Calcaneal broadband ultrasound attenuation predicts physical capability: EPIC-Norfolk prospective population-based study

Sarah Perrott* (Corresponding Author), Kathryn Martin, Victoria L Keevil, Nicholas J. Wareham, Kay-Tee Khaw, Phyo Kyaw Myint

*Corresponding author for this work

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Calcaneal ultrasound (broadband ultrasound attenuation – BUA), a marker of bone strength, may predict future physical capability and thus provide a strategy to identify individuals at risk of age-related deterioration of health. This study aims to determine if BUA can predict future physical capability among middle-aged and older adults.

Summary performance scores (SPS), an objective quantification of physical capability, were devised using participants' measures of standing balance, gait speed and timed chair rises. Associations between BUA and SPS, measured at least six years apart, were investigated using univariable and multivariate sex-specific linear and logistic regression, adjusting for confounders.

5893 participants were included. In men and women, for every five points lower BUA, there was a 0.2-point decrease in SPS. In women, BUA less than one standard deviation below the mean was associated with low physical capability (defined as SPS 3–6); fully adjusted odds ratio (OR) (95 % confidence interval (CI)) 1.35 (1.01–1.84). No association existed among men; OR (95 % CI) 0.84 (0.59–1.19). Significant risk factors for low physical capability in men with baseline low BUA were: older age [OR 5.77]; high BMI [OR 2.85]; lower social class [OR 1.59]; low physical activity [OR 1.64]. Risk factors among women were: older age [OR 5.54]; high BMI [OR 2.08]; lower education [OR 1.42], low physical activity [OR 1.27]; steroid use [OR 2.05]; and stroke [OR 2.74].

BUA may predict future physical capability in older adults. With further validation, BUA could stratify individuals at risk of deterioration in physical health.

BUAbroadband ultrasound attenuation;SPSsummary performance score2HCsecond health checkBMIbody mass indexSDstandard deviationORodds ratioCIconfidence intervalADLactivity of daily livingEPICEuropean Prospective Investigation into CancerCUBAcalcaneal ultrasound broadband attenuationDEXAdual energy X-ray absorptiometryTDITownsend Deprivation IndexHRThormone replacement therapy
Original languageEnglish
Pages (from-to)7-15
Number of pages9
Early online date3 May 2023
Publication statusPublished - 1 Jul 2023

Bibliographical note

This work was supported by funding from the Medical Research Council (Grant/Award Numbers: MR/N003284/1, MC-UU_12015/1) and Cancer Research UK (Grant/Award Number: C864/A14136), with additional support from the Stroke Association, British Heart Foundation, Department of Health, Europe Against Cancer Programme Commission of the European Union, Food Standards Agency, Research into Ageing, AAcknowledgements
We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would also like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) was funded by the Medical Research Council, Grant number (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK, Grant number (C864/A14136).cademy of Medical Sciences and Wellcome Trust.


  • Physical capability
  • Broadband ultrasound attenuation
  • Bone strength
  • Older adults


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