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The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study

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Abstract

Quantitative ultrasound (QUS) techniques have been shown to be as good as bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA), in predicting fracture risk: QUS technique could increase substantially the accessibility to a reliable bone osteoporosis risk evaluation, but little is know regarding the relationship of QUS to risk factors that have been found to predict DXA-BMD values and this is even more true in men. We studied 6,811 postmenopausal women 40 to 80 years of age and 4,981 men 60–80 years of age representative of the general population of all regions of Italy. All participants were questioned on lifestyle habits and on their medical history. After a physical examination "bone stiffness" (called here for simplicity, stiffness), which is derived from the values of broadband ultrasound attenuation (BUA) and speed of sounds (SoS) was measured by a heel QUS device (Achilles apparatus, Lunar, Madison, USA) . The most common recognized determinants of bone mass (either categorical or continuous variables) were modeled with stiffness by multiple regression analysis or ANOVA. Stiffness was strongly related to age and weight. After adjusting for these variables, the women who had taken hormone replacement therapy for more than a year had significantly higher stiffness values. The difference versus nonusers remained significant for up to 20 years-since-menopause (YSM). This effect was so strong that for further analysis these women were excluded. By multivariate analysis, stiffness was then found to be significantly related to recalled body weight at 25 years of age, actual and past cigarettes smoked per day, and dairy calcium intake. Stiffness was also associated with a number of categorial factors adjusted for age, weight, and YSM: prior ovariectomy, history of more than 2 months confined to bed, outdoor physical activity, smoking, chronic use of any drug, and past corticosteroid use. All these categorial and continuous variables predicted stiffness equally in men and women. In conclusion, QUS bone measurements discriminate postmenopausal women according to past use of hormone replacement therapy. Risk factors usually associated to BMD as measured by DXA are also associated to calcaneal bone stiffness as measured by QUS, and most risk factors for osteoporosis usually observed in women are equally applicable to men.

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Acknowledgements

This work was totally funded by an unlimited grant from Procter & Gamble, Rome, Italy.

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Authors and Affiliations

  1. Riabilitazione Reumatologica, University of Verona, Ospedale Valeggio, 37067 , Verona, Italy

    Silvano Adami

  2. Department of Internal Medicine, University of Padua, Padua, Italy

    Sandro Giannini, Stefania Maggi & Gaetano Crepaldi

  3. Procter & Gamble, Rome, Italy

    Ruben Giorgino

  4. Institute of Internal Medicine, University of Turin, Italy

    GianCarlo Isaia

  5. Instituto Gaetano Pini Institute, University of Milan, Milan, Italy

    Luigi Sinigaglia

  6. Divisione Medicina Interna, Umbertide, Perugia, Italy

    Paolo Filipponi

  7. Department of Internal Medicine, University of Pisa, Pisa, Italy

    Ombretta Di Munno

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  1. Silvano Adami
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  2. Sandro Giannini
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Correspondence to Silvano Adami.

Appendix: Local coordinators of the ESOPO study

Appendix: Local coordinators of the ESOPO study

Antonino Accardi, Marsala; Alberto Angeli, Orbassano; Salvatore Baglio, Rome; Alfonso Baldoncini, Arezzo; Pierluigi Ballardini, Lagosanto (FE); Cataldo Bancheri, Rome; Franco Beghe, Imperia; Luigi Bernini, S. Miniato (PI); Maurizio Bevilacqua, Milan; Gerolamo Bianchi, Arenzano (GE); Giuseppe Bonomi, Palmanova (Udine); Massimo Bottai, Sarzana (SP); Giovanni Brogi, Pescia (PT); Giuseppe Candioto, Agrigento; Sergio Candiotto, Dolo (VE); Riccardo Cecchetti, Pontedera (PI); Raffaele Serqua, S.Felice a Cancello (CE); Sandro Cervelli, Rome; Stefano Coaccioli, Terni; Franco Coin, Dolo (VE); Cataldo Colella, Aversa (CE); Daniele Costi, Parma; Massimo Cravero, Torino; Salvatore D'Auria, Benevento; Giovanni D'Avola, Catania; Nicola De Gennaro, Capua (CE); Lucio Del Forno, Vasto (CH); Arturo D'Elia, Napoli; Ombretta Di Munno, Pisa; Roberto Di Virgilio, Treviso; Filippo Favazzi, Mistretta (ME); Mario Ferraris, Vercelli; Paolo Filippini, Umbertide (PG); Cristiano Maria Francucci, Ancona; Bruno Frediani, Siena; Giorgio Gandolini, Milan; Romildo Gasparini, Legnago (VR); Romeo Gatti, Viterbo; Salvatore Gatto, Napoli; Ernesto Gemini, Napoli; Tommaso Gismondi, Bari; Stefano Gonnelli, Siena; Siro Grassi, Napoli; Giovanni Iolascon, Napoli; Gian Carlo Isaia,Torino; Tommaso Izzo, Nocera Inferiore (SA); Giovanni La Montagna Renato La forgia, Matera; Giovanni Lapadula, Bari; Gaetano Loiacono Martina, Franca (TA); Pierluigi Lombardi, Castelnuovo G. (LU); Roberto Lovato, Vicenza; Riccardo Maglitto, Lentini (SR);Fabio Magnani, Vignola (MO);Nazzarena Malavolta, Bologna; Giorgio Mancini, Macerata; Giuseppe Masellis, Carpi (MO); Domenico Maugeri, Catania; Carmelo Micale, Cuggiono (MI); Redento Mora, Pavia; Maurizio Muratore, S. Cesario di Lecce (LE); Rita Occhipinti, Belluno; Geremia Oliva, Frattamaggiore (NA); Ernesto Palummeri, Genova; Domenica Panzavecchia, Partinico (PA); Salvatore Parello, Canelli (AT); Raffaele Pellerito, Torino; Giovanni Pisanu, Oristano (CA); Domenico Policicchio, Avellino; Marco Pozone, L'Aquila; Giulio Pucci, Spoleto (PG); Stefano Respizzi, Rozzano (MI); Giuseppe Roberti, Chivasso (TO); Maurizio Rossini, Verona; Sergio Rossitto, Piazza Armerina (EN); Luciano Sabadini, Arezzo; Carlo Salvarani, Reggio Emilia; Salvatore Salvini, Anzio (RM); Giuseppe SanteufemiaIglesias (CA); Ivana Santi, Milan; Leonardo Sartori, Padova; Mario Sfrappini, S. Benedetto del Tronto (AP); Ferdinando Silveri, Jesi (AN); Luigi Sinigaglia, Milano; Michele Soriano Vibo, Valentia; Ruggero Spinazzè, Conegliano (TV); Giuseppe Stancati, Cosenza; Giancarlo Tartarelli, Massa; David Topini, Viterbo; Francesco Trotta, Ferrara; Giuseppe Varcasia, Castrovillari (CS); Alfredo Zanatta, Legnago (VR).

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Adami, S., Giannini, S., Giorgino, R. et al. The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study. Osteoporos Int 14, 198–207 (2003). https://doi.org/10.1007/s00198-002-1352-5

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