title: Comparison of three bone ultrasounds for the discrimination of subjects with and without osteoporotic fractures among 7562 elderly women.
abstract: Bone ultrasound measures (QUSs) can assess fracture risk in the elderly. We compared three QUSs and their association with nonvertebral fracture history in 7562 Swiss women 70-80 years of age. The association between nonvertebral fracture was higher for heel than phalangeal QUS.
  
  
  BACKGROUND
  Because of the high morbidity and mortality associated with osteoporotic fractures, it is essential to detect subjects at risk for such fractures with screening methods. Because quantitative bone ultrasound (QUS) discriminated subjects with osteoporotic fractures from controls in several cross-sectional studies and predicted fractures in prospective studies, QUS could be more practical than DXA for screening.
  
  
  METHODS
  This cross-sectional and retrospective multicenter (10 centers) study was performed to compare three QUSs (two heel ultrasounds: Achilles+ [GE-Lunar] and Sahara [Hologic]; the phalanges: ultrasound DBM sonic 1200 [IGEA]) for determining by logistic regression nonvertebral fracture odds ratio (OR) in a sample of 7562 Swiss women, 75.3 +/- 3.1 years of age. The two heel QUSs measured the broadband ultrasound attenuation (BUA) and the speed of sound (SOS). In addition, Achilles+ calculated the stiffness index (SI) and the Sahara calculated the quantitative ultrasound index (QUI) from BUA and SOS. The DBM sonic 1200 measured the amplitude-dependent SOS (AD-SOS).
  
  
  RESULTS
  Eighty-six women had a history of a traumatic hip fracture after the age of 50, 1594 had a history of forearm fracture, and 2016 had other nonvertebral fractures. No fracture history was reported by 3866 women. Discrimination for hip fracture was higher than for the other nonvertebral fractures. The two heel QUSs had a significantly higher discrimination power than the QUSs of the phalanges, with standardized ORs, adjusted for age and body mass index, ranging from 2.1 to 2.7 (95% CI = 1.6, 3.5) compared with 1.4 (95% CI = 1.1, 1.7) for the AD-SOS of DBM sonic 1200.
  
  
  CONCLUSIONS
  This study showed a high association between heel QUS and hip fracture history in elderly Swiss women. This could justify integration of QUS among screening strategies for identifying elderly women at risk for osteoporotic fractures.
authors.affiliation: Department of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland. Marc-Antoine.Krieg@chuv.hospvd.ch
authors.forename: M A
authors.initials: MA
authors.lastname: Krieg
authors.forename: J
authors.initials: J
authors.lastname: Cornuz
authors.forename: C
authors.initials: C
authors.lastname: Ruffieux
authors.forename: L
authors.initials: L
authors.lastname: Sandini
authors.forename: D
authors.initials: D
authors.lastname: Büche
authors.forename: M A
authors.initials: MA
authors.lastname: Dambacher
authors.forename: F
authors.initials: F
authors.lastname: Hartl
authors.forename: H J
authors.initials: HJ
authors.lastname: Häuselmann
authors.forename: M
authors.initials: M
authors.lastname: Kraenzlin
authors.forename: K
authors.initials: K
authors.lastname: Lippuner
authors.forename: M
authors.initials: M
authors.lastname: Neff
authors.forename: P
authors.initials: P
authors.lastname: Pancaldi
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.forename: F
authors.initials: F
authors.lastname: Tanzi
authors.forename: R
authors.initials: R
authors.lastname: Theiler
authors.forename: A
authors.initials: A
authors.lastname: Tyndall
authors.forename: K
authors.initials: K
authors.lastname: Wimpfheimer
authors.forename: P
authors.initials: P
authors.lastname: Burckhardt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002138:Calibration; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D016017:Odds Ratio; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D014463:Ultrasonography