title: Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group.
abstract: BACKGROUND
  Quantitative ultrasound of bone is a new radiation-free technique that measures bone mass and may assess bone quality. Retrospective studies have suggested that low-bone ultrasound of the calcaneus is associated with an increased risk for hip and other fractures in older women.
  
  
  OBJECTIVE
  To establish the utility of calcaneal quantitative ultrasound of bone for the prediction of fractures and to compare quantitative ultrasound of bone with bone mineral densitometry by performing a prospective cohort study within the Study of Osteoporotic Fractures.
  
  
  METHODS
  We studied 6189 postmenopausal women older than 65 years of 4 US clinical centers. Broadband ultrasound attenuation (BUA), a measurement of the differential attenuation of sound waves transmitted through the calcaneus, and bone mineral density of the calcaneus and hip were measured. Subsequent hip and other nonspine fractures were documented during a mean follow-up of 2.0 years.
  
  
  RESULTS
  In age- and clinic-adjusted analyses, each SD reduction in calcaneal BUA was associated with a doubling of the risk for hip fractures (relative risk [RR], 2.0; 95% confidence interval [CI], 1.5-2.7); a similar relationship was observed with bone mineral density of the calcaneus (RR, 2.2; 95% CI, 1.9-3.0) and femoral neck (RR, 2.6; 95% CI, 1.9-3.8). After adjustment for bone mineral density of the femoral neck, BUA was still associated with an increased risk for hip fracture (RR, 1.5; 95% CI, 1.0-2.1). Intertrochanteric fractures in particular were strongly associated with a low BUA measurement (RR, 3.3; 95% CI, 2.0-5.5).
  
  
  CONCLUSIONS
  Broadband ultrasound attenuation predicts the occurrence of fractures in older women and is a useful diagnostic test for osteoporosis. The strength of the association between BUA and fracture is similar to that observed with bone mineral density.
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Bauer
authors.forename: C C
authors.initials: CC
authors.lastname: Glüer
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.forename: T M
authors.initials: TM
authors.lastname: Vogt
authors.forename: K E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: H K
authors.initials: HK
authors.lastname: Genant
authors.forename: D M
authors.initials: DM
authors.lastname: Black
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003720:Densitometry; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D014463:Ultrasonography