RESEARCH - Long-term fracture prediction by DX and QUS: a 10-year prospective study

[Guest guest]

J Bone Miner Res. 2006 Mar;21(3):413-8. Epub 2005 Dec 19.

Long-term fracture prediction by DXA and QUS: a 10-year prospective study.

A, Kumar V, Reid DM.

Osteoporosis Research Unit, Department of Medicine and Therapeutics,

University of Aberdeen, Aberdeen, United Kingdom. a.stewart@...

This study investigated the ability of DXA and QUS to predict fractures long

term when measured around the time of the menopause. We found both DXA and

QUS are able to predict both any fracture and " osteoporotic " fractures and

that QUS can predict independently of BMD. INTRODUCTION: There are now many

treatments available for prevention of osteoporotic fracture. To be

cost-effective, we need to target those most at risk. This study examines

the ability of DXA and QUS to predict fractures in an early postmenopausal

population of women. MATERIALS AND METHODS: We prospectively measured 3883

women who had been randomly selected from a community-based register. At

baseline, they were measured using DXA of spine and hip (Norland XR-26) and

QUS of the heel ( Sonix UBA 575). Follow-up had a mean of 9.7 +/- 1.1

(SD) years. All incident fractures were identified and validated by

examination of X-ray reports, and these were compared with those without

fracture in a -regression model to calculate hazard ratios (HRs).

RESULTS: We found adjusted HRs for any fracture per 1 SD reduction in spine

BMD to be 1.61 (1.42-1.83), whereas neck of femur BMD was 1.54 (1.34-1.75).

Areas under the curve (AUC) for a receiver operator characteristic (ROC)

analysis were 0.62 for spine BMD and 0.59 for neck BMD. In a subgroup where

QUS was also measured, the HR for a 1 SD reduction in BMD was 1.69

(1.29-2.22) for spine BMD and 1.55 (1.17-2.06) for neck BMD. The HR for a 1

SD reduction in broadband ultrasound attenuation (BUA) was 1.53 (1.19-1.96),

and 1.44 (1.12-1.86) when further adjusted for neck BMD. The AUCs were 0.63

for spine BMD, 0.59 for neck BMD, and 0.62 for BUA. When only osteoporotic

fractures were examined, the HRs increased in all situations. BUA showed the

highest HR of 2.25 (1.51-3.34), and when further adjusted for neck BMD was

2.12 (1.38-3.28).

CONCLUSIONS: In conclusion, it may be possible to scan women around the time

of the menopause to predict future fractures. It seems that, for

" osteoporotic " fractures, BUA may be an improved predictor of fractures in

comparison with DXA, because the relative risk is highest for BUA, and

independent of BMD.

PMID: 16491289

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16491289

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org