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Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study

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Abstract

Identifying women with osteoporosis remains a clinical challenge, as it may not be feasible or cost-effective to recommend dual-energy X-ray absorptiometry (DXA) for all postmenopausal women. In this regard, quantitative ultrasound (QUS) has emerged as an attractive screening tool because of the (relatively) low cost and because QUS and DXA-assessed BMD appear to be equally predictive of future (hip) fracture risk. The objective of this study was to compare the ability of calcaneal QUS to identify osteoporosis with two alternative potential screening methods: digital X-ray radiogrammetry (DXR) and radiographic absorptiometry (RA). We enrolled a total of 221 postmenopausal community-dwelling Caucasian women aged 50–75 years. Bone mineral density (BMD) was measured at the lumbar spine and the total hip regions using DXA. Calcaneal ultrasound attenuation and velocity were assessed using QUS and metacarpal and phalangeal bone density were estimated by the use of DXR and RA, respectively. Receiver operating characteristic (ROC) curves were constructed by calculating the specificity and sensitivity of QUS, DXR, and RA at different cut-point values in discriminating osteoporosis, as defined by a T-score below –2.5 at the spine or hip using DXA, and the areas under the curves (AUCs) were computed. The sensitivity for identifying women with osteoporosis was 67.6% [95% confidence interval (CI), 50.2–82.0%] using QUS and was 76.9% (95% CI, 60.7–88.8%) and 82.9% (95% CI, 67.9–92.8%), respectively, using DXR and RA. The negative predictive value (NPV, the proportion of patients with a negative test who have no osteoporosis) was 90% for QUS, compared with an NPV of 94% for both DXR and RA. These data suggest that metacarpal DXR and phalangeal RA may be as effective as calcaneal QUS for targeting DXA testing in high-risk postmenopausal women.

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Refererences

  1. Grampp S, Genant HK, Mathur A, Lang P, Jergas M (1997) Comparisons of non-invasive bone mineral measurements in assessing age related loss, fracture discrimination and diagnosis classification. J Bone Miner Res 12:697–711

    CAS  PubMed  Google Scholar 

  2. Kanis J for the WHO study group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381

    CAS  PubMed  Google Scholar 

  3. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant H, Hulley S, Palermo L, Scott J, Vogt T (1993) Bone density at various sites for prediction of hip fractures. Lancet 341:72–75

    CAS  PubMed  Google Scholar 

  4. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 4:37–48

    CAS  PubMed  Google Scholar 

  5. Von Mühlen D, Visby Lunde A, Barrett-Connor E, Betencourt R (1999) Evaluation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) in older Caucasian women: the Rancho Bernardo Study. Osteoporos Int 10:79–84

    Article  CAS  PubMed  Google Scholar 

  6. Genant HK, Engelke K, Fuerst T (1996) Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 11:707–730

    CAS  PubMed  Google Scholar 

  7. Rosholm A, Hyldstrup L, Baeksgaard L, Grunkin M, Thodberg H (2001) Estimation of bone mineral density by digital X-ray radiogrammetry: theoretical background and clinical testing. Osteoporos Int 12:961–969

    Article  CAS  PubMed  Google Scholar 

  8. Mussolino ME, Looker AC, Madans JH, Edelstein D, Walker RE, Lydick E, Epstein RS, Yates AJ (1997) Phalangeal bone density and hip fracture risk. Arch Int Med 157:433–438

    Article  CAS  Google Scholar 

  9. Boonen S, Kaufman JM, Réginster JY, Devogelaer JP (2003) Patient assessment using standardized bone mineral density values and a national reference data base. Osteoporos Int 14:110–115

    CAS  PubMed  Google Scholar 

  10. Hans D, Dargent-Molina P, Schott A (1996) Ultrasonographic heel measurements to predict hip fracture in the elderly. Lancet 348:511–514

    CAS  PubMed  Google Scholar 

  11. Bauer D, Glüer C, Cauley J (1997) Bone ultrasound predicts fractures strongly and independently of densitometry in older women: a prospective study. Arch Int Med 157:629–634

    Article  CAS  Google Scholar 

  12. Glüer C, Wu C, Jergas M, Goldstein S, Genant H (1994) Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 55:46–52

    PubMed  Google Scholar 

  13. Cummings S, Black D, Thompson D, Applegate W, Barrett-Connor E, Musliner T, Palermo L, Prinea R, Rubin S, Scott J, Vogt T, Wallace R, Yates J, LaCroix A (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082

    CAS  PubMed  Google Scholar 

  14. Black D, Cummings S, Karpf D, Cauley J, Thompson D, Nevitt M, Bauer D, Genant H, Haskell W, Marcus R, Ott S, Torner J, Quandt S, Reiss T, Ensrud K (1996) Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541

    CAS  PubMed  Google Scholar 

  15. Ettinger B, Black D, Mitlak B, Knickerbocker R, Nickelsen T, Genant H, Christiansen C, Delmas P, Zanchetta J, Stakkestad J, Glüer C, Krueger K, Cohen F, Eckert S, Ensrud K, Avioloi L, Lips P, Cummings S (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. JAMA 282:637–645

    CAS  PubMed  Google Scholar 

  16. Réginster JY, Minne H, Sorensen O, Hooper M, Roux C, Brandi M, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 11:83–91

    CAS  PubMed  Google Scholar 

  17. Kanis J, Glüer C for the Committee of Scientific Advisors of the IOF (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 11:192–202

    Article  CAS  PubMed  Google Scholar 

  18. National Osteoporosis Foundation (1999) Physician’s guide to prevention and treatment of osteoporosis. Excerpta Medica, Belle Mead, N.J.

  19. Hanley J, McNeil B (1982) The meaning and use of the area under a receiver operating characteristic curve. Radiology 143:29–36

    CAS  PubMed  Google Scholar 

  20. Cadarette S, Jaglal S, Murray T, McIsaac W, Joseph L, Brown J for the Canadian Multicentre Osteoporois Study (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorptiometry. JAMA 286:57–63

    Article  CAS  PubMed  Google Scholar 

  21. Faulkner K, McClung M, Coleman L (1994) Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites. Osteoporos Int 4:42–47

    CAS  PubMed  Google Scholar 

  22. Herd R, Blake G, Miller C (1994) The ultrasonic assessment of osteopenia as defined by dual X-ray absorptiometry. Br J Radiol 67:631–635

    CAS  PubMed  Google Scholar 

  23. Young H, Howey S, Purdie D (1993) Broadband ultrasound attenuation compared with dual-energy X-ray absorptiometry in screening for postmenopausal low bone density. Osteoporos Int 3:160–164

    CAS  PubMed  Google Scholar 

  24. Benitez C, Schneider D, Barrett-Connor E, Sartoris D (2000) Hand ultrasound for osteoporosis screening in postmenopausal women. Osteoporos Int 11:203–210

    Article  CAS  PubMed  Google Scholar 

  25. Glüer C and the International Quantitative Ultrasound Consensus Group (1997) Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. J Bone Miner Res 12:1280–1288

    PubMed  Google Scholar 

  26. Greenspan S, Maitland-Ramsey L, Myers E (1998) Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tissue Int 58:409–414

    Google Scholar 

  27. Eddy DM, Johnston CC, Cummings SR, Dawson-Hughes B, Lindsay R, Melton LJ, Slemenda CW (1998) Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporos Int 8:S1–S88

    Article  Google Scholar 

  28. Looker A, Wahner H, Dunn W (1995) Proximal femur bone mineral levels of US adults. Osteoporos Int 5:389–409

    CAS  PubMed  Google Scholar 

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Acknowledgements

Dr. S. Boonen and J. Nijs contributed equally to the manuscript. Dr. S. Boonen is the holder of the Leuven University Chair in Metabolic Bone Diseases, founded and supported by Merck Sharp & Dohme. Dr. S. Boonen and Dr. D. Vanderschueren are senior clinical investigators of the Fund for Scientific Research-Flanders, Belgium (F.W.O.-Vlaanderen). The authors wish to thank J. Cartois and H. Vanderstraeten for excellent editorial assistance. This study was supported by Agfa Gevaert NV, Mortsel, Belgium.

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Authors and Affiliations

  1. Leuven University Center for Metabolic Bone Diseases, Universitaire Ziekenhuizen K.U.Leuven, Herestraat 49, B-3000, Leuven, Belgium

    Steven Boonen, Herman Borghs, Dirk Vanderschueren & Frank P. Luyten

  2. Department of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

    Steven Boonen

  3. Department of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium

    Dirk Vanderschueren

  4. Department of Rheumatology, Katholieke Universiteit Leuven, Leuven, Belgium

    Jos Nijs, Herman Borghs, Herman Peeters & Frank P. Luyten

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  1. Steven Boonen
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  2. Jos Nijs
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Correspondence to Steven Boonen.

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Boonen, S., Nijs, J., Borghs, H. et al. Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study. Osteoporos Int 16, 93–100 (2005). https://doi.org/10.1007/s00198-004-1660-z

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  • DOI: https://doi.org/10.1007/s00198-004-1660-z

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