Graafmans W C, Bouter L M, Lips P
Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Amsterdam, The Netherlands.
Osteoporos Int. 1998;8(5):449-54. doi: 10.1007/s001980050090.
In this cross-sectional study we investigated the relationship between ultrasound measurements in the calcaneus versus daily physical activity and fractures sustained in the past in elderly subjects. Ultrasound measurements were performed at both heels, which enabled us to examine determinants of differences between contralateral heels. Participants were 132 men and 578 women, aged 70 years and over (mean age and standard deviation (SD): 83 +/- 6 years), living in homes for the elderly (n = 343) or apartment houses for the elderly (n = 367). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the right and left calcaneus. The median difference (and interquartile range) between the two heels for BUA and SOS, expressed as a percentage of the mean value for each individual, was 9.6% (4.2-15.7%) and 1.0% (0.4-1.7%), corresponding to 25% and 40% of the study population SD, respectively. Greater differences in BUA between the two heels were associated with variables indicating poorer functional status, such as past fractures at the lower extremities. The level of daily physical activity was obtained by means of a questionnaire regarding household and leisure activities. Subsequently sumscores were calculated for daily physical activity and a subscore indicating weight-bearing physical activity. After adjustment for age, gender, residence, and body weight, physical activity scores were positively linearly related to both BUA and SOS. Each 5 point increase on the weight-bearing physical activity score, corresponding to, for example, walking for 2.5 h per week, was associated with a difference in BUA of 4.7 dB/MHz and in SOS of 5.1 m/s, which is similar to the differences associated with 10 kg higher body weight, or 10 years younger age. After the age of 50 years, 47 subjects had fractured a hip, 61 subjects had sustained another lower extremity fracture, 104 subjects a wrist fracture, and 62 subjects another upper extremity fracture. After adjusting for age, gender and residence, odds ratios for all fracture types in the lowest terciles of BUA and SOS versus the highest terciles ranged from 1.9 to 3.8. This study showed significant differences in ultrasound measurements between the left and the right heel, indicating that measurements at both sides are necessary for optimal evaluation of bone strength. Furthermore, after careful adjustments, ultrasound parameters had higher values with higher daily physical activity in elderly subjects and discriminated subjects with a history of fracture from those without.
在这项横断面研究中，我们调查了老年受试者跟骨超声测量值与日常身体活动及既往骨折之间的关系。在双足跟进行超声测量，这使我们能够研究双侧足跟差异的决定因素。参与者为132名男性和578名女性，年龄在70岁及以上（平均年龄和标准差(SD)：83±6岁），居住在养老院(n = 343)或老年公寓(n = 367)。测量双侧跟骨的宽带超声衰减(BUA)和声速(SOS)。以每个个体平均值的百分比表示，双侧足跟BUA和SOS的中位数差异（及四分位间距）分别为9.6%（4.2 - 15.7%）和1.0%（0.4 - 1.7%），分别相当于研究人群标准差的25%和40%。双侧足跟BUA差异越大，与功能状态较差的变量相关，如下肢既往骨折。通过关于家务和休闲活动的问卷获取日常身体活动水平。随后计算日常身体活动的总分及表示负重身体活动的分项得分。在对年龄、性别、居住情况和体重进行调整后，身体活动得分与BUA和SOS均呈正线性相关。负重身体活动得分每增加5分，例如相当于每周步行2.5小时，与BUA差异4.7 dB/MHz和SOS差异5.1 m/s相关，这与体重高10 kg或年龄小10岁相关的差异相似。50岁以后，47名受试者发生髋部骨折，61名受试者发生其他下肢骨折，104名受试者发生腕部骨折，62名受试者发生其他上肢骨折。在对年龄、性别和居住情况进行调整后，BUA和SOS最低三分位数与最高三分位数相比，所有骨折类型的比值比在1.9至3.8之间。本研究显示左右足跟的超声测量存在显著差异，表明双侧测量对于最佳评估骨强度是必要的。此外，经过仔细调整后，老年受试者的超声参数值随着日常身体活动增加而升高，并且能够区分有骨折史和无骨折史的受试者。
