Calcaneal quantitative ultrasonometry as a field-friendly tool for bone quality assessment in Italian postmenopausal women: Associations with body composition and menopausal duration
Aug 2026· Anthropologiai Közlemények· pp. 55· 0 citations
TL;DR
Menopausal duration is the primary determinant of calcaneal bone quality in postmenopausal women, independent of body composition, and these findings support the use of calcaneal QUS as a field-friendly pre-screening tool for bone quality monitoring in non-clinical and large-scale epidemiological settings.
Abstract
Background: In postmenopausal women, bone quality assessment is essential for identifying skeletal fragility risk. The calcaneal bone quality index (BQI), assessed via quantitative ultrasound (QUS), represents a non-invasive, field-friendly alternative to dual-energy X-ray absorptiometry (DXA).
Objective: To investigate the associations between BQI, body composition, menopausal duration and functional variables in Italian postmenopausal women.
Subjects and methods: A cross-sectional study design – in which all measurements were taken at a single point in time – was conducted on 138 Italian postmenopausal women (mean age: 61.1±5.3 years; mean years since menopause (YSM): 10.5±6.1 years). BQI was assessed using calcaneal QUS (SONOST 3000). Body composition was assessed through bioelectrical impedance analysis (BIA 101, Akern), providing fat-free mass (FFM), fat mass (FM) and fat percentage (%F). Handgrip strength (HGS) was measured bilaterally using a dynamometer. Pearson correlations and two multiple linear regression models were performed using BQI as the dependent variable: a background model (age, YSM, BMI) and a body composition model (%F, FFM, HGS). A simple linear regression with YSM alone was also conducted.
Results: BQI showed significant negative correlations with age (r=-0.30, p=0.0003) and YSM (r=-0.34, p<0.0001), and positive correlations with BMI, FFM and FM (r=0.18 for all, p=0.033). No significant correlations emerged for %F and HGS. The body composition model was not statistically significant (F=1.864, R²=0.040, p=0.139), whereas the background model was statistically significant (F=7.133, R²=0.138, p=0.0002), with YSM as the strongest predictor (p<0.0001). In simple linear regression, YSM alone explained 12% of BQI variance (R²=0.120, p<0.0001).
Conclusions: Menopausal duration is the primary determinant of calcaneal bone quality in postmenopausal women, independent of body composition. These findings support the use of calcaneal QUS as a field-friendly pre-screening tool for bone quality monitoring in non-clinical and large-scale epidemiological settings.
Fracture risk assessment in osteoporosis is largely based on bone mineral density and FRAX, yet these approaches do not capture the contribution of muscle-related factors. This study investigated the association between muscle quantity, muscle quality, and physical performance with FRAX-derived fracture probability in postmenopausal women. This cross-sectional study included 70 postmenopausal women with osteoporosis. Participants were categorized into low- and high-risk groups according to FRAX thresholds (major osteoporotic fracture ≥ 20% and/or hip fracture ≥ 3%). Rectus femoris muscle thickness (MT), cross-sectional area (CSA), pennation angle (PA), and echogenicity (Heckmatt scale) were assessed using ultrasonography. Physical performance was evaluated with the Short Physical Performance Battery (SPPB). Group comparisons and correlation analyses were performed. Demographic characteristics were comparable between groups. The high-risk group demonstrated significantly lower MT and CSA and higher muscle echogenicity. Physical performance, particularly SPPB total score, was significantly reduced in this group. FRAX-derived probabilities showed moderate inverse correlations with MT, CSA, and SPPB scores, and positive correlations with the Heckmatt score, with the strongest association observed for SPPB total score. FRAX-derived fracture probability in postmenopausal women is associated not only with bone-related parameters but also with muscle structure, muscle quality, and physical performance. These findings highlight the potential relevance of muscle-related parameters within the broader musculoskeletal profile reflected by FRAX and support the need for further prospective research in this area.
It is suggested that visceral adiposity measured by opportunistic CT may serve as a potential biomarker for identifying postmenopausal women with osteopenia who are at an increased risk of fracture.
Tae Ran Ahn, Hyun Su Kim, D. Cha et al.· Skeletal Radiology· 0 citations
Objectives This study evaluated the association between Body Roundness Index (BRI) and QUS-defined osteoporosis, its discriminative ability, empirical cutoff, and subgroup heterogeneity in middle-aged and older adults. Methods We analyzed cross-sectional data from 1,444 community-dwelling adults aged 35–75 years. Osteoporosis was defined using tibial quantitative ultrasound-derived T-scores. Receiver operating characteristic curves assessed discrimination, restricted cubic splines examined dose-response relationships, logistic and robust regression analyses quantified associations, and subgroup analyses evaluated effect modification. Results The Youden index identified an optimal BRI cutoff of 4.5. High BRI (≥ 4.5) was associated with higher odds of osteoporosis in the unadjusted model (OR = 1.606, 95% CI: 1.292–1.996; P < 0.001), the age- and sex-adjusted model (OR = 1.432, 95% CI: 1.141–1.797; P = 0.002), and the fully adjusted model excluding BMI (OR = 1.404, 95% CI: 1.105–1.783; P = 0.005). The association was approximately linear (P for non-linearity = 0.539; P-overall < 0.001). BRI alone showed modest discrimination (AUC = 0.562, 95% CI: 0.529–0.594), which increased after adjustment for age and sex (AUC = 0.680, 95% CI: 0.652–0.710) and after full covariate adjustment (AUC = 0.695, 95% CI: 0.674–0.731). The association was stronger among participants with metabolic syndrome (OR = 2.62, 95% CI: 1.641–4.179) than among those without it (OR = 1.39, 95% CI: 1.040–1.860; P for interaction = 0.022). Conclusions Higher BRI was associated with QUS-defined osteoporosis, but BRI alone showed limited discrimination, and the fully adjusted model remained only moderately discriminative. BRI should therefore be considered an adjunctive anthropometric indicator within a broader assessment framework, rather than a stand-alone predictor or screening tool. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=187762, identifier ChiCTR2300071492.
Yu-Cong Yang, Qichao Wang, Xiuwei Hou et al.· Frontiers in Endocrinology· 0 citations
OBJECTIVE
To evaluate age-related changes in lumbar spine trabecular bone microarchitecture using the trabecular bone score (TBS) and to establish age-specific reference values for healthy Brazilian women.
METHODS
In this cross-sectional study, we evaluated 527 healthy adult women aged 20-82 years recruited as a convenience sample from hospital employees and their relatives. Lumbar spine TBS and bone mineral density (BMD) were obtained from a Hologic Discovery A DXA system using TBS iNsight software (v3.0.3). Primary analyses were restricted to BMI 15-37 kg/m2 and excluded current menopausal hormone therapy users, with sensitivity analyses including these participants. Women were stratified by age decade; menopause-centered analyses were additionally performed using years since menopause, and nonlinearity was explored using restricted cubic splines.
RESULTS
In the primary analytical sample (n=477), TBS was independently associated with age after adjustment for height and weight (β=-0.004 per year, P<0.001). Among postmenopausal women, years since menopause was independently associated with lower TBS (β=-0.002 per year, P=0.010). Menopausal status and the age-by-menopausal status interaction were not independently associated with TBS. TBS declined earlier across age decades than BMD T-scores, and sensitivity analyses including hormone therapy users yielded similar results. Using the reference distribution from premenopausal women aged 20-39 years, TBS cutoffs were 1.365 for normal microarchitecture and 1.248 for degraded microarchitecture, with intermediate values indicating partially degraded microarchitecture. A substantial proportion of women with normal BMD showed impaired trabecular microarchitecture by TBS, ranging from 34.8% to 41.6% across skeletal sites.
CONCLUSIONS
This study provides the first age-specific normative TBS reference data for Brazilian women. The findings indicate that trabecular microarchitecture deteriorates earlier and more rapidly with aging than bone mass loss captured by BMD, supporting the use of TBS as a complementary tool for evaluating skeletal health and fracture risk.
C. Gomes, R. M. R. Pereira, J. C. Alvarenga et al.· Menopause· 0 citations
In this cross-sectional study, we aimed to explore the correlation between body composition and bone mineral density (BMD) in young and middle-aged people with different gender and different BMI groups. We selected 1,295 young and middle-aged people (20 to 50 years old) who underwent physical examination at the Health Management Center of the International Medical Service (Xidan Branch) of Peking Union Medical College Hospital from January 2020 to June 2024 as the study subjects, and demographic characteristics, laboratory examinations, body composition(assessed by bioelectrical impedance analysis, including measurements of skeletal muscle mass, skeletal muscle index, body fat mass, percent body fat, fat-free mass, and visceral Fat Area), and dual-energy X-ray bone absorptiometry (DXA) results were collected. Based on gender and body mass index (BMI), the study participants were categorized into three groups: normal weight (18.5 kg/m² ≤ BMI < 24 kg/m²), overweight (24 kg/m² ≤ BMI < 28 kg/m²), and obese (BMI ≥ 28 kg/m²). One-way ANOVA was employed to assess differences among the three groups. The relationship between BMI and BMD was analyzed using multiple regression models along with natural cubic spline models. Additionally, multiple regression models were used to examine the association between body composition and BMD. There were 774 males (216 in the normal body composition group, 380 in the overweight group, and 178 in the obese group) and 521 females (386 in the normal body composition group, 99 in the overweight group, and 36 in the obese group), and there was a significant difference in the laboratory results, body composition, and BMD among the three groups of males and females (all P < 0.05). Multiple regression analysis, after adjusting for age, smoking and alcohol consumption history, hypertension, and diabetes mellitus, revealed a significant positive correlation between BMI and BMD at all skeletal sites (all P < 0.05). The obese group exhibited a more pronounced increase in BMD compared to the overweight group (lumbar spine BMD: β = 0.04, 95% CI 0.02-0.07; femoral neck BMD: β = 0.09, 95% CI 0.07-0.11; total hip BMD: β = 0.11, 95% CI 0.09-0.13; all P < 0.05). Further analysis of the nonlinear relationship between BMI and BMD demonstrated that in women, BMD at all sites increased with higher BMI. In contrast, men exhibited an inverted U-shaped nonlinear association, with a decline in BMD observed in the high BMI range (BMI ≥ 30 kg/m²). The correlation between body composition and BMD, skeletal muscle mass (SMM), skeletal muscle index (SMI), and fat free mass (FFM) were significantly positively correlated with BMD at all sites in both males and females (P < 0.05), and percent body fat (PBF) was negatively correlated with BMD at all sites in the obese group of males, the overweight groups of males and females (P < 0.05). Among young and middle-aged individuals, men show a decline in BMD when BMI reaches 30 or above, whereas women continue to experience a gradual increase in BMD with rising BMI. Additionally, elevated PBF is negatively correlated with BMD. This suggests that maintaining an appropriate BMI and PBF may be beneficial for bone health in this age group.
Yanmeng Qi, Xiaoyu Zhou, Xiao Wang et al.· BMC Endocrine Disorders· 0 citations
Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to compare bilateral femoral neck BMD and Z-scores in pregnant and non-pregnant women using Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology, and to assess correlation between bilateral measurements. In this cross-sectional study, 100 women were enrolled, including 40 pregnant women and 60 non-pregnant women with comparable age and body mass index (BMI). Bilateral femoral neck BMD and age-adjusted Z-scores were evaluated using REMS. Pregnant women had a mean age of 33 ± 5 years, pre-pregnancy BMI of 25.8 ± 6.5 kg/m2, and gestational age of 21 ± 5 weeks, with no significant differences in age or pre-pregnancy BMI compared with controls. Pregnant women demonstrated significantly lower left femoral neck BMD than controls (0.805 vs. 0.862 g/cm2; p = 0.0018) and lower left femoral neck Z-scores (−0.08 vs. 1.18 SD; p = 0.003). A strong positive correlation between left and right femoral neck BMD was observed (R = 0.78). Similarly, right femoral neck BMD was significantly lower in pregnant women compared with controls (0.835 g/cm2 vs. 0.892 g/cm2; p = 0.0026). The right femoral neck Z-score was 0.15 ± 1.15 SD in pregnant women and 1.45 ± 1.10 SD in controls (p = 0.002). REMS demonstrated the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency. These findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy. However, the cross-sectional design and lack of longitudinal follow-up limit conclusions regarding the progression and reversibility of pregnancy-associated bone changes. Future prospective studies with larger cohorts and postpartum monitoring are needed to further define the clinical role of REMS in maternal bone health assessment.
E. Bischoff, S. Vladeva, F. Bischoff et al.· Life· 0 citations