| Objective: The purpose of this study was to explore the correlation between the bone mass measured by dual-energy X-ray absorption method,quantitative ultrasound method and vitamin D,so as to further explore the clinical application value of quantitative ultrasound method and the significance of the application of bone mass in the clinical guidance of vitamin D supplement in children.Methods:The study subjects were 119 children who attended free clinic in the Pediatric Endocrinology Clinic of the Second Hospital of Hebei Medical University from March 8 to 10,2019.Screening was conducted in strict accordance with the inclusion and exclusion criteria,and all the children had no obvious skeletal abnormalities,malnutrition,thyroid disease,etc.A medical examination is performed and recorded by a professional.BMD of the right forearm and lumbar spine were measured by DEXA(Discovery)produced by Hologic Company.At the same time,SOS of the left calcaneus(CM-200model)and the distal 1/3 of the left radius(BMD-9 model)were measured by quantitative ultrasound(QUS).25 hydroxyvitamin D was selected as the representative index of vitamin D,and SPSS21.0 statistical software was used for statistical analysis of the data.Results:1.correlation analysis between SOS measured by QUS and BMD measured by DEXA in all children: there is no correlation between SOS of calcaneus and BMD of right forearm(distal 1/3,middle and whole of radioulna)and lumbar spine(L1-4 and whole)(r=-0.027,P = 0.774;r=0.029,P=0.757;r=0.04,P=0.67;r=0.032,P=0.728;r=0.006,P=0.945;r=0.014,P=0.876;r=-0.011,P=0.908;r=0.02,P=0.834);SOS of calcaneus is positively correlated with BMD of right forearm(middle of radial ulna),but the correlation is very weak(r=0.208,P=0.024).There is no correlation between SOS of radius and BMD of right forearm(distal 1/3 of radius and ulna,middle,distal ulna,whole)and lumbar spine(L2,L4 and whole)(r=0.142,P = 0.125;r=0.144,P=0.12;r=0.12,P=0.196;r=0.133,P=0.151;r=0.174,P=0.06;r=0.128,P=0.169;r=0.162,P=0.079);SOS of radius is positively correlated with BMD of lumbar vertebrae(L1,L3),but the correlation is very weak(r=0.193,P = 0.036;r=0.193,P=0.037);2.There was no correlation between SOS of calcaneus and radius(r=-0.113,P = 0.221).3.Correlation analysis between BMD of right forearm(distal 1/3,middle,distal ulna and whole)and lumbar spine(L1-L4 and whole): The distal 1/3 of radial ulna is positively correlated with BMD of right forearm(middle,distal ulna and whole)and lumbar spine(L1-L4 and whole)(r=0.943)r=0.734,P<0.001;r=0.940,P<0.001;r=0.797,P<0.001;r=0.778,P<0.001;r=0.769,P<0.001;r=0.753,P<0.001;r=0.802,P<0.001);Among them,the distal 1/3BMD of the radioulna has a strong correlation with the overall BMD of the lumbar spine,which accords with linear regression.The distal 1/3BMD of the radioulna can explain 65.9% of the overall variation of the lumbar spine(r = 0.802,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.997,R2=0.659,and the overall BMD of the lumbar spine)The middle of radius and ulna were positively correlated with BMD of right forearm(distal 1/3 of radius and ulna and whole)and lumbar spine(L1-L4 and whole)(r=0.943,P < 0.001;r=0.844,P<0.001;r=0.969,P<0.001;r=0.759,P<0.001;r=0.705,P<0.001;r=0.720,P<0.001;r=0.713,P<0.001;r=0.756,P<0.001);Among them,BMD in the middle of radius and ulna has strong correlation with distal 1/3BMD,distal ulna BMD and overall BMD of radius and ulna,and all conform to linear regression.The distal 1/3BMD of radius and ulna can explain 89.5% of the total variation of BMD in the middle of radius and ulna(r = 0.943,P correlation coefficient < 0.001,P linear correlation < 0.001,residual independence =1.850)Medial BMD of radius and ulna= 0.715 * distal 1/3 BMD of radius and ulna+0.063),and distal BMD of ulna can explain 58.3% of the total variation of median BMD of radius and ulna(r= 0.844,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.907,R2 = 0.55)The middle BMD of radius and ulna can explain 93.8% of the total variation of BMD of radius and ulna(r = 0.969,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =2.103,R2=0.938,the whole BMD of radius and ulna = 0.915 * the middle BMD of radius and ulna+0.029).BMD of distal ulna was positively correlated with BMD of right forearm(distal 1/3,middle and whole of ulna and radius)and lumbar spine(L1-L4 and whole)(r=0.734,P < 0.001;r=0.844,P<0.001;r=0.843,P<0.001;r=0.683,P<0.001;r=0.602,P<0.001;r=0.597,P<0.001;r=0.585,P<0.001;r=0.632,P<0.001);The distal ulna BMD can explain 62.4% of the total variation of the whole ulna and radius BMD(r =0.843,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.883,R2=0.624,the whole ulna and radius BMD=1.073*distal ulna BMD+0.075).The whole BMD of radius and ulna was positively correlated with the BMD of right forearm(distal 1/3,middle and distal ulna)and lumbar spine(L1-L4 and whole)(r=0.940,P < 0.001;r=0.976,P<0.001;r=0.843,P<0.001;r=0.770,P<0.001;r=0.715,P<0.001;r=0.717,P<0.001;r=0.701,P<0.001;r=0.757,P<0.001);L1BMD was positively correlated with BMD of right forearm(distal 1/3 of radius and ulna,middle,distal ulna and whole)and lumbar spine(L2-L4 and whole)(r=0.797,P < 0.001;r=0.759,P<0.001;r=0.683,P<0.001;r=0.770,P<0.001;r=0.938,P<0.001;r=0.900,P<0.001;r=0.864,P<0.001;r=0.944,P<0.001);L1BMD can explain 90.2%of L2 BMD total variation(r = 0.938,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.533,R2=0.902,L2BMD=0.944*L1BMD+0.09),and L1 BMD can explain L3 BMD total variation.P linear correlation < 0.001,residual independence =1.842,R2=0.822,L3BMD=0.912*L1BMD+0.138),L1 BMD can explain 73.9% of the total variation of L4BMD(r = 0.864,P correlation coefficient < 0.001,P linear correlation < 0.001)L4BMD=0.912*L1BMD+0.157),L1 BMD can explain89.2% of the total variation of lumbar BMD(r = 0.944,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.904,R2=0.892,lumbar BMD = 0 L2 BMD was positively correlated with BMD of right forearm(distal 1/3 of radius and ulna,middle,distal ulna and whole)and lumbar spine(L1,L3-L4 and whole)(r=0.778,P < 0.001;r=0.705,P<0.001;r=0.602,P<0.001;r=0.715,P<0.001;r=0.938,P<0.001;r=0.954,P<0.001;r=0.921,P<0.001;r=0.971,P<0.001);L3BMD can explain 90.4% of the total variation of L2BMD(r = 0.954,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =2.123,R2=0.904,L2BMD=0.940*L3BMD+0.004),and L4 BMD can explain L2 BMD P linear correlation< 0.001,residual independence =2.239,R2=0.84,L2BMD= 0.859*L4BMD+0.036),in which L2 BMD can explain 93.3% of the total variation of lumbar BMD(r = 0.971,P correlation coefficient < 0.001,P linear correlation < 0.01)L3BMD was positively correlated with BMD of right forearm(distal 1/3 of radius and ulna,middle,distal ulna and whole)and lumbar spine(L1,L2,L4 and whole)(r=0.769,P < 0.001;r=0.720,P<0.001;r=0.597,P<0.001;r=0.717,P<0.001;r=0.900,P<0.001;r=0.954,P<0.001;r=0.947,P<0.001;r=0.964,P<0.001);L4BMD can explain 89.6% of the total variation of L3BMD(r =0.947,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.854,R2=0.896,L3BMD=0.897*L4BMD+0.044),and L3 BMD can explain the whole lumbar spine P linear correlation < 0.001,residual independence =1.797,R2=0.929,lumbar BMD = 0.971 * l4bmd+0.007);L4BMD was positively correlated with BMD of right forearm(distal1/3 of radius and ulna,middle,distal ulna and whole)and lumbar spine(L1-L3 and whole)(r=0.753,p < 0.001;r=0.713,P<0.001;r=0.585,P<0.001;r=0.701,P<0.001;r=0.864,P<0.001;r=0.921,P<0.001;r=0.947,P<0.001;r=0.954,P<0.001);L4BMD can explain 90.9% of the total variation of lumbar BMD(r = 0.954,p correlation coefficient < 0.001,p linear correlation < 0.001,residual independence =1.877,R2=0.909,lumbar BMD = 0.910 * l4bmd+0.011).The whole BMD of lumbar spine measured by DEXA was positively correlated with BMD of right forearm(distal 1/3 of radius and ulna,middle,distal and whole ulna)and lumbar spine(L1-l4)(r=0.802,P< 0.001;r=0.756,P<0.001;r=0.632,P<0.001;r=0.757,P<0.001;r=0.944,P<0.001;r=0.971,P<0.001;r=0.964,P<0.001;R=0.954,P<0.001).4.Correlation analysis between calcaneus and radius SOS and right forearm(distal 1/3,middle and whole of radius and ulna)and lumbar spine(L1-4 and whole)BMD measurement and 25 hydroxyvitamin D: calcaneus,radius SOS and DEXA measurement(distal ulna,L1)and 25 hydroxyvitamin D were not found r=0.016,P=0.86;r=-0.165,P=0.074;r=-0.176,P=0.056);BMD of right forearm(distal 1/3 of radius and ulna,middle,whole radius and ulna)and lumbar spine(L2-L4 and whole)measured by DEXA was negatively correlated with 25 hydroxyvitamin D,but the correlation was very weak(r=-0.332,P < 0.001;r=-0.287,P=0.002;r=-0.261,P=0.004;r=-0.226,P=0.014;r=-0.251,P=0.006;r=-0.264,P=0.004;r=-0.261,P=0.004);Conelusions:1.The ultrasonic sound velocity measured by quantitative ultraso-und method can hardly reflect the real bone mass of children;2.Bone mass status of children is difficult to guide vitamin D supplementation. |
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