Quantitative ultrasound for the detection and management of osteoporosis: [review] / Ultrasonido cuantitativo para la detección y manejo de osteoporosis: [revisión]

Quantitative ultrasound (QUS) appears to be developing into an acceptable, low-cost and readily-accessible alternative to dual X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the detection and management of osteoporosis. Perhaps the major difficulty with their widespread use is that many different QUS devices exist that differ substantially from each other, in terms of the parameters they measure and the strength of empirical evidence supporting their use. But another problem is that virtually no data exist outside of Caucasian or Asian populations. In general, heel QUS appears to be most tested and most effective. Some, but not all heel QUS devices are effective assessing fracture risk in some, but not all populations, the evidence being strongest for Caucasian females > 55 years old, though some evidence exists for Asian females > 55 and for Caucasian and Asian males > 70. Certain devices may allow to estimate the likelihood of osteoporosis, but very limited evidence exists supporting QUS use during the initiation or monitoring of osteoporosis treatment. Likely, QUS is most effective when combined with an assessment of clinical risk factors (CRF); with DXA reserved for individuals who are not identified as either high or low risk using QUS and CRF. However, monitoring and maintenance of test and instrument accuracy, precision and reproducibility are essential if QUS devices are to be used in clinical practice; and further scientific research in non-Caucasian, non-Asian populations clearly is compulsory to validate this tool for more widespread use.

El ultrasonido cuantitativo (QUS) es una alternativa para la detección y manejo de la osteoporosis de bajo costo y uso práctico, si se compara con las densitometrías de rayos X de doble haz de baja energía (DXA) que determinan densidad mineral ósea (BMD). La mayor dificultad para el uso generalizado del QUS por un lado es que existen muchos instrumentos que son significativamente diferentes uno del otro y por otro en la calidad de la evidencia en que se justifica su empleo, que generalmente es insuficiente y/o poco sistematizada. Otro problema importante del QUS, es que prácticamente no existe información que no sea la generada en poblaciones asiáticas o caucásicas. En general, los estudios de calcáneo realizados con QUS son los más utilizados y mejor validados para evaluar el riesgo de fracturas en algunas poblaciones. La evidencia más grande de su efectividad se conoce para las mujeres caucásicas y asiáticas mayores de 55 años e incluso para los hombres asiáticos mayores de 70 años. Varios instrumentos cuentan con buen sustento científico, que los vuelve confiables para establecer un pronóstico preciso e identificar el riesgo individual de sufrir fracturas por osteoporosis, sin embargo, existe poca evidencia que respalde su uso para iniciar y monitorear el resultado del tratamiento de la osteoporosis. El QUS mejora su efectividad diagnóstica cuando se combina con los resultados de un cuestionario que identifica riesgos clínicos. En un escenario ideal, el DXA se debe reservar solo para aquellos individuos que no puedan ser identificados de manera confiable usando QUS y el cuestionario de riesgos clínicos. Si se quiere aceptar a los instrumentos QUS en la práctica clínica, para el monitoreo es indispensable asegurar y mantener la exactitud, precisión y reproducibilidad de los instrumentos y de los técnicos que los utilizan. Se requieren más estudios científicos de poblaciones no caucásicas o asiáticas para validar el uso generalizado del QUS.

Spinal bone mineral density by quantitative computed tomography in Thais compared with Westerners.

The present study was to determine age- and gender-based spinal bone mineral density (BMD) by quantitative computed tomography (QCT) in Thais and to compare it with that of Westerners. Four hundred and twenty five healthy Thais, age 20 to 76 years (322 females, mean age 43.4 years; 103 males, mean age 42.8 years) were recruited for BMD assessment by QCT. Spinal BMD peaks in the 20-29 year age group in both genders with a mean value of 171.9 mg/cu cm in females and 171.0 mg/cu cm in males. It subsequently decreases in older age groups. Males' BMD has a higher rate of decline than females' until age 40-49. It then stabilizes from 50-59 while females' BMD shows the highest rate decline at this period After the mid-50's, both genders have bone loss from aging. Compared to Westerners, peak bone mass is reached in the same age group in both genders. Peak bone mass of Thai females is significantly higher than Western females, but that of Thai males is not significantly higher than Western males. BMD of Thai males in the 50-59 and over-60 age groups is higher than that of Westerners. The findings suggest that the cut-off points for osteopenia and osteoporosis, in Thai females are at spinal BMD lower than 143.6 mg/cu cm and 101.15 mg/cu cm, respectively. While the values lie at 143.2 mg/cu cm and 101.5 mg/cu cm among Thai males for osteopenia and osteoporosis, respectively.

Effect of alendronate on bone mineral density in Puerto Rican males with osteoporosis

Osteoporosis in men was not recognized as a major health problem until recently, and increased research in this area resulted in the approval of alendronate for the treatment of osteoporosis in men at the beginning of this decade. Low bone mineral density (BMD) has been demonstrated to be a strong predictor of fracture in men as it is in women. The causes of osteoporosis in men are variable and can be classified as primary or secondary. The aim of these report is to present the response of BMD in 10 Puerto Rican men with secondary causes of osteoporosis treated with alendronate. A significant increase of BMD in spine, total hip, trochanter and intertrochanteric regions were noted. A non-significant increase in femoral neck was observed.

Medida da densidade mineral óssea em mulheres na pós-menopausa / Bone mineral density determination in postmenopausal women

Objetivos: Avaliar a densidade óssea (DMO) em mulheres pós-menopausadas e verificar suas correlações com a idade cronológica, grupo étnico, o tempo decorrido a partir da menopausa, paridade, índice de massa corpórea (IMC) e tabagismo. Material e métodos: Um total de 200 mulheres pós-menopausadas foram avaliadas e submeteram-se a densitometria óssea para medida da DMO em quatro regiões: vértebras lombares, fêmur proximal, triângulo de Ward e trocanter. Resultados: A idade das pacientes variou de 40 a 69 anos, com média de 53,4 anos. A DMO medida na coluna lombar, variou de 0,632 a 1,390 g/cm2; no colo do fêmur variou de 0,605 a 1,207 g/cm2; no triângulo de Ward variou de 0,386 a 1,128 g/cm2; e no tocanter, variou de 0,460 a 1,047g/cm2. O tempo médio decorrido após a menopausa foi de 7,8 anos, o número médio de filhos encontrado foi de 4,3 e o IMC foi de 26,6. Conclusões: A DMO do osso trabecular sofre redução com o aumento da idade, aumento do tempo de menopausa, aumento do número de filhos, e diminuição da massa corporal. No osso cortical esta redução é mais intensa com o aumento da idade cronológica e redução da massa corporal