Abstract
Using an improved version of ultrasound critical angle reflectometry, the bone quality of cortical and trabecular bone was assessed in vivo by measuring elastic moduli (normalized for bone density) at both principal axes, referred to as the minimum and maximum normalized elasticities. The measurements were made in 30 normal premenopausal women, 30 normal postmenopausal women, 22 untreated postmenopausal women with osteoporosis, 74 postmenopausal women with osteoporosis or osteopenia on bisphosphonate treatment, and 32 patients with renal transplantation (16 women and 16 men) taking steroids. Cortical elasticity was higher than trabecular elasticity; both declined slightly and non-significantly with age in normal women. Among untreated postmenopausal women with osteoporosis, cortical maximum normalized elasticity (Ecmax) remained within 95% prediction intervals of normal women. Among patients on bisphosphonate, Ecmax was low in the majority of patients. Ecmax was significantly more depressed among those taking the drug ≥3 years than <3 years (22.1% below normal premenopausal women versus 17.2%, P =0.001), and among those with incident non-spinal fractures than without (75.9 vs. 81.5%, P =0.008). Ecmax was independent of bone mineral density at the calcaneus. Most patients with renal transplantation had low Ecmax, with a mean 20.8% below the normal premenopausal mean. Qualitatively similar findings were found with cortical minimum elasticity and with trabecular minimum and maximum elasticities. Thus, the material bone quality of cortical and trabecular bone may be impaired following bisphosphonate treatment, as in renal transplantation on steroids.
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Acknowledgements
This study was supported by a GCRC grant from NIH M01-RR00633, and by the discretionary funds of the Center for Mineral Metabolism and Clinical Research and the Bone Quality Research Institute. The new UCR device is being developed by a non-profit entity, the Bone Quality Research Institute, in cooperation with the sponsor, the University of Texas Southwestern Medical Center. None of the authors own equity in the Bone Quality Research Institute.
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Richer, E., Lewis, M.A., Odvina, C.V. et al. Reduction in normalized bone elasticity following long-term bisphosphonate treatment as measured by ultrasound critical angle reflectometry. Osteoporos Int 16, 1384–1392 (2005). https://doi.org/10.1007/s00198-005-1848-x
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DOI: https://doi.org/10.1007/s00198-005-1848-x