Discrimination of fractures by low-frequency axial transmission ultrasound in postmenopausal females.

SUMMARY: In this cross-sectional study, 95 postmenopausal women, with and without fracture history, were measured by low-frequency axial transmission ultrasound. The measured ultrasound velocity discriminated the fractured subjects from the nonfractured ones equally or better than peripheral quantitative computed tomography (pQCT) and dual energy x-ray absorptiometry (DXA). These results suggest that low-frequency ultrasound is suitable for bone fragility assessment. INTRODUCTION: Quantitative low-frequency axial transmission ultrasound is a promising modality for assessing mineral density and geometrical properties of long bones such as radius and tibia. The aim of the current study was to evaluate the ability of low-frequency axial transmission ultrasound to discriminate fractures retrospectively in postmenopausal women. METHODS: A cross-sectional study involved 95 female subjects aged 45-88 years, whose fracture information was gathered retrospectively. The fracture group was defined as subjects with one or more low-/moderate-energy fractures. The radius and tibial shaft were measured with a custom-made ultrasonometer to assess the velocity of the low-frequency first-arriving signal (V (LF)). Site-matched pQCT was used to measure volumetric cortical and subcortical bone mineral density (sBMD), and cortical thickness (CTh). Areal BMD (aBMD) was measured using DXA for the whole body (WB), lumbar spine, and hip. RESULTS: The majority (19/32; 59 %) of the fractures were in the upper limb. V (LF) in the radius, but not in the tibia, discriminated fractures with an age- and BMI-adjusted odds ratio (OR) of 2.06 (95 % CI 1.21-3.50, p < 0.01). In the radius, CTh and cortical BMD (CBMD) significantly discriminated fractures, as did the total, cortical, and sBMD in the tibia (adjusted OR 1.35-2.15, p < 0.05). Sensitivity and specificity were similar among all the measurements (area under the receiver operating characteristic curve 0.74-0.81, p < 0.001). CONCLUSIONS: Low-frequency axial transmission ultrasound in the radius was able to discriminate fractured subjects from the nonfractured ones. This suggests that low-frequency axial transmission ultrasound has the potential to assess bone fragility in postmenopausal women.

Low-frequency axial ultrasound velocity correlates with bone mineral density and cortical thickness in the radius and tibia in pre- and postmenopausal women.

UNLABELLED: Axial transmission velocity of a low-frequency first arriving signal (V (LF)) was assessed in the radius and tibia of 254 females, and compared to site-matched pQCT measurements. V (LF) best correlated with cortical BMD, but significantly also with subcortical BMD and cortical thickness. Correlations were strongest for the radius in postmenopausal females. INTRODUCTION: Ultrasonic low-frequency (LF; 0.2-0.4 MHz) axial transmission, based on the first arriving signal (FAS), provides enhanced sensitivity to thickness and endosteal properties of cortical wall of the radius and tibia compared to using higher frequencies (e.g., 1 MHz). This improved sensitivity of the LF approach has not yet been clearly confirmed by an in vivo study on adult subjects. The aims of the present study were to evaluate the extent to which LF measurements reflect cortical thickness and bone mineral density, and to assess whether an individual LF measurement can provide a useful estimate for these bone properties. METHODS: Velocity of the LF FAS (V (LF)) was assessed in the radius and tibia shaft by a new ultrasonometer (CV(RMS) = 0.5%) in a cross-sectional study involving 159 premenopausal (20-58 years) and 95 postmenopausal females (45-88 years). Site-matched volumetric total bone mineral density (BMD), cortical bone mineral density (CBMD), subcortical bone mineral density (ScBMD) and cortical thickness (CTh) were assessed using pQCT. RESULTS: For the postmenopausal females, V (LF) correlated best with CBMD in the radius (R = 0.850, p < 0.001), but significantly also with ScBMD and CTh (R = 0.759 and R = 0.761, respectively; p < 0.001). Similar trends but weaker correlations were observed for the tibia and for the premenopausal women. CONCLUSIONS: The LF assessment, with an optimal excitation frequency, thus provided good prediction of both cortical thickness and subcortical bone material properties. These results suggest that the LF approach does indeed have enhanced sensitivity for detecting osteoporotic changes that occur deep in the endosteal bone.

Quantitative ultrasound predicts bone mineral density and failure load in human lumbar vertebrae.

BACKGROUND: Quantitative ultrasound is in widespread clinical use for assessment of bone quality at peripheral skeletal sites, but has not yet been applied to those sites in the axial skeleton, such as the spine and hip, where osteoporotic fractures are common. METHODS: Ultrasound measurements were made in 11 cadaveric vertebrae and relationships with bone mineral density and failure load were investigated. An ultrasonic imaging system was used to measure speed of sound, broadband ultrasonic attenuation, and attenuation at a single frequency, through the vertebral body in the sagittal plane. Ultrasonic measurements were averaged over a region of interest centrally within the vertebral body, and were calculated with and without normalization for bone size. Vertebral bone mineral density was measured in antero-posterior and lateral projections using dual energy X-ray absorptiometry. Compressive mechanical testing was performed to determine vertebral failure load. FINDINGS: Bone mineral density correlated with failure load (r=0.74-0.78, all P<0.01), and with quantitative ultrasound (r=0.63-0.82, P=0.038-0.004), in line with previous studies. Of the ultrasonic measurements, those parameters not normalized for bone size gave the highest correlations with failure load, ranging from r=0.71 (P=0.021) for speed of sound to r=0.93 (P<0.001) for attenuation. When ultrasonic measurements were normalized for bone size, the correlations with both failure load and bone mineral density were lower. INTERPRETATION: These results confirm the feasibility of vertebral quantitative ultrasound in vitro, and indicate that ultrasound does provide information on both bone mineral density and failure load. The predictive performance of ultrasonic measurements for failure load was comparable to or greater than that of bone mineral density, suggesting that ultrasound has the potential to be at least as useful as mineral density in the assessment of vertebral bone. Normalizing ultrasonic measurements for bone size reduced the strength of correlations because both bone mineral density and bone strength reflect bone size to a certain extent.

Measuring guided waves in long bones: modeling and experiments in free and immersed plates.

Guided waves, consistent with the A0 Lamb mode, have previously been observed in bone phantoms and human long bones. Reported velocity measurements relied on line fitting of the observed wave fronts. Such an approach has limited ability to assess dispersion and is affected by interference by other wave modes. For a more robust identification of modes and determination of phase velocities, signal processing techniques using the fast Fourier transform (FFT) were investigated. The limitations of FFT because of spatial resolution were addressed to improve the precision of the measured modes. An inversion scheme was developed for determining the plate thickness from the measured velocity. Experiments were performed on free and immersed plates, mimicking bone without and with an overlying tissue. With group velocity filtering, modes could be identified reliably with precise phase velocities and thicknesses. These methods were essential for the immersed plates and they should lead to more reliable in vivo measurements.

Influence of physical activity and maturation status on bone mass and geometry in early pubertal girls.

This study aimed to evaluate the influence of leisure-time physical activity on the development of bone mass and density in early pubertal girls. Scores of physical activity were obtained from 242 Finnish girls (10-12 years old within Tanner Stages I-II) using a questionnaire. Bone mass and density were assessed using different densitometric techniques. At Tanner Stage I, active girls had significantly higher bone mineral mass (BMC) and areal bone mineral density (aBMD) of the whole body and cortical volumetric BMD and thickness of the tibial shaft compared with sedentary girls (P<0.05). On the other hand, the active girls at Tanner Stage II showed significantly higher values only in BMC and aBMD at the lumbar spine (P=0.017 and P=0.007, respectively). These indicated that girls at Tanner Stage I with higher leisure-time physical activity level benefited more from physical activity in terms of their bone development than their less active counterparts. Our results provide evidence that the most beneficial time for physical exercise to exhibit its effect on bone development is in the earlier pubertal period for normal school children, but the positive effect on the lumbar spine is also demonstrated in Tanner Stage II.

Assessment of the tibia using ultrasonic guided waves in pubertal girls.

The purpose of this study was to compare low frequency ultrasonic guided wave measurements with established ultrasound and bone density measurements in terms of their ability to characterize the tibia in pubertal girls. Subjects were 12-14-year-old girls ( n=106) who were participating in a calcium and vitamin D intervention study. A prototype low frequency pulse transmission device consisting of a uniaxial scanning mechanism and low frequency transducers orientated perpendicularly to the limb was used to measure two ultrasound velocities in the tibia. The first velocity, V1, was that of the first arriving signal, similar to that measured by existing commercial tibial ultrasound devices. The second velocity, V2, was that of a slower wave propagating at 1,500-2,000 m/s, which has been shown elsewhere to be consistent with the lowest order antisymmetric guided mode in the bone. In addition, commercial ultrasound devices (Omnisense, Sunlight Ltd.; QUS-2, Quidel Corp.) were used to measure the speed of sound (SOS) in the tibia and the radius and attenuation (BUA) in the calcaneus. Cortical bone cross-sectional area (CSA), mineral density (BMD) and cortical thickness (cTh) of the tibia were measured using pQCT, site-matched to the ultrasound measurements. Both V1 and V2 correlated significantly with cortical BMD and with cTh and CSA. On the other hand, tibial SOS correlated with BMD, but not with cTh and CSA. These results indicate that the prototype device using guided waves captures aspects of tibial cortical bone geometry in addition to bone density, thereby potentially offering increased diagnostic information compared to existing tibial ultrasound devices.

Effect of temperature on ultrasonic properties of the calcaneus in situ.

To assess the dependence of calcaneal quantitative ultrasound (QUS) on foot temperature, a series of acoustic measurements were made in five cadaver feet in situ (all soft tissues retained) over a temperature range of 25 degrees C to 40 degrees C in steps of 5 degrees C. An implanted probe was used to measured temperature directly in the calcaneus itself. Ultrasound velocity decreased linearly with increasing temperature, with a mean thermal coefficient of -2.2 m/s/ degrees C. In contrast, broadband ultrasonic attenuation (BUA) increased with temperature with a mean thermal coefficient of +0.75 dB/MHz/ degrees C. We argue that the temperature trends in velocity are likely to be due to the influence of fat, present in the bone marrow and in the soft tissues, which has a negative thermal coefficient for acoustic velocity. The attenuation trends may arise, in part, from greater scattering losses inside the cancellous bone due to an increased acoustic impedance mismatch between trabeculae and fatty marrow at higher temperatures. These considerations suggest that the greatest temperature effects may be expected in patients with a high proportion of fat within the measured volume and/or low calcaneal bone density. Given the magnitude of the thermal coefficients observed, the clinical impact of temperature-related QUS errors is likely to be modest for diagnostic purposes but of greater significance in follow-up studies.