Fracture detection unimproved by combining bone resorption markers with heel QUS
MedWire News: Combining urinary bone resorption markers with heel quantitative ultrasound (QUS) to predict non-vertebral fracture in elderly women is no more sensitive than using either test alone, Swiss research shows.
To assess the discriminatory power of urinary markers of bone resorption and heel QUS for non-vertebral fractures, David Nanchen (University of Lausanne) and colleagues studied 195 women (mean age 76.2 years) with low-trauma hip or arm fractures and 173 non-fracture controls matched for age, body mass index, medical center, and follow-up duration.
All women underwent bone evaluations using Achilles+ and Sahara heel QUS, while urinary total pyridinolines (PYD) and deoxypyridinolines (DPD) were measured by high performance liquid chromatography. The ability of each of these tests to discriminate between patients with and without fracture was evaluated using receiver operating-characteristic analysis.
The researchers report that the women in the fracture group had significantly higher levels of PYD and DPD and significantly lower QUS measurements than the controls.
The area under the receiver operating-characteristic curve (AUC) scores were 0.62 and 0.59 for PYD and DPD, and 0.64 and 0.65 for Achilles+ and Sahara QUS, respectively. There was no significant difference between the discriminatory powers of each of the tests.
Combining the resorption marker data with QUS increased the AUC slightly to 0.66 for Achilles+ with PYD and 0.68 for Sahara with PYD, but the improvement was not statistically significant compared with either test alone.
In sub-analyses, the discriminatory power was higher for all tests when only the hip fracture subgroup was considered, with PYD exhibiting the highest AUC, at 0.75, but again, no single test was statistically better than any other.
“Our study increases the quantity of evidence supporting the relatively equal capacity of urinary bone resorption markers and heel QUS to detect elderly ambulant women at risk for low-trauma non-vertebral fractures relative to matched controls,” conclude Nanchen et al in the journal Osteoporosis International.
They add: “These data, in turn, may help in the design of efficient strategies to evaluate fracture risk in elderly women.”
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By Laura Dean