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. 2016 Nov;5(11):538-543.
doi: 10.1302/2046-3758.511.BJR-2016-0116.R1.

Is calcaneal broadband ultrasound attenuation a valid index of dual-energy x-ray absorptiometry-derived bone mass in children?

B K Weeks  1 , R Hirsch  2 , R C Nogueira  2 , B R Beck  2
Affiliations

Is calcaneal broadband ultrasound attenuation a valid index of dual-energy x-ray absorptiometry-derived bone mass in children?

B K Weeks et al. Bone Joint Res. 2016 Nov.

Abstract

Objectives: The aim of the current study was to assess whether calcaneal broadband ultrasound attenuation (BUA) can predict whole body and regional dual-energy x-ray absorptiometry (DXA)-derived bone mass in healthy, Australian children and adolescents at different stages of maturity.

Methods: A total of 389 boys and girls across a wide age range (four to 18 years) volunteered to participate. The estimated age of peak height velocity (APHV) was used to classify children into pre-, peri-, and post-APHV groups. BUA was measured at the non-dominant heel with quantitative ultrasonometry (QUS) (Lunar Achilles Insight, GE), while bone mineral density (BMD) and bone mineral content (BMC) were examined at the femoral neck, lumbar spine and whole body (DXA, XR-800, Norland). Associations between BUA and DXA-derived measures were examined with Pearson correlations and linear regression. Participants were additionally ranked in quartiles for QUS and DXA measures in order to determine agreement in rankings.

Results: For the whole sample, BUA predicted 29% of the study population variance in whole body BMC and BMD, 23% to 24% of the study population variance in lumbar spine BMC and BMD, and 21% to 24% of the variance in femoral neck BMC and BMD (p < 0.001). BUA predictions were strongest for the most mature participants (pre-APHV R2 = 0.03 to 0.19; peri-APHV R2 = 0.05 to 0.17; post-APHV R2 = 0.18 to 0.28) and marginally stronger for girls (R2 = 0.25-0.32, p < 0.001) than for boys (R2 = 0.21-0.27, p < 0.001). Agreement in quartile rankings between QUS and DXA measures of bone mass was generally poor (27.3% to 38.2%).

Conclusion: Calcaneal BUA has a weak to moderate relationship with DXA measurements of bone mass in children, and has a tendency to misclassify children on the basis of quartile rankings.Cite this article: B. K. Weeks, R. Hirsch, R. C. Nogueira, B. R. Beck. Is calcaneal broadband ultrasound attenuation a valid index of dual-energy x-ray absorptiometry-derived bone mass in children? Bone Joint Res 2016;5:538-543. DOI: 10.1302/2046-3758.511.BJR-2016-0116.R1.

Keywords: Bone quality; Densitometry; Paediatric; Ultrasonometry.

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Conflict of interest statement

ICMJE COI Statement: B. R. Beck is a co-director of The Bone Clinic, Brisbane, Australia, a health service providing support for individuals with osteoporosis. Quantitative ultrasonometry is not used at, nor are children ever clients of, the clinic.

Figures

None
Calcaneal broadband ultrasound attenuation (BUA) predictions of a) femoral neck bone mineral content (BMC), b) lumbar spine BMC, and c) whole body BMC for the whole cohort (n = 389).
See this image and copyright information in PMC

References

    1. Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol 2007;37:21-31. - PMC - PubMed
    1. Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application. Pediatr Res 2008;63:220-228. - PubMed
    1. Guglielmi G, Adams J, Link TM. Quantitative ultrasound in the assessment of skeletal status. Eur Radiol 2009;19:1837-1848. - PubMed
    1. Williams JE, Wilson CM, Biassoni L, et al. Dual energy x-ray absorptiometry and quantitative ultrasound are not interchangeable in diagnosing abnormal bones. Arch Dis Child 2012;97:822-824. - PubMed
    1. Hadji P, Hars O, Wüster C, et al. Stiffness index identifies patients with osteoporotic fractures better than ultrasound velocity or attenuation alone. Maturitas 1999;31:221-226. - PubMed