doi:10.1016/j.ultrasmedbio.2007.01.002 ● Original Contribution QUANTITATIVE BONE ULTRASOUND AT PHALANGES AND CALCANEUS IN OSTEOPOROTIC POSTMENOPAUSAL WOMEN: INFLUENCE OF AGE AND MEASUREMENT SITE VALENTINA CAMOZZI,* FRANCESCA DE TERLIZZI, † MONICA ZANGARI,* and GIOVANNI LUISETTO* *Department of Medical and Surgical Sciences, Division of Endocrinology, University of Padua, Padua, Italy; and † IGEA, Carpi, Italy (Received 30 August 2006; revised 21 December 2006; in final form 3 January 2007) Abstract—Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmeno- pausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than 2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group (p < 0.05). When patients aged <70 y (n  43) and patients aged > 70 y (n  84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group (p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one (p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life. (E-mail: francedt@igea.it) © 2007 Published by Elsevier Inc. on behalf of the World Federation for Ultrasound in Medicine & Biology. Key Words: Osteoporosis, Fracture risk, Quantitative ultrasonography, Aging, Postmenopause. INTRODUCTION Osteoporosis is a disease characterized by a reduction of bone strength owing both to bone loss and to deteriora- tion of the normal skeletal architecture (NIH Consensus Development Panel 2001). In women, the mechanism determining bone damage mainly depends on meno- pausal state and age. Oestrogen deficiency causes a con- siderable acceleration in bone turnover, with an increase in the resorption processes that may lead not only to early demineralization but also to trabecular perforation, with disarrangement of the normal skeletal architecture (Takagi et al. 1995; Chavassieux and Meunier 1995; Parfitt 1992). The reduction in bone mass does not occur uni- formly in all skeletal sites, but earlier and more rapidly affects the structures where the mechanical load is lesser, i.e., the horizontal trabeculae of spongy bones (Lang et al. 2004; Zehnder et al. 2004; Luisetto et al. 1993). Several methods are currently available for evalu- ating bone status (Kanis et al. 1997; Kanis 2002; Gluer 1997; Gregg et al. 1997; Hans et al. 1996): standard radiography is useful for identifying fractures, but fails to detect osteoporosis in its initial stage. Dual energy X-ray absorptiometry (DXA) is the most widely known and employed method to detect bone mineral density (BMD, in g/cm 2 ). Quantitative computed tomography (QCT) is able to evaluate the trabecular portion and is the only method that expresses bone density as a volumetric unit. Lastly, quantitative ultrasound techniques (QUS) seem to be correlated not only to the mineral content, but also to some qualitative properties of bone. DXA is the most commonly used method to eval- uate bone status, however, it measures only the mineral Address correspondence to: Francesca de Terlizzi, IGEA s.r.l., Via Parmenide 10/A, 41012 Carpi, Mo, Italy. E-mail: francedt@igea.it Ultrasound in Med. & Biol., Vol. 33, No. 7, pp. 1039 –1045, 2007 © 2007 Published by Elsevier Inc. on behalf of the World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/07/$–see front matter 1039