RESEARCH - Risk of vertebral fractures using ultrasound measurements and BMD

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ls of the Rheumatic Diseases 2009;68:391-396

CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Prospective evaluation of risk of vertebral fractures using

quantitative ultrasound measurements and bone mineral density in a

population-based sample of postmenopausal women: results of the Basel

Osteoporosis Study

R Hollaender1, F Hartl1, M-A Krieg2, A Tyndall1, C Geuckel3, C

Buitrago-Tellez4, M Manghani1, M Kraenzlin5, R Theiler6 and D Hans7

1 Department of Rheumatology, Felix Platter-Hospital, University of

Basel, Basel, Switzerland

2 Department of Internal Medicine, University of Lausanne, Switzerland

3 Imamed Radiologie Nordwest, Basel, Switzerland

4 Hightech Research Center, Institute of Radiology, Zofingen Hospital,

Switzerland

5 Department of Endocrinology, University of Basel, Basel, Switzerland

6 Department of Rheumatology, City Hospital Triemli, Zurich, Switzerland

7 Nuclear Medicine Division, Geneva University Hospital, Geneva, Switzerland

Objective: Prospective studies have shown that quantitative ultrasound

(QUS) techniques predict the risk of fracture of the proximal femur

with similar standardised risk ratios to dual-energy x-ray

absorptiometry (DXA). Few studies have investigated these devices for

the prediction of vertebral fractures. The Basel Osteoporosis Study

(BOS) is a population-based prospective study to assess the

performance of QUS devices and DXA in predicting incident vertebral

fractures.

Methods: 432 women aged 60–80 years were followed-up for 3 years.

Incident vertebral fractures were assessed radiologically. Bone

measurements using DXA (spine and hip) and QUS measurements (calcaneus

and proximal phalanges) were performed. Measurements were assessed for

their value in predicting incident vertebral fractures using logistic

regression.

Results: QUS measurements at the calcaneus and DXA measurements

discriminated between women with and without incident vertebral

fracture, (20% height reduction). The relative risks (RRs) for

vertebral fracture, adjusted for age, were 2.3 for the Stiffness Index

(SI) and 2.8 for the Quantitative Ultrasound Index (QUI) at the

calcaneus and 2.0 for bone mineral density at the lumbar spine. The

predictive value (AUC (95% CI)) of QUS measurements at the calcaneus

remained highly significant (0.70 for SI, 0.72 for the QUI, and 0.67

for DXA at the lumbar spine) even after adjustment for other

confounding variables.

Conclusions: QUS of the calcaneus and bone mineral density

measurements were shown to be significant predictors of incident

vertebral fracture. The RRs for QUS measurements at the calcaneus are

of similar magnitude as for DXA measurements.

http://ard.bmj.com/cgi/content/abstract/68/3/391

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