# Patterns and Correlates of Bone Mineral Density Parameters Measured Using Calcaneus Quantitative Ultrasound in Chinese Adults

## TL;DR

This study explores how bone mineral density parameters measured with ultrasound relate to lifestyle and demographic factors in Chinese adults, finding that certain behaviors like physical activity and tea drinking are linked to better bone health.

## Contribution

The study identifies lifestyle and anthropometric correlates of calcaneal QUS measures and their association with fracture risk in a large Chinese cohort.

## Key findings

- Men had higher stiffness index (SI) but lower T-score than women.
- Physical activity and tea drinking were positively associated with bone mineral density measures.
- Lower SI and T-score were linked to a 26-40% higher fracture risk in both genders.

## Abstract

Background: Monitoring bone mineral density (BMD) in adults is critical for early detection of osteoporosis and prevention of fracture, for which quantitative ultrasound (QUS) is a good non-invasive tool. We examined the associations of QUS measures, including stiffness index (SI) and T-score, with socio-demographic, lifestyle, and anthropometric correlates and risk of subsequent fracture. Methods: Calcaneal QUS was performed using GE’s Lunar Achilles EXPII among 24,651 adults (mean age 59.5 years, 61.7% women) from the China Kadoorie Biobank study. Socio-demographic and lifestyle information was collected using an interviewer-administered electronic questionnaire, and anthropometrics were measured following standard protocols. Incidence of fracture and osteoporosis was recorded via linkage with nationwide health insurance database. Linear and Cox regression analyses were conducted, adjusting for potential confounders. Results: On average, men had higher SI (92.8 vs. 86.0) but lower T-score (−0.85 vs. −0.64) than women. In both men and women, advanced age and smoking were inversely associated with SI and T-score, while physical activity and tea drinking were positively so (p < 0.0001 for all). Except for height, all other anthropometric measures were significantly and positively associated with both BMD measures. With each SD lower SI, the risk of subsequent fracture was 26% (95% confidence interval: 10–44%) and 40% (25–57%) higher in men and women, and the corresponding associations of T-score were identical. Conclusions: Among Chinese adults, the SI and T-score provided by Achilles EXPII had similar patterns and predictive values for subsequent fracture, despite the T-score for men and women not being directly comparable because of gender-specific references used. Future studies are needed to confirm or refute the causality of relationship between lifestyle and anthropometric factors and BMD.