Growth patterns at distal radius and tibial shaft in pubertal girls: a 2-year longitudinal study.

Bone changes, in terms of both size and BMD, were assessed longitudinally in pubertal girls. Before puberty, BMD at the distal radius declined, whereas bone size increased, suggesting that normal growing girls experience a transient period of increased bone fragility. This could explain the elevated low-trauma forearm fracture rates reported in earlier studies. Introduction: Longitudinal data on bone growth during puberty are sparse. Such information is needed to understand the sequence of biological changes, the physical and mechanical consequences for the growing skeleton, and the implications for later life. Materials and Methods: The geometric properties and volumetric BMD (vBMD) of the…

Assessment of the cortical bone thickness using ultrasonic guided waves: Modelling and in vitro study

Determination of cortical bone thickness is warranted, e.g., for assessing the level of endosteal resorption in osteoporosis or other bone pathologies. We have shown previously that the velocity of the fundamental antisymmetric (or flexural) guided wave, measured for bone phantoms and bones in vitro, correlates with the cortical thickness significantly better than those by other axial ultrasound methods. In addition, we have introduced an inversion scheme based on guided wave theory, group velocity filtering and 2-D fast Fourier transform, for determination of cortical thickness from the measured velocity of guided waves. In this study, the method was validated for tubular structures by usi…

Modeling the impact of soft tissue on axial transmission measurements of ultrasonic guided waves in human radius

Recent in vitro and simulation studies have shown that guided waves measured at low ultrasound frequencies (f=200 kHz) can characterize both material properties and geometry of the cortical bone wall. In particular, a method for an accurate cortical thickness estimation from ultrasound velocity data has been presented. The clinical application remains, however, a challenge as the impact of a layer of soft tissue on top of the bone is not yet well established, and this layer is expected to affect the dispersion and relative intensities of guided modes. The present study is focused on the theoretical modeling of the impact of an overlying soft tissue. A semianalytical method and finite-differ…

Guided ultrasonic waves in long bones: modelling, experiment and in vivo application.

Existing ultrasound devices for assessing the human tibia are based on detecting the first arriving signal, corresponding to a wave propagating at, or close to, the bulk longitudinal velocity in bone. However, human long bones are effectively irregular hollow tubes and should theoretically support the propagation of more complex guided modes similar to Lamb waves in plates. Guided waves are attractive because they propagate throughout the bone thickness and can potentially yield more information on bone material properties and architecture. In this study, Lamb wave theory and numerical simulations of wave propagation were used to gain insights into the expected behaviour of guided waves in …

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. Th…

Corrigendum to “Low volumetric BMD is linked to upper-limb fracture in pubertal girls and persists into adulthood: A seven-year cohort study” [Bone 45 (2009) 480-486]

a Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland b Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland c Department of Preventive Medicine, University of Tennessee Health Science Center, USA d Endocrine Centre, Heidelberg Repatriation Hospital, Austin Health/Department of Medicine, University of Melbourne, Australia e Department of Medical Rehabilitation, Oulu University Hospital and Institute of Health Sciences, University of Oulu, Oulu, Finland

Monitoring bone growth using quantitative ultrasound in comparison with DXA and pQCT.

Quantitative ultrasound (QUS) is a safe, inexpensive, and nonradiation method for bone density assessment. QUS correlates with, and predicts fragility fractures comparable to, dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) in postmenopausal women. However, its validity in monitoring bone growth in children is not well understood. Two hundred and fifty-eight 10-13 yr pubertal girls and 9 37-43 yr adults without diseases or history of medications known to affect bone metabolism were included in the 2-yr prospective study. Calcaneal broadband ultrasound attenuation (cBUA) was assessed using QUS-2 (Quidel, Santa Clara, CA), speed of sound of tibial shaft (tSOS) using …

Is bone loss the reversal of bone accrual? Evidence from a cross-sectional study in daughter-mother-grandmother trios.

Bone adapts to mechanical loads applied on it. During aging, loads decrease to a greater extent at those skeletal sites where loads increase most in earlier life. Thus, the loss of bone may occur preferentially at sites where most bone has been deposited previously; ie, bone loss could be the directional reversal of accrual. To test this hypothesis, we compared the bone mass distribution at weight-bearing (tibia) and non-weight-bearing (radius) bones among 18-year-old girls, their premenopausal mothers, and their postmenopausal maternal grandmothers. Bone and muscle properties were measured by pQCT, and polar distribution of bone mass was obtained in 55 girl-mother–maternal grandmother trio…

Differential effects of sex hormones on peri- and endocortical bone surfaces in pubertal girls.

Context: The role of sex steroids in bone growth in pubertal girls is not yet clear. Bone biomarkers are indicators of bone metabolic activity, but their value in predicting bone quality has not been studied in growing girls. Objective: This study examines the association of sex hormones and bone markers with bone geometry and density in pubertal girls. Design: The study was designed as a 2-yr longitudinal study in pubertal girls. Measurements were performed at baseline and at 1and 2-yr follow-ups. Setting: The study was conducted in a university laboratory. Participants: A total of 258 10- to 13-yr-old healthy girls at the baseline participated. Methods:Peripheralquantitativecomputedtomogr…

Influence of physical activity and maturation status on bone mass and geometry in early pubertal girls1

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 an…

Concerted actions of insulin-like growth factor 1, testosterone, and estradiol on peripubertal bone growth: a 7-year longitudinal study.

A better understanding of how bone growth is regulated during peripuberty is important for optimizing the attainment of peak bone mass and for the prevention of osteoporosis in later life. In this report we used hierarchical models to evaluate the associations of insulin-like growth factor 1 (IGF-1), estradiol (E(2) ), and testosterone (T) with peripubertal bone growth in a 7-year longitudinal study. Two-hundred and fifty-eight healthy girls were assessed at baseline (mean age 11.2 years) and at 1, 2, 3.5, and 7 years. Serum concentrations of IGF-1, E(2) , and T were determined. Musculoskeletal properties in the left lower leg were measured using peripheral quantitative computed tomography …

Comparison of three ultrasonic axial transmission methods for bone assessment.

Abstract This study compared three approaches to bone assessment using ultrasonic axial transmission. In 41 fresh human radii, velocity of the first arriving signal was measured with a commercial device (Sunlight Omnisense ™ ) operating at 1.25 MHz, a prototype based on 1-MHz bidirectional axial transmission and a low-frequency (200 kHz) prototype, also measuring the velocity of a slower wave. Cortical and trabecular bone mineral density, cortical thickness and cross-sectional area were determined by peripheral quantitative computed tomography. Significant but modest correlation between velocities reflects differences in the nature of the propagating waves and methodological differences. Of…

Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: a 2-y randomized trial

Little is known about the relative effectiveness of calcium supplementation from food or pills with or without vitamin D supplementation for bone mass accrual during the rapid growth period.The purpose was to examine the effects of both food-based and pill supplements of calcium and vitamin D on bone mass and body composition in girls aged 10-12 y.This placebo-controlled intervention trial randomly assigned 195 healthy girls at Tanner stage I-II, aged 10-12 y, with dietary calcium intakes900 mg/d to 1 of 4 groups: calcium (1000 mg) + vitamin D3 (200 IU), calcium (1000 mg), cheese (1000 mg calcium), and placebo. Primary outcomes were bone indexes of the hip, spine, and whole body by dual-ene…

Low volumetric BMD is linked to upper-limb fracture in pubertal girls and persists into adulthood: A seven-year cohort study

Abstract The aetiology of increased incidence of fracture during puberty is unclear. This study aimed to determine whether low volumetric bone mineral density (vBMD) in the distal radius is associated with upper-limb fractures in growing girls, and whether any such vBMD deficit persists into adulthood. Fracture history from birth to 20 years was obtained and verified by medical records in 1034 Finnish girls aged 10–13 years. Bone density and geometry at distal radius, biomarkers and lifestyle/behavioural factors were assessed in a subset of 396 girls with a 7.5-year follow-up. We found that fracture incidence peaked during puberty (relative risk 3.1 at age of 8–14 years compared to outside …

Correlation of Tibial Low-Frequency Ultrasound Velocity with Femoral Radiographic Measurements and BMD in Elderly Women

The ultrasonic axial transmission technique has been proposed as a method for cortical bone characterization. Using a low enough center frequency, Lamb modes can be excited in long bones. Lamb waves propagate throughout the cortical bone layer, which makes them appealing for characterizing bone material and geometrical properties. In the present study, a prototype low-frequency quantitative ultrasonic axial transmission device was used on elderly women (n = 132) to investigate the relationships between upper femur geometry and bone mineral density (BMD) and tibial speed of sound. Ultrasonic velocities (V) were recorded using a two-directional measurement set-up on the midtibia and compared …

Relationship of sex hormones to bone geometric properties and mineral density in early pubertal girls.

This study aimed to evaluate the associations among serum 17beta-estradiol (E2), testosterone (T), sex hormone-binding globulin (SHBG), bone geometric properties, and mineral density in 248 healthy girls between the ages of 10 and 13 yr old. The left tibial shaft was measured by peripheral quantitative computed tomography (Stratec XCT-2000; Stratec Medizintechnik, GmbH, Pforzheim, Germany). The cortical bone and marrow cavity areas were expressed as proportions of the total tibial cross-sectional area (CSA). Cortical thickness and total volumetric bone mineral density (vBMD) were also determined. These tibial geometric and densitometric measures were correlated against the serum sex hormone…

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. Experi…

Long Term Leisure Time Physical Activity Has a Positive Effect on Bone Mass Gain in Girls

The purpose of this 7-year prospective longitudinal study was to examine whether the level and consistency of leisure-time physical activity (LTPA) during adolescence affected the bone mineral content (BMC) and bone mineral density (BMD) attained at early adulthood. The study subjects were 202 Finnish girls who were 10 to 13 years of age at baseline. Bone area (BA), BMC, and BMD of the total body (TB), total femur (TF), and lumbar spine (L2–L4) were assessed by dual-energy X-ray absorptiometry (DXA). Scores of LTPA were obtained by questionnaire. Girls were divided into four groups: consistently low physical activity (GLL), consistently high (GHH), and changed from low to high (GLH) and fro…

Growth and aging of proximal femoral bone - a study with women spanning three generations

Abstract. Osteoporotic hip fracture is a serious clinical event associated with high morbidity and mortality. Understanding femoral growth patterns is important for promoting bone health in the young and preventing fractures in later life. In this study, growth patterns of areal bone mineral density (aBMD) and geometric properties of the proximal femur were measured by dual-energy X-ray absorptiometry (GE Lunar Prodigy, USA). They were studied in 251 girls from premenarche (11.2±0.7 yrs) to late adolescence (18.3±1.1 yrs), and compared to their premenopausal mothers (n=128, aged 44.9±4.1 yrs) and postmenopausal grandmothers (n=128, aged 70.0±6.3 yrs). Hip axis length (HAL) was the first to …

The associations of serum serotonin with bone traits are age- and gender-specific

Context Serotonin plays a potential role in bone metabolism, but the nature and extent of this relationship is unclear and human studies directly addressing the skeletal effect of circulating serotonin are rare. Objective The study aimed to investigate the associations between serum serotonin and bone traits at multiple skeletal sites in women and men. Subjects and Methods Subjects were part of the CALEX-family study and comprised 235 young women, 121 premenopausal women, 124 postmenopausal women, and 168 men. Body composition was assessed using DXA, as was areal bone mineral density (aBMD) of spine, femur and whole body. In addition, pQCT was used to determine bone properties at tibial mid…

Bone and Muscle Development During Puberty in Girls: A Seven-Year Longitudinal Study

The growth of lean mass precedes that of bone mass, suggesting that muscle plays an important role in the growth of bone. However, to date, no study has directly followed the growth of bone and muscle size through puberty and into adulthood. This study aimed to test the hypothesis that the growth of muscle size precedes that of bone size (width and length) and mass during puberty. Bone and muscle properties were measured using pQCT and DXA in 258 healthy girls at baseline (mean age, 11.2 yr) and 1-, 2-, 3-4- and 7-yr follow-up. Growth trends as a function of time relative to menarche were determined from prepuberty to early adulthood for tibial length (TL), total cross-sectional area (tCSA)…

Weight-bearing, muscle loading and bone mineral accrual in pubertal girls--a 2-year longitudinal study.

Abstract Objectives: The mechanical environment is considered to be the most important determinant of bone strength. Local muscle force, in turn, is regarded as the largest source of loading applied to bones. However, the effect of weight-bearing on bone mineral accrual is unclear. Comparing the relationship between muscle force and bone mineral content (BMC) in the upper and lower limbs provides a means of investigating this issue. Subjects and methods : The study group comprised 258 healthy girls aged 10–13 years old at baseline. BMC, lean body mass (LM) and fat body mass (FM) of total body were assessed by dual-energy X-ray absorptiometry at baseline and 2 years after. The maximal isomet…

Thickness sensitivity of ultrasound velocity in long bone phantoms

One approach to bone disease diagnosis such as osteoporosis is to measure the velocity of ultrasound propagating axially along long bones. In this study, the variation in velocity as a function of radial position was assessed using two polyvinyl chloride (PVC) bone phantoms with cross-sectional geometry similar to the human tibia but differing in medullary cavity diameter. Two ultrasonometers were used: these were a commercial device operating at a relatively high frequency (HF) of 1.25 MHz and a prototype low frequency (LF) device operating at approximately 200 kHz. The LF measurements showed a larger variation with radial position, with changes in velocity of up to 20% occurring around th…

Authors’ Response: Relationship of Sex Hormones to Bone Geometric Properties and Mineral Density in Early Pubertal Girls: Use of Correlation Analyses

Fat mass accumulation compromises bone adaptation to load in finnish women: A cross-sectional study spanning three generations

Body weight and lean mass correlate with bone mass, but the relationship between fat mass and bone remains elusive. The study population consisted of 396 girls and 138 premenopausal mothers and 114 postmenopausal grandmothers of these girls. Body composition and tibial length were assessed using dual-energy X-ray absorptiometry (DXA), and bone traits were determined at the tibia using peripheral quantitative computed tomography (pQCT) in the girls at the ages of 11.2 ± 0.8, 13.2 ± 0.9, and 18.3 ± 1.0 years and in the mothers (44.7 ± 4.1 years) and grandmothers (70.7 ± 6.3 years). The values of relative bone strength index (RBSI), an index reflecting the ratio of bone strength to the load ap…

Differences in estimates of change of bone accrual and body composition in children because of scan mode selection with the prodigy densitometer.

Abstract Girls of age 10–13 yr with Tanner stage I–III maturation status ( n = 155) were measured using the Prodigy (GE Lunar) densitometer. Bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were assessed for the whole body, lumbar spine, and proximal femur using the Thin (T) and Standard (S) scan modes at years 1 and 3 of the study. The differences obtained between the T and S mode at year 1 were 1–2% for the lumbar spine and proximal femur and 5–11% for the whole body. For those girls whose default mode changed from T at year 1 to S mode at year 3, the estimated gain in BA, BMC, and BMD was 3.4%, 7.6%, and 3.1% respectively, lower than that obtained when scanning …