Open Access Research article

Bone health comparison in seven Asian countries using calcaneal ultrasound

Marlena C Kruger1*, Joanne M Todd2, Linda M Schollum23, Barbara Kuhn-Sherlock23, Drew W McLean2 and Kim Wylie1

Author Affiliations

1 Institute of Food, Nutrition and Human Health, Massey University, Private Bag 11222, Palmerston North 4442, Palmerston North, New Zealand

2 Fonterra Co-operative Ltd, Private Bag 92032, Auckland, New Zealand

3 Fonterra Research and Development Centre, Private Bag 11029, Palmerston North 4442, New Zealand

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BMC Musculoskeletal Disorders 2013, 14:81  doi:10.1186/1471-2474-14-81

Published: 5 March 2013



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.


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.


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.


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.

Heel ultrasound; Asia; Risk for osteoporosis