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Evaluation of Osteoporosis Using Skin Thickness Measurements

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Abstract

Measurement of skin thickness has been proposed as a method of predicting low bone mineral density (BMD) and the consequent risk of osteoporotic fracture in postmenopausal women. The Episcan I-100 device is a new type of ultrasound device that uses high-frequency (20 MHz) ultrasound to measure skin thickness using a small probe placed on the skin. The aims of this study were to investigate whether there is any correlation between skin thickness as measured by ultrasound and BMD as measured by dual-energy X-ray absorptiometry, to establish whether patients with osteoporotic fractures have reduced skin thickness, and to investigate the relationship between skin thickness and clinical risk factors for osteoporosis. Short-term precision based on duplicate measurements on 132 patients gave a coefficient of variation of 3.2%. Small but statistically significant correlations between skin thickness measurements and BMD measurements at axial and peripheral sites were observed (r = 0.21–0.29, P < 0.0001). An odds ratio of 1.42 was found for identifying patients with a prevalent fracture at any skeletal site, suggesting that skin thickness measurements can discriminate patients with fractures. ROC analyses also demonstrated the ability of skin thickness measurements to discriminate fracture patients from controls. When measured by the decrease in Z-score, clinical risk factors for low BMD were found to affect skin thickness measurements to a similar extent as spine and hip BMD measurements. Skin thickness measurements have limited utility in identifying patients with low bone mass.

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References

  1. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  2. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    PubMed  CAS  Google Scholar 

  3. Stone KL, Seeley DG, Lui L-Y, et al. (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954

    Article  PubMed  Google Scholar 

  4. Eastell R (1998) Treatment of postmenopausal osteoporosis N Engl J Med 338:736–746

    Article  PubMed  CAS  Google Scholar 

  5. National Osteoporosis Society (2002) Position statement on the reporting of dual X-ray absorptiometry (DXA) bone mineral density scans. National Osteoporosis Society, Bath, UK

    Google Scholar 

  6. World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843. World Health Organisation, Geneva

    Google Scholar 

  7. Orme SM, Belchez PE (1994) Is a low skinfold thickness an indicator of osteoporosis? Clin Endocrinol 41:283–287

    CAS  Google Scholar 

  8. Varila E, Sievanen H, Vuori I, et al. (1995) Limited value of ultrasound measured skin thickness in predicting bone mineral density in peri- and postmenopausal women. Maturitas 21:45–49

    Article  PubMed  CAS  Google Scholar 

  9. Pierard GE, Pierard-Franchimont C, Vanderplaetsen S, et al. (2001) Relationship between bone mass density and tensile strength of the skin in women. Eur J Clin Invest 31:731–735

    Article  PubMed  CAS  Google Scholar 

  10. Albright F, Bloomberg E, Smith PH (1940) Postmenopausal osteoporosis. Trans Assoc Am Phys 55:298–305

    CAS  Google Scholar 

  11. McConkey B, Fraser GR, Bligh AS, Whitely M (1963) Transparent skin and osteoporosis. Lancet 1:693–695

    Article  Google Scholar 

  12. Fornage BD, Deshayes JL (1986) Ultrasound of normal skin. J Ultrasound 14:619–622

    Article  CAS  Google Scholar 

  13. Hoffman K, Dirting K, Stucker M, et al. (1994) History of high frequency sonography. Ultraschall Med 4:192–197

    Article  Google Scholar 

  14. Njeh CF, Hans D, Fuerst T, Glüer C-C, Genant HK (1999) Quantitative ultrasound: assessment of osteoporosis and bone status. Martin Dunitz, London

    Google Scholar 

  15. Looker AC, Wahner HW, Dunn WL, et al. (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  16. Royal College of Physicians (1999) Strategic considerations. In: Osteoporosis: clinical guidelines for prevention and treatment. Royal College of Physicians, London

  17. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D, on behalf of the European Foundation for Osteoporosis and Bone Disease (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7:390–406

    Article  PubMed  CAS  Google Scholar 

  18. National Osteoporosis Foundation (1998) Risk assessment. In: Physician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington DC

  19. Brincat M, Kabalan S, Studd JW, et al. (1987) A study of the decrease of skin collagen content, skin thickness and bone mass in the postmenopausal woman. Obstet Gynecol 70:840–845

    PubMed  CAS  Google Scholar 

  20. Chappard D, Alexandre C, Robert JM, Rifaat G (1991) Relationships between bone and skin atrophies during ageing. Acta Anat 141:239–244

    Article  PubMed  CAS  Google Scholar 

  21. Smeets AJ, Kuiper JW, Kuijk C, Berning B, Zwamborn AW (1994) Skin thickness does not reflect bone mineral density in postmenopausal women. Osteoporos Int 4:32–35

    Article  PubMed  CAS  Google Scholar 

  22. Ahmed AIH, Ilic D, Blake GM, Rymer JM, Fogelman I (1998) Review of 3530 referrals for bone density measurements of spine and femur: evidence that radiographic osteopenia predicts low bone mass. Radiology 207:619–624

    PubMed  CAS  Google Scholar 

  23. Bainbridge PR, Eastell R (1998) Indications for bone densitometry: do they identify patients with low bone mineral density? Current research in osteoporosis and bone mineral measurement. Br J Radiol 5:5–6

    Google Scholar 

  24. Capewell S, Reynolds S, Shuttleworth D, Edwards C, Finlay AY (1990) Purpura and dermal thinning associated with high dose inhaled corticosteroids. BMJ 300:1548–1551

    PubMed  CAS  Google Scholar 

  25. Haapasaari K, Rossi O, Risteli J, Oikarinen A (1998) Effect of long-term inhaled corticosteroids on skin collagen synthesis and thickness in asthmatic patients. Eur Respir J 11:139–143

    Article  PubMed  CAS  Google Scholar 

  26. Baran YM, Brincat P, Galea R (1999) Increased reduction in bone density and skin thickness in postmenopausal women taking long-term corticosteroid therapy: a suggested role for estrogen add-back therapy. Climacteric 2:189–196

    Google Scholar 

  27. Brincat M, Moniz CJ, Studd JWW, et al. (1985) Long-term effects of menopause and sex hormones on skin thickness. Br J Obstet Gynaecol 92:256–259

    PubMed  CAS  Google Scholar 

  28. Shah MG, Maibach HI (2001) Estrogen and skin: an overview. Am J Clin Dermatol 2:143–150

    Article  PubMed  CAS  Google Scholar 

  29. Brincat MP (2000) Hormone replacement therapy and the skin: beneficial effects: the case in favor of it. Acta Obstet Gynecol Scand 79:244–249

    Article  PubMed  CAS  Google Scholar 

  30. Sator PG, Schmidt JB, Sator MO, Huber JC, Honigsmann H (2001) The influence of hormone replacement therapy on ageing skin: a pilot study. Maturitas 39:43–55

    Article  PubMed  CAS  Google Scholar 

  31. Chen L, Dyson M, Rymer J, Bolton P, Young SR (2002) Evaluation of the effect of HRT on skin thickness using high frequency diagnostic ultrasound. Menopause Digest 14:24

    CAS  Google Scholar 

  32. Chen L, Dyson M, Rymer J, Bolton P, Young SR (2001) The use of high frequency diagnostic ultrasound to investigate the effect of HRT on skin thickness. Skin Res Technol 7:95–97

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology, and Anaesthethetics, Imperial College Faculty of Medicine, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK

    Rajesh Patel

  2. King’s College London Medical School, Guy’s Campus, London, UK

    Glen M. Blake & Ignac Fogelman

Authors
  1. Rajesh Patel
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  2. Glen M. Blake
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  3. Ignac Fogelman
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Correspondence to Rajesh Patel.

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Patel, R., Blake, G.M. & Fogelman, I. Evaluation of Osteoporosis Using Skin Thickness Measurements. Calcif Tissue Int 81, 442–449 (2007). https://doi.org/10.1007/s00223-007-9081-6

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  • DOI: https://doi.org/10.1007/s00223-007-9081-6

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