Low heel ultrasound parameters predict mortality in men: Results from the European Male Ageing Study (EMAS)

Stephen R. Pye, Dirk Vanderschueren, Steven Boonen, Evelien Gielen, Judith E. Adams, Kate A. Ward, David M. Lee, György Bartfai, Felipe F. Casanueva, Joseph D. Finn, Gianni Forti, Aleksander Giwercman, Thang S. Han, Ilpo T. Huhtaniemi, Krzysztof Kula, Michael E. Lean, Neil Pendleton, Margus Punab, Frederick C. Wu, Terence W. O'Neill

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2 Citations (Scopus)


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 BUAwas 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). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men.

Original languageEnglish
Article numberafv073
Pages (from-to)801-807
Number of pages7
JournalAge and Ageing
Issue number5
Publication statusPublished - Sep 1 2015


  • Epidemiology
  • Men
  • Mortality
  • Older people
  • Quantitative heel ultrasound

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology

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    Pye, S. R., Vanderschueren, D., Boonen, S., Gielen, E., Adams, J. E., Ward, K. A., Lee, D. M., Bartfai, G., Casanueva, F. F., Finn, J. D., Forti, G., Giwercman, A., Han, T. S., Huhtaniemi, I. T., Kula, K., Lean, M. E., Pendleton, N., Punab, M., Wu, F. C., & O'Neill, T. W. (2015). Low heel ultrasound parameters predict mortality in men: Results from the European Male Ageing Study (EMAS). Age and Ageing, 44(5), 801-807. [afv073]. https://doi.org/10.1093/ageing/afv073