Discriminatory Ability of Quantitative Ultrasound Parameters and Bone Mineral Density in a Population‐Based Sample of Postmenopausal Women With Vertebral Fractures: Results of the Basel Osteoporosis Study

The discriminatory potential to classify subjects with or without vertebral fractures was tested cross‐sectionally with different methods for the measurement of bone status in a population‐based sample of postmenopausal women. Quantitative ultrasound (QUS) measurement at the calcaneus (Lunar Achilles, Hologic Sahara), the proximal phalanges (Igea Bone Profiler), and measurement of bone mineral density (BMD) with dual‐energy X‐ray absorptiometry (DXA; Lunar Expert) at several anatomic sites was performed in 500 postmenopausal women (aged 65‐75 years) randomly selected from the population. In addition, 50 young female subjects (20‐40 years old) had QUS measurements and served as controls to express QUS results as T‐score values. Radiographs of the lumbar and thoracic spine were performed in the elderly women. Two independent radiologists reviewed the X‐rays for the presence of vertebral fractures. Of 486 eligible study participants, no fracture was seen in 396 participants. Single vertebral fractures were observed in 71 subjects; 19 individuals presented multiple fractures. The overall prevalence of vertebral fractures was 18.5%. Participants without vertebral fractures were compared with subjects with vertebral fractures. Normal statistical distributions were found for all bone measurement results. Risk of vertebral fracture in subjects with no and multiple vertebral fracture was estimated using age adjusted odds ratios (ORs) for QUS and dual‐energy X‐ray absorptiometry (DXA) values. Each SD decrease in bone measurement increased the risk of multiple vertebral fracture by 3.0 (95% CI, 1.6‐5.6) for the Achilles stiffness, by 3.8 (95% CI, 1.8‐8.2) for the Sahara QUI, 2.1 (95% CI, 1.3‐3.4) for the Bone Profiler amplitude‐dependent speed of sound (AD‐SOS), and 2.1 (95% CI, 1.2‐3.9) and 2.4 (95% CI, 1.3‐4.3) for DXA lumbar spine and for DXA total hip, respectively. Results of a discriminant analysis showed sensitivities between 84% and 58% and specificities between 72% and 58% for the respective DXA and QUS parameters. Optimum fracture thresholds for QUS measurements derived from this analysis were calculated also. Optimum T‐score threshold values for QUS measurements tended to be higher than those for DXA measurements. However, the performance of QUS measurements is at least comparable with DXA measurements in identifying subjects with multiple vertebral fractures randomly selected from the population.

[1]  C. Cooper,et al.  Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. , 1997, Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA.

[2]  C. Cooper,et al.  The crippling consequences of fractures and their impact on quality of life. , 1997, The American journal of medicine.

[3]  C C Glüer,et al.  An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. , 2000, Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA.

[4]  J. Kanis,et al.  An Update on the Diagnosis and Assessment of Osteoporosis with Densitometry , 2000, Osteoporosis International.

[5]  J. Davis,et al.  Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound. , 1995, Bone.

[6]  J. Jurvelin,et al.  Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture. , 1995, Acta orthopaedica Scandinavica.

[7]  M. Funke,et al.  Broadband ultrasound attenuation in the diagnosis of osteoporosis: correlation with osteodensitometry and fracture. , 1995, Radiology.

[8]  G. Emons,et al.  Stiffness index identifies patients with osteoporotic fractures better than ultrasound velocity or attenuation alone. , 1999, Maturitas.

[9]  M. Nevitt,et al.  Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. , 1999, Bone.

[10]  G. Blake,et al.  Contact Quantitative Ultrasound: An Evaluation of Precision, Fracture Discrimination, Age-Related Bone Loss and Applicability of the WHO Criteria , 1999, Osteoporosis International.

[11]  A. Silman,et al.  Mortality Associated with Vertebral Deformity in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS) , 1998, Osteoporosis International.

[12]  S. B. Palmer,et al.  Prediction of hip fracture in elderly women: a prospective study. , 1990, BMJ.

[13]  C C Glüer,et al.  Quantitative ultrasound and vertebral fracture in postmenopausal women , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[14]  R. Mazess.  Quantitative heel ultrasound as a predictor for osteoporosis , 2000, The Medical journal of Australia.

[15]  J. Eisman,et al.  Assessment of spinal and femoral bone density by Dual X‐Ray absorptiometry: Comparison of lunar and hologic instruments , 1992, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[16]  P. Miller,et al.  Discordance in patient classification using T-scores. , 1999, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[17]  H K Genant,et al.  Defining Incident Vertebral Deformity: A Prospective Comparison of Several Approaches , 1999, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[18]  H. Minne,et al.  Ultrasound Analyses of the Calcaneus Predict Relative Risk of the Presence of at Least One Vertebral Fracture and Reflect Different Physical Qualities of Bone in Different Regions of the Skeleton , 1997, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[19]  P. Ross,et al.  Prediction of Fracture Risk by Radiographic Absorptiometry and Quantitative Ultrasound: A Prospective Study , 1998, Calcified Tissue International.

[20]  C. Mautalen,et al.  Ultrasound and dual X-ray absorptiometry densitometry in women with hip fracture , 1995, Calcified Tissue International.

[21]  L. Melton,et al.  Medical Expenditures for the Treatment of Osteoporotic Fractures in the United States in 1995: Report from the National Osteoporosis Foundation , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[22]  M. Bouxsein,et al.  Quantitative Ultrasound of the Calcaneus Reflects the Mechanical Properties of Calcaneal Trabecular Bone , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[23]  D Felsenberg,et al.  Vertebral fractures in men and women: how discriminative are bone mass measurements? , 1995, The British journal of radiology.

[24]  R. Recker,et al.  Ultrasound velocity through bone predicts incident vertebral deformity , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[25]  Glüer Cc.  Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group. , 1997 .

[26]  O Johnell,et al.  Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. , 1996, BMJ.

[27]  S. Rossi,et al.  The combined use of ultrasound and densitometry in the prediction of vertebral fracture. , 1997, The British journal of radiology.

[28]  K. Luk,et al.  Quantitative Ultrasound and Symptomatic Vertebral Fracture Risk in Chinese Women , 1999, Osteoporosis International.

[29]  L. Bouter,et al.  Ultrasound Measurements for the Prediction of Osteoporotic Fractures in Elderly People , 1999, Osteoporosis International.

[30]  V. De Maertelaer,et al.  Evaluation of quantitative ultrasound and dual X-Ray absorptiometry measurements in women with and without fractures. , 1999, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[31]  Claus Christiansen,et al.  Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. , 1994, World Health Organization technical report series.

[32]  L. Melton,et al.  The worldwide problem of osteoporosis: insights afforded by epidemiology. , 1995, Bone.

[33]  J. Aloia,et al.  Stiffness in Discrimination of Patients with Vertebral Fractures , 1999, Osteoporosis International.

[34]  Harry K. Genant,et al.  Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group. , 1997, Archives of internal medicine.

[35]  C. Glüer,et al.  Quantitative Ultrasound Techniques for the Assessment of Osteoporosis: Expert Agreement on Current Status , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[36]  C. Cooper,et al.  Vertebral Fractures Predict Subsequent Fractures , 1999, Osteoporosis International.

[37]  J. Cauley,et al.  Prevalent Vertebral Deformities Predict Mortality and Hospitalization in Older Women with Low Bone Mass , 2000, Journal of the American Geriatrics Society.

[38]  C C Glüer,et al.  Osteoporosis: association of recent fractures with quantitative US findings. , 1996, Radiology.

[39]  Dretakis Ec,et al.  Decreased broadband ultrasound attenuation of the calcaneus in women with fragility fracture. 85 Colles' and hip fracture cases versus 77 normal women. , 1994 .

[40]  S. Cummings,et al.  Bone density at various sites for prediction of hip fractures , 1993, The Lancet.

[41]  G. Breart,et al.  Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study , 1996, The Lancet.

[42]  P. Delmas.  Do We Need to Change the WHO Definition of Osteoporosis? , 2000, Osteoporosis International.

[43]  F Duboeuf,et al.  Ultrasound discriminates patients with hip fracture equally well as dual energy X‐ray absorptiometry and independently of bone mineral density , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[44]  P Burckhardt,et al.  [Epidemiology of osteoporosis]. , 1997, Schweizerische medizinische Wochenschrift.

[45]  C. Cooper,et al.  Epidemiology of osteoporosis. , 2002, Best practice & research. Clinical rheumatology.

[46]  D. Felsenberg,et al.  Bone Density Reduction in Various Measurement Sites in Men and Women with Osteoporotic Fractures of Spine and Hip: The European Quantitation of Osteoporosis Study , 1999, Calcified Tissue International.

[47]  J. Reginster,et al.  Phalangeal Osteosonogrammetry Study: Age‐Related Changes, Diagnostic Sensitivity, and Discrimination Power , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[48]  S. Bonnick.  Densitometry Techniques in Medicine Today , 1998 .