title: Bone health comparison in seven Asian countries using calcaneal ultrasound.
abstract: BACKGROUND
  Bone density measurements by DXA are not feasible for large population studies, whereas portable ultrasound heel scanners can provide a practical way of assessing bone health status. The purpose of this study was to assess bone health in seven Asian countries using heel ultrasound.
  
  
  METHODS
  Stiffness index (SI) was measured and T-scores generated against an Asian database were recorded for 598,757 women and 173,326 men aged over 21 years old using Lunar Achilles (GE Healthcare) heel scanners. The scanners were made available in public centres in Singapore, Vietnam, Malaysia, Taiwan, Thailand, Indonesia and the Philippines.
  
  
  RESULTS
  The mean SI was higher for men than women. In women SI as well as T-scores declined slowly until approximately 45 years of age, then declined rapidly to reach a mean T-score of < -2.5 at about 71-75 years of age. For men, SI as well as the T-score showed a slow steady decline to reach a mean of -2.0 to -2.5 at about 81-85 years. The results for females indicate that there are differences in the rate of decline between countries (significant differences between the slopes at P < 0.05). Vietnam had the fastest decrease for both T-Score and SI, resulting in this population having the poorest bone health of all countries at older ages. The results for males aged 46-85 years indicate that there are no significant differences in the rate of decline between countries for SI and T-Score. In both men and women aged 46-85 years, Vietnam and Indonesia have the lowest SI as well as T-Score for all age groups. For Vietnam and Indonesia, more than 50% of the women could be at risk of having osteoporosis and related fractures after the age of 70, while in Thailand and the Philippines this was >80 years.
  
  
  CONCLUSIONS
  The heel scan data shows a high degree of poor bone health in both men and women in Asian countries, raising concern about the possible increase in fractures with ageing and the expected burden on the public health system.
authors.affiliation: Institute of Food, Nutrition and Human Health, Massey University, Private Bag 11222, Palmerston North 4442, Palmerston North, New Zealand. m.c.kruger@massey.ac.nz
authors.forename: Marlena C
authors.initials: MC
authors.lastname: Kruger
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Todd
authors.forename: Linda M
authors.initials: LM
authors.lastname: Schollum
authors.forename: Barbara
authors.initials: B
authors.lastname: Kuhn-Sherlock
authors.forename: Drew W
authors.initials: DW
authors.lastname: McLean
authors.forename: Kim
authors.initials: K
authors.lastname: Wylie
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001208:Asia; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D017678:Sex Distribution; D012737:Sex Factors; D014463:Ultrasonography; D055815:Young Adult