Quantitative ultrasound may aid osteoporotic fracture detection
By Joanna Lyford
08 March 2012
J Clin Endocrinol Metab 2012; 97: 800–809

MedWire News: Researchers have published thresholds for quantitative ultrasound (QUS) of the calcaneus that predicts the risk for osteoporotic fracture in middle-aged Chinese individuals.

Jian-Min Liu (Shanghai Jiao-Tong University, China) and co-workers say that a calcaneus stiffness index T-score of less than 1.25 in women and less than 1.30 in men should trigger further evaluation of bone mineral density.

Their figures are based on a cross-sectional, population-based study involving 9352 women and men aged 40 years and above living in two communities in Shanghai, China. These individuals were participating in a wider epidemiologic study of metabolic diseases and their risk factors.

For the present analysis, all participants underwent QUS at the dominant calcaneus for assessment of speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI)-derived T-score. They were also interviewed about their medical history, including any fractures occurring after the age of 25 years.

The results, reported in the Journal of Clinical Endocrinology and Metabolism, showed that the participants' mean age was 57.60 years, the mean body mass index (BMI) was 24.98 kg/m2, and mean SI-derived T-score was -0.36.

The prevalence of osteoporotic fracture was 14.9% in women and 12.2% in men, and these figures increased with older age and lower BMIs.

Interestingly, participants with a prior fracture had significantly lower values for all QUS parameters - including SOS, BUA, and SI-derived T score - than those without a fracture. These differences persisted after adjusting for age, gender, and other fracture risk factors.

Indeed, each 1-standard deviation decrease in the SI-derived T-score was associated with an increased risk for nonvertebral, vertebral, and multiple fractures, at adjusted odds ratios of 1.50, 1.49, and 1.89, respectively.

Using receiver operating characteristic curves, Liu et al showed that SI-derived T-score was the best QUS parameter for predicting prevalent fracture. Optimal cutpoints to detect nonvertebral fractures, clinical vertebral fractures, and multiple fractures were -1.25, -1.55, and -1.80 in postmenopausal women, respectively, and -1.30, -1.90, and -2.00 in men, respectively.

Liu et al conclude: "The present large-scale, population-based study provides further evidence to support the effectiveness of calcaneus QUS measurements in identifying postmenopausal women and men at high risk for fractures."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

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