title: Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS).
abstract: BACKGROUND
  low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men.
  
  
  METHODS
  men aged 40-79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic-SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model.
  
  
  RESULTS
  from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0-1.4). Compared with those in higher quintiles (2nd-5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1-2.3 and SOS: HR = 1.6; 95% CI = 1.2-2.2).
  
  
  CONCLUSIONS
  lower heel ultrasound parameters are associated with increased mortality in European men.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.affiliation: Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.affiliation: Leuven University Division of Geriatric Medicine and Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Evelien
authors.initials: E
authors.lastname: Gielen
authors.affiliation: Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Adams
authors.affiliation: MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Ward
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.affiliation: Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.affiliation: Santiago de Compostela University, Complejo Hospitalario, Universitario de Santiago (CHUS), A Coruña, Spain.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.affiliation: Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.affiliation: University of Florence, Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: University of Lund, Lund, Sweden.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Royal Free and University College Hospital Medical School, London, UK.
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.affiliation: Imperial College, London, UK.
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.affiliation: Medical University of Łódź, Łódź, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.affiliation: Human Nutrition, University of Glasgow, Glasgow, UK.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lean
authors.affiliation: Geriatric Medicine, Salford Royal Hospital NHS Trust, Manchester, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.affiliation: United Laboratories of Tartu University Clinics, Tartu, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Wu
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK.
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D015992:Body Mass Index; D002423:Cause of Death; D015897:Comorbidity; D005060:Europe; D015577:Geriatric Assessment; D006304:Health Status; D006365:Heel / Q000000981:diagnostic imaging*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014463:Ultrasonography
keywords: epidemiology; men; mortality; older people; quantitative heel ultrasound