P and bound water (BW) densities were correlated negatively with porosity ((31)P: R(2) = 0.32, p < 0.005; BW: R(2) = 0.63, p < 0.0005) and age ((31)P: R(2) = 0.39, p < 0.05; BW: R(2) = 0.70, p < 0.0001), and positively with pQCT density ((31)P: R(2) = 0.46, p < 0.05; BW: R(2) = 0.50, p < 0.005). In contrast, the bone mineralization ratio (expressed here as the ratio of (31)P density to bound water density), which is proportional to true bone mineralization, was found to be uncorrelated with porosity, age or pQCT density. This work establishes the feasibility of image-based quantification of bone mineral and bound water densities using clinical hardware.

Effects of cadmium on bone microstructure and serum tartrate-resistant acid phosphatase 5b in male rats

This study investigated the effects of cadmium on bone microstructure and serum tartrate-resistant acid phosphatase 5b (Tracp 5b) in male rats. Sprague-Dawley male rats were divided into three groups that were given CdCl2 by subcutaneous injection at doses of 0, 0.1 and 0.5 mg/kg body weight (bw) for 12 weeks, respectively. Before killing at the 12th week, microcomputed tomography scanning was performed on the proximal tibia, and urine samples were collected from all of the rats. All rats were then killed, and their blood was collected for biomarkers assay. Bone tissues were dissected for mineral density determinations and histology. The concentration of cadmium in the blood, urine and bone of rats treated with cadmium were significantly higher than in the control group. The bone mineral density, bone mineral concentrations and bone microstructure index of rats treated with cadmium at 0.5 mg/kg bw were clearly lower than in the control rats. Histological investigation also revealed damage to the bone microstructure caused by cadmium. Tracp 5b concentrations in rats treated with cadmium were dose dependently higher than the control. The concentration of cadmium in blood, urine and bone was significantly correlated with Tracp 5b and bone microstructure parameters. Cadmium was shown to induce bone microstructure damage, especially to trabecular bone. The elevated concentrations of serum Tracp 5b suggest that bone resorption mediated via osteoclasts is an important mechanism for the toxic effects of cadmium on bone.

A Wavelet-Based Processing method for simultaneously determining ultrasonic velocity and material thickness

Methods of measuring ultrasonic wave velocity in an elastic sample require data on the thickness of the sample and/or the distances between the transducers and the sample. The uncertainty of the ultrasonic wave velocity measurements generally depends on that of the data available. Conversely, to determine the thickness of a material, it is necessary to have a priori information about the wave velocity. This problem is particularly hard to solve when measuring the parameters of biological specimens such as bones having a greater acoustical impedance contrast (typically 3-5 MRayl) than that of the surrounding soft tissues (typically 1.5 MRayl). Measurements of this kind cannot easily be performed. But obtaining the thickness of a bone structure and/or the ultrasonic wave velocity is a important problem, for example, in biomechanical field for the calculation of elastic modulus, or in acoustical imaging field to parameterize the images, and to reference the grey or color level set to a physical parameter. The aim of the present study was to develop a method of simultaneously and independently determining the velocity of an ultrasonic wave in an elastic sample and the wave path across the thickness of this sample, using only one acquisition in pure transmission mode. The new method, which we have called the "Wavelet-Based Processing" method, is based on the wavelet decomposition of the signals and on a suitable transmitted incident wave correlated with the experimental device, and the mathematical properties such as orthonormality, of which lend themselves well to the time-scale approach. By following an adapted algorithm, ultrasonic wave velocities in parallelepipedic plates of elastic manufactured material and the apparent thicknesses were both measured using a water tank, a mechanical device and a matched pair of 1MHz ultrasonic focused transducers having a diameter of 3mm, a focal length of 150mm and beam width of 2×2mm at the focus (mean temperature 22°). The results were compared with those obtained with a conventional Pulse-mode method and with the control values, to check their validity. Measurements performed on bovine and human dry cortical bone samples are also presented to assess the limitations of the method when it is applied to elastic biological samples, including those of an equal-wavelength size (≈1.5mm). The thicknesses and the ultrasonic wave velocities were then measured in this kind of (quasi-) parallelepipedic elastic materials with an mean estimated error ranged from 1% to 3.5% compared to the referenced values.

Impact of metabolic control on bone quality in phenylketonuria and mild hyperphenylalaninemia

OBJECTIVES

A reduction of bone mineral density of unknown etiology has been reported in phenylketonuria (PKU) by radiological techniques, whereas no data on bone density in mild hyperphenylalaninemia (HPA) are available. We aimed to assess bone condition in PKU and HPA by quantitative ultrasound (QUS), taking into account patients' clinical and biochemical features.

PATIENTS AND METHODS

Phalangeal QUS has been used for bone assessment in 78 patients affected by PKU (n = 42) or mild HPA (n = 36). For each patient, blood phenylalanine concentrations in the 2 years before the study have been recorded and related to bone assessment.

RESULTS

Overall normal bone quality has been observed in the whole study group (AD-SoS standard deviation score [SDS] 0.25 ± 1.29; BTT SDS -0.13 ± 1.08). PKU adolescents (age older than 15 years, AD-SoS SDS -0.54 ± 1.33; BTT SDS -0.85 ± 1.21) and patients with poor compliance with treatment (blood phenylalanine >10 mg/dL, AD-SoS SDS -0.47 ± 1.39; BTT SDS -0.97 ± 1.14) showed lower BTT SDS with respect to normal population (P = 0.003 and P < 0.001, respectively). Patients with PKU with good compliance with treatment (blood phenylalanine < 10 mg/dL, AD-SoS SDS 0.65 ± 1.33; BTT SDS 0.15 ± 0.94) and patients with mild HPA (AD-SoS SDS 0.44 ± 1.06 and BTT SDS 0.19 ± 0.85) showed normal bone mineral density and cortical thickness.

CONCLUSIONS

Good compliance with treatment in PKU during adolescence and adulthood is desirable because diet discontinuation is associated with bone loss. Mild HPA seems not to be complicated by bone damage.

Bone impairment in phenylketonuria is characterized by circulating osteoclast precursors and activated T cell increase

BACKGROUND

Phenylketonuria (PKU) is a rare inborn error of metabolism often complicated by a progressive bone impairment of uncertain etiology, as documented by both ionizing and non- ionizing techniques.

METHODOLOGY

Peripheral blood mononuclear cell (PBMC) cultures were performed to study osteoclastogenesis, in the presence or absence of recombinant human monocyte-colony stimulating factor (M-CSF) and receptor activator of NFκB ligand (RANKL). Flow cytometry was utilized to analyze osteoclast precursors (OCPs) and T cell phenotype. Tumour necrosis factor α (TNF-α), RANKL and osteoprotegerin (OPG) were quantified in cell culture supernatants by ELISA. The effects of RANKFc and anti-TNF-α antibodies were also investigated to determine their ability to inhibit osteoclastogenesis. In addition, bone conditions and phenylalanine levels in PKU patients were clinically evaluated.

PRINCIPAL FINDINGS

Several in vitro studies in PKU patients' cells identified a potential mechanism of bone formation inhibition commonly associated with this disorder. First, PKU patients disclosed an increased osteoclastogenesis compared to healthy controls, both in unstimulated and M-CSF/RANKL stimulated PBMC cultures. OCPs and the measured RANKL/OPG ratio were higher in PKU patients compared to healthy controls. The addition of specific antagonist RANKFc caused osteoclastogenesis inhibition, whereas anti-TNF-α failed to have this effect. Among PBMCs isolated from PKU patients, activated T cells, expressing CD69, CD25 and RANKL were identified. Confirmatory in vivo studies support this proposed model. These in vivo studies included the analysis of osteoclastogenesis in PKU patients, which demonstrated an inverse relation to bone condition assessed by phalangeal Quantitative Ultrasound (QUS). This was also directly related to non-compliance to therapeutic diet reflected by hyperphenylalaninemia.

CONCLUSIONS

Our results indicate that PKU spontaneous osteoclastogenesis depends on the circulating OCP increase and the activation of T cells. Osteoclastogenesis correlates with clinical parameters, suggesting its value as a diagnostic tool for an early assessment of an increased bone resorption in PKU patients.

Reference values for quantitative ultrasonography (QUS) of radius and tibia in healthy greek pediatric population: clinical correlations

The aim of this study was to provide reference standards for measurements of quantitative ultrasonography (QUS) of radius and tibia in normative Greek pediatric population. Analysis was performed in 1549 healthy subjects (814 girls and 735 boys) with a mean decimal age of 11.41+/-3.52 yr (range: 3.78-18.33 yr). Results showed a gradual increase of absolute values of radial and tibial speed of sound (SOS), with aging and with pubertal progressing, in both girls and boys. Gender comparison showed significantly increased SOS values measured both at radius and at tibia in girls more than 13 yr of age compared with aged-matched boys. Significant but mild correlation was noted between standard deviation scores (SDS) of SOS at radius and at tibia (r = 0.259, p < 0.001). Additionally, tibial SOS SDS were significantly negatively correlated with body mass index (BMI) SDS (r = -0.230, p < 0.001). Finally, subjects that spend more than 3h of daily "screen time" (television and personal computer) showed significantly decreased SOS values measured both at radius and at tibia. On the contrary, no correlation was observed between SOS values and the amount of physical activity reported.

Relationships between density and Young's modulus with microporosity and physico-chemical properties of Wistar rat cortical bone from growth to senescence

The aim of this study is to assess density and elastic properties of Wistar rat cortical bone from growth to senescence and to correlate them with morphological and physico-chemical properties of bone. During growth (from 1 to 9 months), bone density and Young's modulus were found to increase from 1659+/-85 to 2083+/-13 kg m(-3) and from 8+/-0.8 to 19.6+/-0.7 GPa respectively. Bone microporosity was found to decrease from 8.1+/-0.7% to 3.3+/-0.7%. Physico-chemical investigations exhibited a mineralization of bone matrix and a maturation of apatite crystals, as protein content decreased from 21.4+/-0.2% to 17.6+/-0.6% and apatite crystal size and carbonate content increased (c-axis length: from 151 to 173 A and CO(3)W%: from 4.1+/-0.3% to 6.1+/-0.2%). At adult age, all properties stabilized. During senescence, a slow decrease of mechanical properties was first observed (from 12 to 18 months, rho=2089+/-14 to 2042+/-30 kg m(-3) and E(3)=19.8 +/-1.3 to 14.8+/-1.5 GPa), followed by a stabilization. Physico-chemical properties stabilized while microporosity increased slightly (from 3.3% to 4%) but not significantly (p>0.05). A multiple regression analysis showed that morphological and physico-chemical properties had significant effects on density regression model. Microporosity had a greater effect on Young's modulus regression model than physico-chemical properties. This study showed that bone structure, mineralization and apatite maturation should be considered to improve the understanding of bone mechanical behaviour.

High frequency ultrasound prediction of mechanical properties of cortical bone with varying amount of mineral content

In this study, we evaluate if high frequency ultrasound impedance measurements can predict the mechanical properties of bones where the amount of bone mineral is varied. The motivation stems from the potential utility of ultrasound as a noninvasive technique to evaluate and monitor the mechanical properties of bone during treatment of diseased states where the ratio of mineral content to organic matrix content could change (e.g., metabolic bone diseases, osteoarthritis, osteogenesis imperfecta, fracture healing). Eleven cortical bovine femur samples, which were taken along the long axis of femur, were used in each group. Bone samples with reduced mineral content (estimated to be 21% and 35% less than the control) were obtained by immersing samples into fluoride ion solution for 3 and 12 d. Control and fluoride treated samples were first tested mechanically in tension. Acoustic impedances of the mechanically tested samples were obtained by using scanning acoustic microscopy (SAM). Results from mechanical tests indicate that the tensile elastic modulus of the samples was highly correlated to the yield strength (r(2) = 0.94, p < 0.01) and to the ultimate strength (r(2) = 0.75, p < 0.01). SAM results indicate that the acoustic impedances were significantly correlated to the elastic modulus (r(2) = 0.85, p < 0.01), yield strength (r(2) = 0.86, p < 0.01) and ultimate strength (r(2) = 0.70, p < 0.01). These results show that ultrasonic techniques could potentially be used to predict the in vivo ultimate strength of bone tissue caused by changes in mineral content.

Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application

Measurement of bone mineral status may be a useful tool in identifying the children who could be exposed to an increased risk of osteoporosis in adulthood. Dual energy x-ray absorptiometry and peripheral quantitative computed tomography may be used to this purpose, but the exposure to ionizing radiation is a limiting factor for preventive studies in large populations of children. In the last years, quantitative ultrasound (QUS) methods have been developed to assess bone mineral status in some peripheral skeletal sites such as calcaneus, phalanges of the hand, and tibia. QUS techniques are safe, easy to use, radiation-free, and devices are portable, so that they are particularly indicated to assess bone mineral status in children. This review will concentrate on the main methodological principles of ultrasounds and the QUS variables derived from their application to bone tissue, technical differences and performance of QUS methods, factors influencing QUS measurements, normative data and results obtained in children with disturbances of growth or affected by disorders of bone and mineral metabolism, including the assessment of fracture risk, and comparison among QUS, dual energy x-ray absorptiometry, and peripheral quantitative computed tomography methods.

Cross-sectional study on bone density-related sonographic parameters in children with asthma: correlation to therapy with inhaled corticosteroids and disease severity

The aim of this study was to screen asthmatic children for bone density-related sonographic parameters on the calcaneal bone. Findings were correlated to therapy with inhaled corticosteroids (ICS) as well as with asthma severity (AS), concomitance and severity of atopic dermatitis (AD), and rhinitis (AR). We enrolled 173 children with AS1-3 consecutively; 44% (AS1) had not received any ICS medication; 56% (AS2 and -3) received ICS therapy for > or =6 months (medium daily dose, 286 microg fluticasone-proprionate-equivalent/maximum 500 microg); and in addition 38% (n = 65) presented with AD and 66% (n = 115) with AR. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) results were compared to regional normative values of 3299 children obtained with the identical system. ICS-treated children showed a tendency toward reduced age-, weight-, and height-adjusted standard deviation scores (SDS) for SOS compared to children without ICS treatment, which tendency did not reach statistical significance and was not as consistent for BUA (mean of ICS-treated children compared to our controls: SOS-SDS, -0.29/-0.31/-0.30; BUA-SDS, -0.23/-0.17/-0.05). For ICS-treated children, the proportion of patients with BUA and SOS values below -1 SDS was statistically significant higher for age-adjusted BUA and SOS than for children without ICS medication (BUA 15.00% vs. 5.41%; SOS 32.98% vs. 17.56%). However, we cannot differentiate possible negative effects of ICS from influences of the underlying inflammatory disease because higher asthma severity was associated with greater use of ICS medication. Additionally, the higher physical activity of children with less severe asthma can have influenced quantitative ultrasound (QUS) parameters positively, compared to patients with a higher degree of exercise-induced symptoms. For differentiation of possible negative effect of ICS on ultrasonic bone quality and for evaluation of the potentials of the method, further longitudinal QUS assessment of asthmatics receiving a new ICS treatment is needed.

Instrumentation for in vivo ultrasonic characterization of bone strength

Although it has been more than 20 years since the first recorded use of a quantitative ultrasound (QUS) technology to predict bone fragility, the field has not yet reached its maturity. QUS has the potential to predict fracture risk in several clinical circumstances and has the advantages of being nonionizing, inexpensive, portable, highly acceptable to patients, and repeatable. However, the wide dissemination of QUS in clinical practice is still limited and suffering from the absence of clinical consensus on how to integrate QUS technologies in bone densitometry armamentarium. Several critical issues need to be addressed to develop the role of QUS within rheumatology. These include issues of technologies adapted to measure the central skeleton, data acquisition, and signal processing procedures to reveal bone properties beyond bone mineral quantity and elucidation of the complex interaction between ultrasound and bone structure. This article reviews the state-of-the art in technological developments applied to assess bone strength in vivo. We describe generic measurement and signal processing methods implemented in clinical ultrasound devices, the devices and their practical use, and performance measures. The article also points out the present limitations, especially those related to the absence of standardization, and the lack of comprehensive theoretical models. We conclude with suggestions of future lines and trends in technology challenges and research areas such as new acquisition modes, advanced signal processing techniques, and modelization.

Calcaneous quantitative ultrasound measurements predicts vertebral fractures in idiopathic male osteoporosis

OBJECTIVES

The aim of this study was to identify the differences in ultrasound bone variables (QUS) and to test the ability to discriminate male patients with and without vertebral fractures.

METHODS

We therefore measured broadband ultrasound attenuation (BUA) and speed of sound (SOS) matched for bone mineral density (BMD) and vertebral deformity in idiopathic male osteoporosis.

RESULTS

One hundred and seventeen men (age 56.6 range 27-78) were divided into three groups (osteoporosis n=25, osteopenia n=58 and age-matched control n=34) according to BMD T-score by WHO criteria. We found 66 patients (56%) with at least one vertebral deformity during the study. BMD and BUA did not differ, while SOS was lower in osteoporosis (p<0.001) and control group (p<0.001) between the patients with and without vertebral compression. Strong positive correlation was demonstrated between BUA and BMD (lumbar spine r=0.44, p<0.001, femoral neck r=0.56, p<0.001, radius r=0.40, p<0.001), while similar association between SOS and BMD values was not shown. There was no relationship between the BUA and vertebral fracture risk (Odds ratio: 1.14 95% CI: 0.80-1.61). However, the relative risk of vertebral fracture by SOS was 1.56 (95% CI: 1.08-2.62). Adjusting for age and BMI the risk of vertebral fracture did not change (odds ratio for SOS 1.50 95% CI: 1.02-2.22). After adjustment for BMD SOS was still associated with fracture risk at all measured sites (odds ratio: 1.43, 95% CI: 1.02-2.22; 1.41, 95% CI: 1.02-2.17 and 1.32, 95% CI: 1.02-2.0).

CONCLUSION

Our results suggest that BUA values are more closely related to density and structure while SOS values are able to predict fractures.

Reduction in normalized bone elasticity following long-term bisphosphonate treatment as measured by ultrasound critical angle reflectometry

Using an improved version of ultrasound critical angle reflectometry, the bone quality of cortical and trabecular bone was assessed in vivo by measuring elastic moduli (normalized for bone density) at both principal axes, referred to as the minimum and maximum normalized elasticities. The measurements were made in 30 normal premenopausal women, 30 normal postmenopausal women, 22 untreated postmenopausal women with osteoporosis, 74 postmenopausal women with osteoporosis or osteopenia on bisphosphonate treatment, and 32 patients with renal transplantation (16 women and 16 men) taking steroids. Cortical elasticity was higher than trabecular elasticity; both declined slightly and non-significantly with age in normal women. Among untreated postmenopausal women with osteoporosis, cortical maximum normalized elasticity (E(cmax)) remained within 95% prediction intervals of normal women. Among patients on bisphosphonate, E(cmax) was low in the majority of patients. E(cmax) was significantly more depressed among those taking the drug > or =3 years than <3 years (22.1% below normal premenopausal women versus 17.2%, P =0.001), and among those with incident non-spinal fractures than without (75.9 vs. 81.5%, P =0.008). E(cmax) was independent of bone mineral density at the calcaneus. Most patients with renal transplantation had low E(cmax), with a mean 20.8% below the normal premenopausal mean. Qualitatively similar findings were found with cortical minimum elasticity and with trabecular minimum and maximum elasticities. Thus, the material bone quality of cortical and trabecular bone may be impaired following bisphosphonate treatment, as in renal transplantation on steroids.

Relationship among MRTA, DXA, and QUS revisited

Inexpensive, commercially produced devices that directly measure bone strength in vivo are not currently available. Mechanical response tissue analysis (MRTA), a unique prototype device, is an in vivo vibrational test that measures transverse bending stiffness (a measure of whole bone strength expressed as the product of estimated Young's modulus of elasticity and cross-sectional moment of inertia, EI, Nm2) at ulna midshaft. We compared speed of sound (SOS; [m/s]) in ulna cortical bone using a commercially available axial transmission quantitative ultrasound (QUS) device with EI using MRTA. Dual-energy X-ray absorptiometry (DXA) was used to provide an estimate of ulna size (cm2), bone mineral content (BMC; [g/cm]) and areal bone mineral density (BMD; [g/cm2]). The objective of the study was to determine if ulna SOS--alone or in combination with BMD from DXA--was correlated with ulna EI, thus becoming a surrogate measure of transverse bending stiffness, and thus whole bone strength. Data were collected from 138 female volunteers (18-86 yr). EI and SOS were significantly correlated, r = +0.218, p = 0.01, but r2 was very low, 4.8%. SOS and total ulna BMD were combined to estimate elastic modulus, which correlated with EI, r = +0.377, p < 0.0001; however, the correlation was not significantly better than with SOS alone. We conclude that axial transmission QUS is not a strong surrogate in vivo technique for estimating transverse bending stiffness.

Effects of extracorporeal shock wave therapy and radial pressure wave therapy on elasticity and microstructure of equine cortical bone

OBJECTIVE

To measure changes in the modulus of elasticity (E) and describe histologic findings after extracorporeal shock wave therapy and radial pressure wave therapy on equine cortical bone specimens.

SAMPLE POPULATION

16 bone specimens from the proximodorsal cortex of an equine third metacarpal or metatarsal bone.

PROCEDURE

Baseline E was determined by the density (p) and unidirectional ultrasound transmission velocity (C) of each specimen according to the equation E = pC2. Eight specimens were treated with 500 pulses of 0.15 mJ/mm2 of extracorporeal shock wave therapy, and 8 specimens were treated with 500 pulses of 0.16 mJ/mm2of radial pressure wave therapy. After treatment, C was determined again. Four treatment sessions resulted in 2,000 pulses and 5 C measurements. The p of each sample was measured again. Mean post-treatment E was calculated for each group. Nondecalcified sections of all specimens were stained with toluidine blue or basic fuchsin for histologic evaluation.

RESULTS

Overall treatment group effect was not significant for C or E. Final E was not different from baseline values for extracorporeal shock wave therapy and radial pressure wave therapy. No histologic changes could be attributed to either treatment modality.

CONCLUSIONS AND CLINICAL RELEVANCE

Extracorporeal shock wave therapy and radial pressure wave therapy did not affect the material properties of equine bone at the energy and pulse values used in this study.

Apparent viscoelastic anisotropy as measured from nondestructive oscillatory tests can reflect the presence of a flaw in cortical bone

There is evidence that damage, viscoelastic stiffness properties, and postyield mechanical properties are related in bone tissue. Our objective was to test whether presence of a flaw would have an influence on the apparent viscoelastic properties of bone. Examining the effect of flaw orientation on apparent viscoelastic properties and utilization of dynamic mechanical analysis (DMA) as a nondestructive means for detection of damage were our secondary objectives. Cortical bone beams (2 x 2 x 19 mm) machined from the cranial cortex of the radii of six Warhill sheep were used. The specimens were placed in a DMA machine and baseline measurements of storage modulus (E1) and loss factor (tan delta), once for loads in the craniocaudal and once in the mediolateral directions, were performed using a three-point bending configuration for a frequency range of 1-10 Hz. Craniocaudal/mediolateral measurement ratio was calculated as a measure of anisotropy for tan delta and E1. After cutting a thin through-thickness macroscopic notch on the caudal surface at the center of each beam, oscillatory tests were repeated. Two-way repeated measures analysis of variance followed by Tukey's test was used with group (craniocaudal, mediolateral, notched craniocaudal, and notched mediolateral measurements) and frequency as factors. Regression analysis and analysis of covariance were used for examining the relationship between viscoelastic parameters and frequency. Tan delta and E1 were not different between craniocaudal and mediolateral measurements before the flaw was introduced (p > 0.8 and p = 1, respectively). In the presence of the flaw, tan delta was significantly increased (p < 0.003) whereas E1 was significantly reduced (p < 0.001) for craniocaudal measurements. Tan delta and E1 were nearly isotropic in the tested directions before the introduction of a flaw into the bone tissue. Introduction of a flaw resulted in increased tan delta and E1 anisotropy. Presence of a notch resulted in a significant increase in tan delta anisotropy with increasing frequency. In conclusion, we have demonstrated that cortical bone tissue exhibits a different apparent viscoelastic behavior in the presence of a flaw and depending on the flaw's orientation. Our finding that the presence of a notch and its orientation can be detected by nondestructive DMA suggests that in vivo techniques may be developed for detection of cortical bone damage.

Relation of PvuII site polymorphism in the COL1A2 gene to the risk of fractures in prepubertal Finnish girls

Genetic susceptibility to fractures may be detectable in early childhood. We evaluated the associations between the polymorphic PvuII site of the COL1A2 gene and bone properties assessed by different modalities (dual-energy X-ray absorptiometry; peripheral quantitative computed tomography; gel coupling scanning quantitative ultrasonometry; ultrasound bone sonometry), bone turnover markers, and the occurrence of fractures in 244 prepubertal Finnish girls. Tanner stage and physical characteristics did not differ significantly among girls with different COL1A2 genotypes. The polymorphism was not significantly associated with different bone properties or any of the bone turnover markers when girls at Tanner stage I (prepuberty) and stage II (early puberty) were considered together, but there was a significant association with spine bone mineral content (BMC) and bone mineral density (BMD), as well as with speed of sound (SOS) (P < 0.05), when girls at Tanner stage I were considered separately, as a purpose to avoid the confounding effect that the pubertal growth spurt has on skeletal development. The distribution of fractures was different between the three genotype groups (P = 0.023). The P alleles were over-represented in girls who had been fractured at least once; 88% of them had at least one copy of the P allele (either PP or Pp). Girls with the PP genotype had 4.9 times higher relative risk for fractures than girls with the pp genotype (95% CI, 1.4 to 17.4; P = 0.015). No significant difference was found between fractured and nonfractured girls in anthropometric measurements, physical activity, or bone mass. However, BMD of the spine and SOS at the radius and tibia were significantly lower in the fractured girls. We conclude that the COL1A2 polymorphism is associated with nonosteoporotic fractures in prepubertal girls independently of bone density.

Accuracy of elastic property measurement in mandibular cortical bone is improved by using cylindrical specimens

Ultrasonic determination of elastic properties in human craniofacial cortical bone is problematic because of a lack of information about the principal material axes, and because the cortex is often thinner than in long bones. This study investigated solutions that permit reasonable determination of elastic properties in the human mandible. We tested whether ultrasonic velocities could be reliably measured in cylindrical samples of aluminum and mandibular bone, and the effects of reduced specimen thickness. Results indicted that (1) varying shape had minimal effects on ultrasonic velocities or derived elastic properties, and (2) ultrasonic velocities have relatively increased measurement error as propagation distances decreased. The increased error in velocity measurements of mandibular cortical specimens of less than 1.2 mm in thickness should be considered when assessing the reliability of single measurements.

Age-related changes in the collagen network and toughness of bone

The hypothesis of this study is that the mechanical integrity of the collagen network in bone deteriorates with age, and such adverse changes correlate with the decreased toughness of aged bone. To test the hypothesis, 30 human cadaveric femurs from donors ranging from 19 to 89 years of age were tested to determine the age-related changes in the mechanical properties of demineralized bone and fresh bone samples. Along with bone porosity, bone density, and weight fractions of the mineral and organic phases, collagen denaturation and concentrations of collagen cross-links (HP, hydroxylysylpyridinoline; LP, lysylpyridinoline; PE, pentosidine) were determined for these bone specimens as a function age. Analysis of variance (ANOVA) showed that age-dependent changes were reflected in the decreased strength, work to fracture, and fracture toughness of bone; in the decreased strength, elastic modulus, and work to fracture of the collagen network; as well as in the increased concentration of pentosidine (a marker of nonenzymatic glycation) and increased bone porosity. Regression analyses of the measured parameters showed that the age-related decrease in work to fracture of bone (especially its postyield portion) correlated significantly with deterioration in the mechanical integrity of the collagen network. The results of this study indicate that the adverse changes in the collagen network occur as people age and such changes may lead to the decreased toughness of bone. Also, the results suggest that nonenzymatic glycation may be an important contributing factor causing changes in collagen and, consequently, leading to the age-related deterioration of bone quality.

The contribution of the organic matrix to bone's material properties

Bone is a two-phase porous composite material comprised primarily of collagen and mineral, which together provide its mechanical properties. The contribution of the mineral phase to bone's mechanical properties has dominated scientific thinking. Collagen's role has been underappreciated and not very well studied. However, there is evidence that changes in collagen content, or changes to inter- and intrafibrillar collagen cross-linking, can reduce the energy required to cause bone failure (toughness), and increase fracture risk. Although collagen may have less effect on bone's strength and stiffness than does mineral, it may have a profound effect on bone fragility. Collagen changes that occur with age and reduce bone's toughness may be an important factor in the risk of fracture in older women with low bone mass.

Bone material ultrasound velocity is predictive of whole bone strength

In humans, bone strength is assessed indirectly by the noninvasive measurement of structure or mass. Recent clinical application of an ultrasonic critical-angle reflectometry technique (UCR) has demonstrated the measurement of the regional and directional distribution of mechanical stiffness. This study investigates the specific question: are these measurements of a local material level property predictive of the strength of whole bone? Maximum values of pressure wave velocity and breaking strength were recorded at two locations (midshaft and base of neck) on rat femurs from growing rats. The results demonstrate a strong empirical relationship between material-level ultrasound (US) velocity and whole bone mechanical strength. However, the US velocity at a specific bone site can be used to assess bone strength at that site only, explaining discrepancies in other published studies that negate a relationship between strength and US velocity. The results indicate an important role for US velocity measurement in clinical evaluation of bone health.

Fundamentals of biomechanics in tissue engineering of bone

The objective of this review is to provide basic information pertaining to biomechanical aspects of bone as they relate to tissue engineering. The review is written for the general tissue engineering reader, who may not have a biomechanical engineering background. To this end, biomechanical characteristics and properties of normal and repair cortical and cancellous bone are presented. Also, this chapter intends to describe basic structure-function relationships of these two types of bone. Special emphasis is placed on salient classical and modern testing methods, with both material and structural properties described.

Bone material elasticity in a murine model of osteogenesis imperfecta

To investigate the source of bone brittleness in the disease osteogenesis imperfecta (OI), biomechanical properties have been measured in the femurs from a homozygous (oim/oim) mutant mouse model of OI, its heterozygous littermates, and wild-type animals. The novel technique of ultrasound critical-angle reflectometry (UCR) was used to determine bone material elasticity matrix from measurements of the pressure and shear wave velocity at different orientations about selected points of the bone specimens. This nondestructive method is the only available means for obtaining measurements of this nature from a single surface. The ultrasound pressure wave velocity showed an increased isotropy in the homozygous compared to the wild-type specimens. This was reflected in a significant decrease in the principal elastic modulus measured along the length of the oim/oim bones (E33) while the modulus along the width (E11) did not change significantly, compared to wild-type specimens. The Poisson's ratio, v12, also had a significantly increased value in oim/oim bones. Measurements of these parameters in heterozygous animals generally fell between those from homozygous and control mice. The differences in the elasticity components in oim/oim bones indicate an altered stress distribution and a modified elastic response to loads, compared to normal bone.

Quantitative ultrasound in postmenopausal osteoporosis

Ultrasound has been proposed as a low-cost, radiation-free method for osteoporosis assessment in postmenopausal women. Large prospective studies have shown that ultrasound parameters can be used for fracture risk estimate in this population, providing that adequate quality control is performed. The places of both ultrasound and the current gold standard method for bone assessment, dual energy x-ray absorptiometry, are still to be determined. Further studies are needed on the diagnosis of osteoporosis using ultrasound, because current diagnostic thresholds, designed by the World Health Organization, do not apply to this-new technology. Monitoring of skeletal changes and treatment effects by ultrasound cannot be recommended.

A new method for quantitative ultrasound measurements at multiple skeletal sites: first results of precision and fracture discrimination

We investigated a new multisite quantitative ultrasound device that measures the acoustic velocity in axial transmission mode along the cortex. Using a prototype of the Omnisense (Sunlight Ultrasound Technologies, Rehovot, Israel), we tested the performance of this instrument at four sites of the skeleton: radius, ulna, metacarpal, and phalanx. Intraobserver (interobserver) precision errors ranged from 0.2% to 0.3% (0.3% to 0.7%) for triplicate measurements with repositioning. Fracture discrimination was tested by comparing a group of 34 women who had previously suffered a fracture of the hip, spine, ankle, or forearm to a group of 28 healthy women who had not suffered a fracture. Age-adjusted standardized odds ratios ranged from 1.6 to 4.5. Except for the ulna the sites showed a significant fracture discrimination (p < 0.01). The areas under the receiver operating curves (ROC) curves were from 0.88 to 0.89 for radius, metacarpal, and phalanx. A combination of the results from the three sites showed a significant increase of the ROC area to 0.95 (p < 0. 05). Our results show promising performance of this new device. The ability to measure a large variety of sites and the potential to combine these measurements are promising with regard to optimizing fracture risk assessment.

The material basis for reduced mechanical properties in oim mice bones

Osteogenesis imperfecta (OI), a heritable disease caused by molecular defects in type I collagen, is characterized by skeletal deformities and brittle bones. The heterozygous and homozygous oim mice (oim/+ and oim/oim) exhibit mild and severe OI phenotypes, respectively, serving as controlled animal models of this disease. In the current study, bone geometry, mechanics, and material properties of 1-year-old mice were evaluated to determine factors that influence the severity of phenotype in OI. The oim/oim mice exhibited significantly smaller body size, femur length, and moment of area compared with oim/+ and wild-type (+/+) controls. The oim/oim femur mechanical properties of failure torque and stiffness were 40% and 30%, respectively, of the +/+ values, and 53% and 36% of the oim/+ values. Collagen content was reduced by 20% in the oim/oim compared with +/+ bone and tended to be intermediate to these values for the oim/+. Mineral content was not significantly different between the oim/oim and +/+ bones. However, the oim/oim ash content was significantly reduced compared with that of the oim/+. Mineral carbonate content was reduced by 23% in the oim/oim bone compared with controls. Mineral crystallinity was reduced in the oim/oim and oim/+ bone compared with controls. Overall, for the majority of parameters examined (geometrical, mechanical, and material), the oim/+ values were intermediate to those of the oim/oim and +/+, a finding that parallels the phenotypes of the mice. This provides evidence that specific material properties, such as mineral crystallinity and collagen content, are indicative and possibly predictive of bone fragility in this mouse model, and by analogy in human OI.

Correlation of quantitative ultrasound of bone with biochemical markers of bone resorption in women with osteoporotic fractures

The purpose of this study was to examine the correlation of parameters of bone quality assessed by quantitative ultrasound (QUS) with biochemical indexes of bone resorption. QUS of the calcaneus and the hand phalanges, and biochemical parameters (urinary excretion of pyridinoline [Pyr] and deoxypyridinoline [D-Pyr]) were measured in a group of 30 well-characterized postmenopausal women with established osteoporosis and fragility fractures. All patients were treatment free. QUS data significantly correlated with both urinary Pyr and D-Pyr (p < 0.001 for speed of sound [SOS], broadband ultrasound attenuation [BUA], and stiffness at the heel; p < 0.001 for amplitude-dependent SOS at the proximal phalanges of the nondominant hand). No significant correlation was observed between spine and femoral bone mineral density and the urinary excretion of Pyr and D-Pyr. Results of this study suggest that QUS of bone evaluates characteristics of bone influenced by the bone resorption rate.

Decreased ulnar bending stiffness in osteoporotic Caucasian women

Mechanical response tissue analysis (MRTA) is a noninvasive measure of ulnar bending stiffness in vivo. It is unique in that the mechanical response to the lower range of vibrational frequencies is used to determine the average cross-sectional bending stiffness. The objective of this study was to compare ulnar bending stiffness among normal, osteopenic, and osteoporotic Caucasian women. World Health Organization criteria were used to define cohorts. Ulnar bending stiffness was expressed as the product of Young's modulus of elasticity (E) and the cross-sectional moment of inertia (I) in units of square Newton meters using MRTA. There was no difference in the mean body weight between cohorts but mean age was significantly different (p < 0.0001, analysis of variance): normal women, 34 +/- 12 yr (n = 55); women with age-related/idiopathic osteopenia, 52 +/- l l yr (n = 36(; and women with osteoporosis, 65 +/- 10 yr (n = 24). The mean EI of osteoporotic Caucasian women (25 Nm(2)) was 25% lower than normal subjects (33.1 Nm(2)) (p < 0.0001). However, there was no significant difference between EI of normal women and osteopenic women (30.l Nm(2)). EI was significantly but weakly correlated (i.e., the greatest r(2) value was 37%) to all dual X-ray absorptiometry variables, ulnar width, age, and body weight. In summary, results with MRTA were consistent with previous studies using classical ex vivo biomechanical techniques and in vivo vibrational techniques, showing decreased strength (i.e., bending stiffness) in osteoporotic bone compared with normal bone and a generalized decrease in bending stiffness with increasing age.