Ultrasonographic evaluation of the effects of osteoporosis on tendon morphology in postmenopausal patients

Ergin Ergani, G.O., Ultrasonographic Evaluation of the Effects of Osteoporosis on Tendon Morphology in Postmenopausal Patients, Hacettepe University Medical School, Thesis in Physical and Rehabilitation Medicine, Ankara, 2024. The aim of this study was to evaluate the effects of osteoporosis and bone mineral density (BMD) values measured by dual energy X-ray absorptiometry (DXA) on tendon morphology, using ultrasonographic (US) imaging in postmenopausal patients. A total of 128 postmenopausal female patients were included in the study. Demographic/clinical data and anthropometric measurements of the individuals were collected. BMD values of the femoral neck, total femur, and lumbar vertebrae (L1-L4) were recorded using DXA. US measurements of the supraspinatus (SSP), patellar, and Achilles tendon as well as SSP and quadriceps muscle thicknesses were performed on the dominant limb. When a tear was detected in the SSP tendon, the type and location of the tear were recorded. Physical performance was assessed during walking speed and a five-repetition sit-to-stand test, while muscle strength was evaluated by hand grip strength measurements. Mean age of the participants was 62,1±8,1 years. Osteoporosis was detected in 53 patients (41,4%), while 75 patients (58,6%) did not have osteoporosis. SSP, patellar, and Achilles tendon thicknesses were found to be significantly lower in patients with osteoporosis compared to those without (all p<0,05). SSP tendon tear was detected in 10 out of 53 patients (18,8%) with osteoporosis and in 12 out of 75 patients (16%) without. SSP tendons of patients with diabetes mellitus (DM) were observed to be thicker compared to those without (p=0,005). Linear regression analyses demonstrated that femoral neck BMD values were independently associated with SSP (β=0.304), patellar (β=0,337) and Achilles (β=0,301) tendons (all p<0,05). Additionally, L1-L4 vertebra BMD values were found to be independently associated with the thicknesses of the SSP (β=0,179) and Achilles (β=0,219) tendons (all p<0,05). Furthermore, the presence of DM was also found to be independently/positively related with SSP (β=0,239) and patellar (β=0,180) tendon thicknesses, while age was independently/negatively related with the SSP tendon (β=-0,204) thickness. In osteoporotic patients, caution must be taken as regards the development of decreased tendon thickness and possible ruptures. Symptomatic evaluation related to tendon pathology and US examination, when necessary, may be beneficial for early diagnosis and treatment. Further studies with larger samples are needed for better evaluation of the relationship between BMD and tendon morphology in postmenopausal women.