Search Results (37)

Background/Objectives: Bone mineral density (BMD) assessments are uncommon in people with chronic stroke, and the relationship between BMD and gait speed remains poorly understood. This study examined between-limb differences in BMD of individuals with chronic stroke and limited versus non-limited community ambulation and analyzed the relationship between BMD and gait speed. Methods: This cross-sectional study included people with chronic stroke divided into two groups by walking speed (slow group [SG], <0.8 m/s, n = 38, and fast group [FG], ≥0.8 m/s, n = 46) and age- and sex-matched healthy individuals (control group [CG], n = 35). All participants underwent calcaneal ultrasound densitometry. Results: All the BMD parameters differed significantly between limbs in the SG, with the affected side demonstrating inferior outcomes. The FG only exhibited a significant difference in the broadband ultrasonic attenuation, with lower values on the affected side. Among groups, the SG demonstrated lower values in the affected leg for all parameters compared with the corresponding limb of both the FG and the CG. Furthermore, the SG demonstrated reduced speed of sound (SOS) in the non-affected limb compared with the FG’s in theirs. Multiple regression analysis revealed that the ambulation ability, the affected gastrocnemius spasticity, disability, and SOS of the affected limb together explained 71.9% of the gait speed variance. Conclusions: Among stroke survivors, a slower gait speed is associated with greater between-limb differences in BMD. SOS in the affected limb emerged as a key predictor of gait speed. This highlights the need for more thorough BMD evaluations for stroke patients. Full article

Background/Objectives: Individuals living with human immunodeficiency virus (HIV) receiving tenofovir-based antiretroviral therapy (ART) are at increased risk of bone loss. Dual-energy X-ray absorptiometry (DXA), the gold standard for determining bone mineral density (BMD), has limited accessibility. Calcaneal quantitative ultrasound (QUS) is an alternative screening tool for bone health, but its performance needs validation. The study aims to compare the performance of QUS between men with HIV on tenofovir-based ART and uninfected men. Methods: A cross-sectional study involving 52 men with HIV on tenofovir-based ART and 42 uninfected men was performed. Their bone health status was determined using DXA (lumbar spine and femoral neck) and QUS (calcaneus). The performance of QUS in identifying individuals with low BMD (DXA T-score < −1) was evaluated using receiver-operating characteristic curve analysis. Results: The HIV-ART group showed significantly lower QUS indices compared to the non-HIV-ART group (p < 0.05). The performance of QUS in identifying individuals with low BMD was poor in the HIV-ART group (p > 0.05), but moderate in the non-HIV-ART group (p < 0.05). After optimising the cutoffs, the performance of QUS was improved in the non-HIV-ART group but not in the HIV-ART group. Conclusions: QUS was not effective in identifying individuals with low BMD in men with HIV on ART. Its utility as a standalone screening tool in this population may be limited. Additional or more sensitive methods should be prioritised for bone health screening. Full article

Background/Objectives: Skeletal impairment has been reported as a common finding in Hyperphenylalaninemia (HPA)/Phenylketonuria (PKU) patients regardless of age and method of diagnosis, both in children and adults. Quantitative Ultrasound (QUS) is a radiation-free and low-cost method for assessing bone quality, used in various chronic conditions. Methods: Bone quality was evaluated using a calcaneal QUS device. Auxological parameters, nutritional intakes, and plasma levels of key bone biomarkers were also registered. The population was divided into four groups: PKU patients under diet therapy and HPA patients on a free diet, both divided into receiving or not receiving single vitamin D supplementation. Results: All HPA/PKU patients had median bone quality index (BQI) Z- and T-score values lower than −1, with slightly better values in HPA children and PKU-supplemented adults. Dietary vitamin D intake in PKU patients was significantly higher than in HPA subjects (p < 0.001), due to protein substitute supplementation. However, plasma 25(OH) vitamin D levels, although increased compared to baseline, were still overlapping among groups (p = 0.845) after supplementation. Approximately a quarter of both pediatric and adult non-supplemented PKU patients had Z-score and T-score levels below −2, and this percentage decreased with vitamin D supplementation in all groups. In PKU-supplemented patients, the Broadband Ultrasound Attenuation (BUA) was significantly higher than in the other groups (p = 0.040). Conclusions: The improvement in BUA may represent preliminary evidence of the effect of vitamin D on bone architecture, which could encourage this supplementation to prevent the worsening of bone structure and reduce the risk of fractures. Full article

Background: Hallux limitus (HL) is a restriction of first metatarsophalangeal joint dorsiflexion, commonly linked to foot biomechanics-related disorders or trauma, increasing sports injury risk. It involves plantar fascia tension, compensations, and tendon adaptations. Rehabilitative ultrasound imaging (RUSI) accurately assesses musculoskeletal changes, supporting physiotherapy evaluation and the study of HL-related structural adaptations. Objectives: Comparing the thickness and cross-sectional area (CSA) of flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), abductor hallucis (AbH), and quadratus plantae (QP) muscles, as well as the thickness of the plantar fascia (PF), Achilles tendon (AT), and plantar calcaneal fat pad (CFP), between participants with and without HL. Methods: Case–control study included 80 basketball players recruited from semi-professional teams by consecutive non-probabilistic sampling. Participants were divided into two groups: an HL group (n = 40) and a healthy group (n = 40). Musculotendinous parameters were assessed using RUSI. Results: The FDB, FHB, AB, and QP showed significant reductions in thickness and CSA at rest and at contraction in the HL group. PF thickness increased in participants with HL, while CFP thickness decreased significantly. Significance was established at (p < 0.05). Conclusions: HL participants exhibited reduced muscle size and CSA, increased PF, and lower CFP thicknesses, indicating adaptive tissue alterations. Full article

Background: Most of the studies that have investigated bone quality in inflammatory bowel disease (IBD) have utilized dual-energy X-ray absorptiometry (DXA). We assessed the bone status of IBD adult patients using a comprehensive array of non-invasive techniques. Methods: Fifty IBD patients (30 women) and 50 healthy volunteers—matched for age, gender, and body mass index—were prospectively recruited. Areal bone mineral density (aBMD) at the anteroposterior and lateral spine and the proximal femur was measured by DXA, including vertebral fracture assessment (VFA). Trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), volumetric bone mineral density (vBMD), and cortical thickness were assessed in the proximal femur with 3D-DXA. A comprehensive laboratory panel of calcium metabolism and bone turnover markers was included. Results: Twenty-nine and 21 patients were diagnosed with ulcerative colitis (UC) and Crohn’s disease (CD), respectively. VFA identified vertebral fractures in two IBD patients and no controls. No statistically significant differences were observed in TBS, aBMD, and vBMD between IBD and healthy controls. After excluding one predefined outlier, broadband ultrasound attenuation (BUA) showed lower values in IBD vs. controls [103.6 ± 14.3 vs. 111.3 ± 19.5 (p = 0.033)]. QUS analysis revealed statistically lower values in the CD group compared to controls. We found a positive correlation between all the QUS parameters with aBMD and vBMD. Conclusions: In our study of IBD subjects, most of whom had mild or quiescent disease, we did not observe significant bone quality deterioration. QUS was the only technique that showed lower values in IBD patients, especially in CD. Full article

Background: Monitoring bone mineral density (BMD) in adults is critical for early detection of osteoporosis and prevention of fracture, for which quantitative ultrasound (QUS) is a good non-invasive tool. We examined the associations of QUS measures, including stiffness index (SI) and T-score, with socio-demographic, lifestyle, and anthropometric correlates and risk of subsequent fracture. Methods: Calcaneal QUS was performed using GE’s Lunar Achilles EXPII among 24,651 adults (mean age 59.5 years, 61.7% women) from the China Kadoorie Biobank study. Socio-demographic and lifestyle information was collected using an interviewer-administered electronic questionnaire, and anthropometrics were measured following standard protocols. Incidence of fracture and osteoporosis was recorded via linkage with nationwide health insurance database. Linear and Cox regression analyses were conducted, adjusting for potential confounders. Results: On average, men had higher SI (92.8 vs. 86.0) but lower T-score (−0.85 vs. −0.64) than women. In both men and women, advanced age and smoking were inversely associated with SI and T-score, while physical activity and tea drinking were positively so (p < 0.0001 for all). Except for height, all other anthropometric measures were significantly and positively associated with both BMD measures. With each SD lower SI, the risk of subsequent fracture was 26% (95% confidence interval: 10–44%) and 40% (25–57%) higher in men and women, and the corresponding associations of T-score were identical. Conclusions: Among Chinese adults, the SI and T-score provided by Achilles EXPII had similar patterns and predictive values for subsequent fracture, despite the T-score for men and women not being directly comparable because of gender-specific references used. Future studies are needed to confirm or refute the causality of relationship between lifestyle and anthropometric factors and BMD. Full article

Background/Objectives: The tibial nerve, commonly misnamed the “posterior tibial nerve”, branches into four key nerves: the medial plantar, lateral plantar, inferior calcaneal (Baxter’s nerve), and medial calcaneal branches. These nerves are integral to both the sensory and motor functions of the foot. Approximately 15% of adults with foot issues experience heel pain, frequently stemming from neural origins, such as tarsal tunnel syndrome (TTS). TTS diagnosis remains challenging due to a high false negative rate in neurophysiological studies. This study aims to improve the understanding and diagnosis of distal tarsal tunnel pathology to enable more effective treatments, including platelet-rich plasma, hydrodissections, radiofrequencies, and prolotherapy. Methods: Ultrasound-guided techniques were employed to examine the distal tarsal tunnel using the Heimkes triangle for optimal probe placement. Results: The results indicate that the tunnel consists of two chambers separated by the interfascicular septum, housing the medial, lateral plantar, and inferior calcaneal nerves. Successful interventions depend on precise visualization and patient positioning. This study emphasizes the importance of avoiding the calcaneus periosteum to reduce discomfort. Conclusions: Standardizing nerve involvement classification in TTS is difficult without robust neurophysiological studies. The accurate targeting of nerve branches is essential for effective treatment. Full article

Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen fiber arrangement. This study aims to validate the reliability of fixed ultrasound compared to manual acquisition in measuring Achilles tendon thickness. Method: Twenty participants, six men and fourteen women, were recruited. Ultrasound was used to measure the Achilles tendon’s thickness at two specific points (4 and 6 cm from the calcaneal insertion of the Achilles tendon). The measurements were conducted by two examiners, one with previous experience and another without. Results: The measurements at 6 cm from the calcaneal insertion showed α = 0.996, α = 0.998 for measurements at 4 cm using manual acquisition, and α = 0.997 for measurements with fixed ultrasound at rest. For the weight-bearing and ankle dorsiflexion measurements, the reliability was excellent (α = 0.999 and α = 1.000). Conclusions: The findings demonstrated excellent reliability in the ultrasound measurements of the Achilles tendon’s thickness, even when performed by different evaluators and under load-bearing conditions. This study suggests the clinical utility of assessing anatomical structures under load, enhancing ultrasound’s applicability beyond the examination table. It is concluded that fixed ultrasound acquisition exhibits excellent reliability in measuring the Achilles tendon’s thickness, offering potential benefits for precise diagnosis of pathologies, planning surgical interventions, and reducing possible errors related to operator variability. Full article

Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical variations of the tibial nerve were observed. Mean tibial nerve thickness was 6 ± 1 mm. The junction with the plantar nerves was located at a maximum of 85 mm and the junction with the medial cutaneous branch was at a maximum of 150 mm proximal to the proximal aspect of the calcaneal tubercle. The mean distance of the tibial nerve to the cranial border of the superficial digital flexor was 11 ± 6 mm. In conclusion, problems with perineural anesthesia of the tibial nerve cannot simply be attributed to anatomical variations. The thickness of the nerve and the amount of perineural tissue may present specific challenges for achieving adequate desensitization. Our results support the generally recommended site for tibial nerve perineural injection at 100 mm proximal to the calcaneal tubercle and 11 mm cranial to the superficial digital flexor. Full article

Screening for osteoporosis is crucial for early detection and prevention, yet it faces challenges due to the low accuracy of calcaneal quantitative ultrasound (QUS) and limited access to dual-energy X-ray absorptiometry (DXA) scans. Recent advances in AI offer a promising solution through opportunistic screening using existing medical images. This study aims to utilize deep learning techniques to develop a model that analyzes chest X-ray (CXR) images for osteoporosis screening. This study included the AI model development stage and the clinical validation stage. In the AI model development stage, the combined dataset of 5122 paired CXR images and DXA reports from the patients aged 20 to 98 years at a medical center was collected. The images were enhanced and filtered for hardware retention such as pedicle screws, bone cement, artificial intervertebral discs or severe deformity in target level of T12 and L1. The dataset was then separated into training, validating, and testing datasets for model training and performance validation. In the clinical validation stage, we collected 440 paired CXR images and DXA reports from both the TCVGH and Joy Clinic, including 304 pared data from TCVGH and 136 paired data from Joy Clinic. The pre-clinical test yielded an area under the curve (AUC) of 0.940, while the clinical validation showed an AUC of 0.946. Pearson’s correlation coefficient was 0.88. The model demonstrated an overall accuracy, sensitivity, and specificity of 89.0%, 88.7%, and 89.4%, respectively. This study proposes an AI model for opportunistic osteoporosis screening through CXR, demonstrating good performance and suggesting its potential for broad adoption in preliminary screening among high-risk populations. Full article

This is a comparative multicenter cross-sectional study that evaluated the potential determinants of Z-scores among premenopausal Saudi women before and after the age of peak bone density. The Study concluded that for better BMD among premenopausal women, attention should be paid to early physical activity and healthy nutrition, especially vitamin D, during the childbearing period. Objective: To explore the potential determinants of Z-scores among premenopausal Saudi females in different age groups before and after the expected age of peak bone density (PBD). Methods: This multicenter comparative cross-sectional study was conducted in Madinah and Jeddah, Saudi Arabia, between August 2021 and March 2022. We recruited 886 premenopausal females (605 (68.3%) below and 281 (31.7%) at or above the age of 30). The structured pre-coded Arabic questionnaire included sociodemographic data, a BMD questionnaire, menstrual history, an Arab Teen Lifestyle Study questionnaire, and food frequency data. Metabolic Equivalents (METs) were calculated from physical activity. Analysis of serum PTH, 25(OH) vitamin D (VD) was performed with chemiluminescent immunoassay. BMD was measured with a calcaneal qualitative ultrasound. Results: Most women had age-matched Z-scores, with very few (24 (2.7%)) being non-age-matched with no identified secondary causes. Significant Z-score determinants before PBD were BMI (OR: 0.167, p = 0.003) and total METs (OR: 0.160, p < 0.005). After the age of PBD, significant predictors were parity (OR: 0.340, p = 0.042), history of vitamin D deficiency (OR: 0.352, p = 0.048), and BMI (OR: 0.497, p = 0.019). Conclusions: Early determinants of Z-scores among premenopausal women were the nutritional status and physical activity. After the age of PBD, parity and vitamin D status offer additional determinants. For better BMD, attention should be paid to early physical activity and healthy nutrition, especially for vitamin D, with intensification of efforts during the childbearing period. Full article

Purpose. This study was aimed at verifying both the intraobserver and interobserver reliability of measuring plantar fascia stiffness for a given image in healthy active adults. Methodology. This study is reported following the Guidelines of Reporting Reliability and Agreement Studies. A total of 20 plantar fascia from healthy volunteers were analyzed. The thickness of the plantar fascia was measured vertically from the anterior edge of the inferior calcaneal border to the inferior border of the plantar fascia and the ultrasound elastography measurement was taken at the calcaneal insertion of the plantar fascia with the region of interest one centimeter away from the insertion. Results. The ultrasound strain elastography measurements: the right intraobserver 1 showed an ICC value of 0.9 and the left intraobserver 1 showed an ICC value of 0.78, while the right intraobserver 2 showed an ICC value of 0.91 and the left intraobserver 2 showed an ICC value of 0.83. Interobserver measurements showed excellent reliability with a right ICC value of 0.8 and a left ICC value of 0.9 for the plantar fascia thickness measurements. Discussion. The results of this study showed a strong correlation between left and right plantar fascia thickness. The intraobserver reliability was excellent for both plantar fascia ultrasound strain elastography and thickness measurements, with interobserver measurements showing excellent reliability. Full article

The study’s aim was to investigate bone condition and see its associations with body composition and age among office worker women in Hungary. In total, 316 individuals participated in this study from Csongrad-Csanad county in 2019. Participants’ ages ranged from 18 to 62, with a mean of 41 years. A questionnaire was used to gather sociodemographic information, whereas body composition was measured using the Inbody 230, and bone density and bone quality were measured with the SONOST 3000 ultrasound device. Results were analyzed using descriptive statistics, ANOVA with Tukey’s post hoc test, correlation analysis, and an independent sample t-test. The results show that Body Fat Mass, Body Mass Index, Obesity Degree, and Percent Body Fat increase significantly as age increases, and Bone Quality Index and t-score decrease substantially. Furthermore, Bone Density and Bone Quality Index were positively influenced by most components of body composition. The differences between normal and osteopenia bone quality showed that Basal Metabolic Rate, Bone Mineral Content, Fat-Free Mass, Mineral Mass, Skeletal Lean Mass, and Skeletal Muscle Mass were lower in participants with osteopenia. Our results provide more evidence of the effects of body composition and age on bone density and quality. It was the first study in Hungary investigating this phenomenon, which could be useful for professionals and researchers who intend to understand the associations of bone density. Full article

Reduced bone mineral density (BMD), osteoporosis, and their associated fractures are one of the main musculoskeletal disorders of the elderly. Quickness in diagnosis could prevent associated complications in these people. This study aimed to perform a systematic review (SR) to analyze and synthesize current research on whether a calcaneal quantitative ultrasound (QUS) can estimate BMD and predict fracture risk in elderly people compared to dual-energy x-ray absorptiometry (DXA), following the PRISMA guidelines. A search was conducted in the main open-access health science databases: PubMed and Web of Science (WOS). DXA is the gold standard for the diagnosis of osteoporosis. Despite controversial results, it can be concluded that the calcaneal QUS tool may be a promising method to evaluate BMD in elderly people, facilitating its prevention and diagnosis. However, further studies are needed to validate the use of calcaneal QUS. Full article

Both veganism and high dietary acid load are linked to unfavorable bone health. However, the specific role of dietary alkali or acid load for the bone health of vegans is so far unknown. Thus, the renal biomarker for dietary acid or alkali load, i.e., urinary potential renal acid load (uPRAL), was measured in 24 h urine samples of 34 vegans and 35 omnivores (50.7% males). Bone health was assessed via calcaneal quantitative ultrasound. Associations between uPRAL and bone health indices were examined using multivariable general linear models. Compared to omnivores, vegans had a significantly lower uPRAL (mean difference = −34.5 mEq/24 h, p < 0.0001), a lower 24 h urinary phosphate excretion (p = 0.0004), a lower 24 h urinary sulfate excretion (p = 0.01), and a higher urine pH value (p < 0.0001). Broadband ultrasound attenuation (BUA) was lower among vegans versus omnivores (p = 0.037), yet it was not associated with uPRAL irrespective of adjustments. This study confirms different acid-base profiles of vegans and omnivores, with a pronounced alkaline excess among vegans and a rather low acid load among a group of omnivores with moderate protein intake. Within this spectrum of alkaline to low acid load, no association with bone health was found. Full article