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Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls

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Abstract

Summary

This nested case-control analysis of a Swiss ambulatory cohort of elderly women assessed the discriminatory power of urinary markers of bone resorption and heel quantitative ultrasound for non-vertebral fractures. The tests all discriminated between cases and controls, but combining the two strategies yielded no additional relevant information.

Introduction

Data are limited regarding the combination of bone resorption markers and heel quantitative bone ultrasound (QUS) in the detection of women at risk for fracture.

Methods

In a nested case-control analysis, we studied 368 women (mean age 76.2 ± 3.2 years), 195 with low-trauma non-vertebral fractures and 173 without, matched for age, BMI, medical center, and follow-up duration, from a prospective study designed to predict fractures. Urinary total pyridinolines (PYD) and deoxypyridinolines (DPD) were measured by high performance liquid chromatography. All women underwent bone evaluations using Achilles+ and Sahara heel QUS.

Results

Areas under the receiver operating-characteristic curve (AUC) for discriminative models of the fracture group, with 95% confidence intervals, were 0.62 (0.56–0.68) and 0.59 (0.53–0.65) for PYD and DPD, and 0.64 (0.58–0.69) and 0.65 (0.59–0.71) for Achilles+ and Sahara QUS, respectively. The combination of resorption markers and QUS added no significant discriminatory information to either measurement alone with an AUC of 0.66 (0.60–0.71) for Achilles+ with PYD and 0.68 (0.62–0.73) for Sahara with PYD.

Conclusions

Urinary bone resorption markers and QUS are equally discriminatory between non-vertebral fracture patients and controls. However, the combination of bone resorption markers and QUS is not better than either test used alone.

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Acknowledgements

The authors are very grateful to the SEMOF group which authorized us to use their database.

Conflicts of interest

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Authors and Affiliations

  1. Department of Ambulatory Care and Community Medicine, University of Lausanne, 44 Rue du Bugnon, 1011, Lausanne, Switzerland

    D. Nanchen, J. Cornuz & M. A. Krieg

  2. Institute of Social and Preventive Medicine, University of Lausanne, 17 Rue du Bugnon, 1005, Lausanne, Switzerland

    D. Nanchen & C. Ruffieux

  3. Institute of Clinical Chemistry and Hematology, State Hospital of St.Gall, Haus 20, 9007, St. Gall, Switzerland

    W. Riesen

  4. Bois-Cerf Clinic, Avenue d’Ouchy 31, 1006, Lausanne, Switzerland

    P. Burckhardt

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  1. D. Nanchen
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Correspondence to D. Nanchen.

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Nanchen, D., Cornuz, J., Ruffieux, C. et al. Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls. Osteoporos Int 20, 1695–1703 (2009). https://doi.org/10.1007/s00198-009-0843-z

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  • DOI: https://doi.org/10.1007/s00198-009-0843-z

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