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Skin Ultrasound Measurement as a Potential Marker of Bone Quality: A Prospective Pilot Study of Patients undergoing Lumbar Spinal Fusion
Author(s) -
Salzmann Stephan N.,
Okano Ichiro,
Rentenberger Colleen,
Winter Fabian,
Miller Courtney Ortiz,
Schadler Paul,
Sax Oliver C.,
Miller Theodore T.,
Shue Jennifer,
Boskey Adele L.,
Sama Andrew A.,
Cammisa Frank P.,
Girardi Federico P.,
Hughes Alexander P.
Publication year - 2019
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24438
Subject(s) - iliac crest , medicine , quantitative computed tomography , ultrasound , vertebra , bone mineral , echogenicity , lumbar , anatomy , osteoporosis , pathology , radiology
Bone mineral density (BMD) is not the sole predictor of fracture development. Qualitative markers including bone collagen maturity contribute to bone fragility. Bone and related type I collagen containing connective tissues degenerate in parallel fashion. With aging, changes in skin collagen content and quality have been observed that can be detected on ultrasound (US) as a decrease in dermal thickness and an increase in reticular layer echogenicity. We hypothesized that US dermal thickness and echogenicity correlate with bone collagen maturity. Data of 43 prospectively enrolled patients (mean age 61 years, 24 females), who underwent instrumented, posterior lumbar fusion was analyzed. Besides preoperative quantitative computed tomography (QCT) and skin US measurements, intraoperative bone biopsies were obtained and analyzed with Fourier‐transform infrared spectroscopy. Among men, there was no correlation between US measurements and collagen maturity. Among women, dermal layer thickness correlated negatively with collagen maturity in trabecular bone of the iliac crest ( r = −0.51, p = 0.01) and vertebra ( r = −0.59, p = 0.01) as well as in cortical bone of the iliac crest ( r = −0.50, p = 0.02) and vertebra ( r = −0.50, p = 0.04). In addition, echogenicity correlated positively with collagen maturity in trabecular vertebral bone ( r = 0.59, p = 0.01). In both genders, US measurements showed no correlation with QCT BMD. In summary, ultrasound skin parameters are associated with bone quality factors such as collagen maturity, rather than bone quantity (BMD). Ultrasound of the skin may thereby be an easy and accessible take off point for diagnosis of bone collagen maturity and connective tissue degeneration in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2508–2515, 2019