Quantitative ultrasound of the heel predicts fracture elsewhere
MedWire: Quantitative ultrasound (QUS) of the heel predicts future fracture risk in elderly men and women, according to the results of a meta-analysis.
Michael Lewiecki (New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico, USA) and colleagues conducted a meta-analysis of prospective studies that measured heel QUS at baseline and the fracture outcomes at follow-up.
They looked at 21 studies, including a total of 55,164 women and 13,742 men, and compared the relative risks of a range of QUS parameters for a number of fracture outcomes (hip, vertebral, any clinical, any osteoporotic, and major osteoporotic fractures).
The current World Health Organization (WHO) criteria for osteoporosis diagnosis are based on bone density measurements using dual-energy X-ray absorptiometry (DXA). QUS has several advantages over this method, say the researchers, "they are smaller, transportable, and less expensive than DXA scanners, and do not use ionizing radiation."
They add: "Over the last 15 years, the body of evidence highlighting the ability of QUS to predict fracture risk has become substantial, but its use in clinical practice is still not well defined."
In this study, published in the journal Osteoporosis International, four QUS parameters were considered: broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and quantitative ultrasound index (QUI).
All four parameters at the heel were found to be associated with the risk for fracture elsewhere in the body. For example, the relative risk for hip fracture for each 1-standard deviation increase in BUA was 1.96, and in SOS 1.96, for SI 2.26, and QUI was 1.99.
"If central DXA cannot be used, appropriate patient management can be initiated if the fracture probability, as assessed by QUS using device-specific thresholds and in conjunction with clinical risk factors, is sufficiently high," conclude Lewiecki et al. "Further studies are needed to test such a clinical approach."
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By Chloe McIvor