Abstract
The aim of this study was to assess the ability of the quantitative ultrasound of the hand phalanges to detect different types of osteoporosis resulting from different pathogenetic mechanisms. For this purpose, postmenopausal and glucocorticoid-induced osteoporosis was studied. Thirteen female patients with Cushing’s syndrome (CS) resulting from pituitary-dependent bilateral adrenal hyperplasia (10 patients) and from adrenal adenoma (3 patients), and 32 postmenopausal osteoporotic (OP) women, were examined. The two groups of patients were comparable for body mass index (BMI), but CS patients were significantly younger than OP ones (CS 44.5±11.6; OP: 73.9±3.6). All the patients had femoral neck bone mineral density (BMD) T-score less than −2.0. Cushing patients had a femoral neck BMD similar to that of OP patients (CS: 603±66 mg/cm2; OP: 628±69 mg/cm2; p=0.19). In contrast, amplitude-dependent speed of sound (AD-SoS) was significantly higher in CS patients than in OP patients (CS: 1997±91 m/s; OP: 1707±114 m/s; p<0.0001). By adjusting DXA and ultrasound parameters according to age, femoral neck BMD was significantly lower in CS patients and AD-SoS remained significantly higher than in OP patients. These findings indicate that these two different kinds of osteoporosis can be distinguished by ultrasonography and that ultrasound parameters alone cannot be used for evaluating skeletal status in CS patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Grardel B, Sutter B, Flautre B, et al. Effect of glucocorticoid on skeletal gowth in rabbits evaluated by dual-photon absorptiometry, microscopic connectivity and vertebral compressive strength. Osteoporos Int 1994, 4: 204–10.
Thomsen JS, Ebbesen EN, Mosekilde L. Predicting human vertebral bone strength by vertebral static histomorphometry. Bone 2002, 30: 502–8.
Wachter NJ, Augat P, Krischak GD, et al. Prediction of strength of cortical bone in vitro by microcomputed tomography. Clin Biomech 2001, 16: 252–6.
Wachter NJ, Augat P, Mentzel M, et al. Predictive value of bone mineral density and morphology determined by peripheral quantitative computed tomography for cancellous bone strength of the proximal femur. Bone 2001, 28: 133–9.
Barger-Lux MJ, Recker RR. Bone microstructure in osteoporosis: transilial biopsy and histomorphometry. Top Magn Reson Imaging 2002, 13: 297–305.
Chai B, Tang X, Zhou W, Li H. A scanning electron microscopic study of trabeculae in osteoporotic femoral head. Chin Med J 1996, 109: 399–403.
Takagi Y, Fujii Y, Miyauchi A, Goto B, Takahashi K, Fujita T. Transmenopausal change of trabecular bone density and structural pattern assessed by peripheral quantitative computed tomography in Japanese women. J Bone Miner Res 1995, 10: 1830–4.
Dempster DW, Birchman R, Xu R, Lindsay R, Shen V. Temporal changes in cancellous bone structure of rats immediately after ovariectomy. Bone 1995, 16: 157–61.
Aaron JE, Francis RM, Peacock M, Makins NB. Contrasting microanatomy of idiopathic and corticosteroid-induced osteoporosis. Clin Orthop 1989, 243: 294–305.
Dempster DW. Bone histomorphometry in glucocorticoid-induced osteoporosis. J Bone Miner Res 1989, 4: 137–41.
Meunier PJ, Dempster DW, Edouard C, Chapuy MC, Arlot M, Charhon S. Bone histomorphometry in corticosteroid-induced osteoporosis and Cushing’s syndrome. Adv Exp Med Biol 1984, 171: 191–200.
Dempster DW, Arlot MA, Meunier PJ. Mean wall thickness and formation periods of trabecular bone packets in corticosteroid-induced osteoporosis. Calcif Tissue Int 1983, 35: 410–7.
Manolagas SC, Weinstein RS. New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res 1999, 14: 1061–6.
Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP, Portero NR, Meunier PJ. Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 2001 Jan, 16: 97–103.
Brooke-Wavell K, Jones PR, Pye DW. Ultrasound and dual X-ray absorptiometry measurement of the calcaneus: influence of region of interest location. Calcif Tissue Int 1995, 57: 20–4.
Cunningham JL, Fordham JN, Hewitt TA, Speed CA. Ultrasound velocity and attenuation at different skeletal sites compared with bone mineral density measured using dual energy X-ray absorptiometry. Br J Radiol 1996, 69: 25–32.
Faulkner KG, McClung MR, Coleman LJ, Kingston-Sandahl E. Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites. Osteoporos Int 1994, 4: 42–7.
Funke M, Kopka L, Vosshenrich R, et al. Broadband ultrasound attenuation in the diagnosis of osteoporosis: correlation with osteodensitometry and fracture. Radiology 1995, 194: 77–81.
Graafmans WC, Van Lingen A, Ooms ME, Bezemer PD, Lips P. Ultrasound measurements in the calcaneus: precision and its relation with bone mineral density of the heel, hip, and lumbar spine. Bone 1996, 19: 97–100.
McCloskey EV, Murray SA, Miller C, et al. Broadband ultrasound attenuation in the os calcis: relationship to bone mineral at other skeletal sites. Clin Sci (Colch) 1990, 78: 227–33.
Massie A, Reid DM, Porter RW. Screening for osteoporosis: comparison between dual energy X-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporos Int 1993, 3: 107–10.
Yeap SS, Pearson D, Cawte SA, Hosking DJ. The relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women. Osteoporos Int 1998, 8: 141–6.
Boscaro M, Rampazzo A, Sonino N, Merola G, Scanarini M, Mantero F. Corticotropin releasing hormone stimulation test: diagnostic aspects in Cushing’s syndrome. J Endocrinol Invest 1987, 10: 297–302.
Black DM, Palermo L, Nevitt MC, Genant HK, Christensen L, Cummings SR. Defining incident vertebral deformity: a prospective comparison of several approaches. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1999, 14: 90–101.
Ventura V, Mauloni M, Mura M, Paltrinieri F, de Aloysio D. Ultrasound velocity changes at the proximal phalanxes of the hand in pre-, peri- and postmenopausal women. Osteoporos Int 1996, 6: 368–75.
Wuster C, Albanese C, De Aloysio D, et al. Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power. The Phalangeal Osteosonogrammetry Study Group. J Bone Miner Res 2000, 15: 1603–14.
Tauchmanovà L, Rossi R, Nuzzo V, et al. Bone loss determined by quantitative ultrasonometry correlates inversely with disease activity in patients with endogenous glucocorticoid excess due to adrenal mass. Eur J Endocrinol 2001, 145: 241–7.
Cortet B, Cortet C, Blanckaert F, et al. Quantitative ultrasound of bone and markers of bone turnover in Cushing’s syndrome. Osteoporos Int 2001, 12: 117–23.
Kaplan FS, Leone VJ, Fallon MD, Haddad JG, Brighton CT, Steinberg ME. Multiple pathologic fractures of the appendicular skeleton in a patient with Cushing’s disease. Clin Orthop 1987, 216: 171–5.
Tavakoli MB, Evans JA. The effect of bone structure on ultrasonic attenuation and velocity. Ultrasonics 1992, 30: 389–95.
Gluer CC, Wu CY, Jergas M, Goldstein SA, Genant HK. Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994, 55: 46–52.
Hodgskinson R, Njeh CF, Currey JD, Langton CM. The ability of ultrasound velocity to predict the stiffness of cancellous bone in vitro. Bone 1997, 21: 183–90.
Borelli A, Leite MO, Correa PH, et al. Bone histomorpho-metry in Cushing’s syndrome. J Endocrinol Invest 1992, 15: 783–7.
Manning PJ, Evans MC, Reid IR. Normal bone mineral density following cure of Cushing’s syndrome. Clin Endocrinol (Oxf) 1992, 36: 229–34.
Hermus AR, Huysmans DA, Smals AG, Corstens FH, Kloppenborg PW. Remarkable improvement of osteopenia after cure of Cushing’s syndrome. Horm Metab Res 1994, 26: 209–10.
Pocock NA, Eisman JA, Dunstan CR, Evans RA, Thomas DH, Huq NL. Recovery from steroid-induced osteoporosis. Ann Intern Med 1987, 107: 319–23.
Lufkin EG, Wahner HW, Bergstralh EJ. Reversibility of steroid-induced osteoporosis. Am J Med 1988, 85: 887–8.
Laan RF, van Riel PL, van de Putte LB, van Erning LJ, van’t Hof MA, Lemmens JA. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis A randomized, controlled study. Ann Intern Med 1993, 119: 963–8.
Luisetto G, Zangari M. Camozzi V, Boscaro M, Sonino N, Fallo F. Recovery of bone mineral density after surgical cure, but not by ketoconazole treatment, in Cushing’s syndrome. Osteoporos Int 2001, 12: 956–60.
Chappard D, Legrand E, Basile MF, et al. Altered trabecular architecture induced by corticosteroids: a bone histomor-phometric study. J Bone Miner Res 1996, 11: 676–85.
Takahasci M, Wehrli FW, Hilaire L, Zemel BS, Hwang SN. In vivo NMR microscopy allows short-term serial assessment of multiple skeletal implications of corticosteroid exposure. PNAS 2002, 99: 4574–9.
Nicholson PHF, Muller R, Lowet G, et al. Do quantitative ultrasound measurements reflect structure independently of density in human vertebral cancellous bone? Bone 1998, 23: 425–31.
Njeh CF, Hans D, Li J, et al. Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimation. Osteoporos Int 2000, 11: 1051–62.
Benhamou CL, Lespessailles E, Royant V. Bone structure and mechanical resistance of the bone tissue. Presse Med 1996, 25: 249–54.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Camozzi, V., Carraro, V., Zangari, M. et al. Use of quantitative ultrasound of the hand phalanges in the diagnosis of two different osteoporotic syndromes: Cushing’s syndrome and postmenopausal osteoporosis. J Endocrinol Invest 27, 510–515 (2004). https://doi.org/10.1007/BF03347471
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03347471