Cortical ultrasound velocity as an indicator of bone status

Normative population data are reported here for velocity of ultrasound in tibial cortical bone in a population-based sample of both men and women (n=371). The cortical measurement is highly precise with reproducibility of the order of 0.5%. As with heel and patellar trabecular velocity, tibial cortical velocity declines with age from the fourth through the ninth decades. The rate is 1.7 m/s per year in men and 4.1 m/s per year in women. Tibial cortical velocity values correlate with patellar velocity and with forearm mineral, with correlation coefficients ranging from + 0.46 to +0.54 in women and +0.27 to +0.43 in men (P<0.002 for all). Tibial velocity averaged 77–104 m/s lower (2–3%: equal to about 1 SD of the young adult normal distribution) in individuals with a history of low-energy appendicular fractures (P<0.05), and the difference remained significant after adjusting for age. However, there were no perceptible differences in tibial velocity for those with and without vertebral fractures. Odds ratios derived from logistic regression showed an approximate twofold increase in likelihood of low-energy appendicular fracture for every standard deviation decrement in velocity. Comparison of tibial velocity with patellar velocity and forearm density in the same individuals revealed tibial velocity to be more strongly associated with appendicular fractures than patellar velocity for women and about the same for men, and less strongly associated than patellar velocity for vertebral fractures. We conclude that tibial cortical velocity provides useful information about bone status in populations at risk for osteoporosis, and seems particularly well suited for assessing appendicular fracture risk.