title: Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS Study.
abstract: We compared the performance of five QUS devices with DXA in a population-based sample of 2837 women. All QUS approaches discriminated women with and without osteoporotic vertebral fractures. QUS of the calcaneus performed as well as central DXA.
  
  
  BACKGROUND
  Quantitative ultrasound (QUS) methods have found widespread use for the assessment of bone status in osteoporosis, but their optimal use remains to be established. To determine QUS performance for current devices in direct comparison with central DXA, we initiated a large population-based investigation, the Osteoporosis and Ultrasound Study (OPUS).
  
  
  METHODS
  A total of 463 women 20-39 years of age and 2374 women 55-79 years of age were measured on five different QUS devices along with DXA of the spine and the proximal femur. Their vertebral fracture status was evaluated radiographically. The association of QUS and DXA with vertebral fracture status was evaluated using logistic regression.
  
  
  RESULTS
  All QUS approaches tested discriminated women with and without osteoporotic vertebral fractures (20% height reduction), with age-adjusted standardized odds ratios ranging 1.2-1.3 for amplitude-dependent speed of sound (AD-SOS) at the finger phalanges, 1.2-1.4 for broadband ultrasound attenuation (BUA) at the calcaneus, and 1.4-1.5 for speed of sound (SOS) at the calcaneus, 1.4-1.6 for DXA of the total femur, and 1.5-1.6 for DXA at the spine. For more severe fractures (40% height reduction), age-adjusted standardized odds ratios increased to up to 1.9 for DXA of the spine and 2.3 for SOS of the calcaneus.
  
  
  CONCLUSIONS
  In conclusion, all five QUS devices tested showed significant age-adjusted differences between subjects with and without vertebral fracture. When selecting the strongest variable, QUS of the calcaneus worked as well as central DXA for identification of women at high risk for prevalent osteoporotic vertebral fractures. QUS-based case-finding strategies would allow halving the number of radiographs in high-risk populations, and this strategy works increasingly well for women with more severe vertebral fractures. It is likely that the good performance of QUS was in part achieved by rigorous quality assurance measures that should also be used in clinical practice.
authors.affiliation: Medical Physics, Department of Diagnostic Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. glueer@rad.uni-kiel.de
authors.forename: Claus C
authors.initials: CC
authors.lastname: Glüer
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.forename: David M
authors.initials: DM
authors.lastname: Reid
authors.forename: Dieter
authors.initials: D
authors.lastname: Felsenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Reinhard
authors.initials: R
authors.lastname: Barkmann
authors.forename: Wolfram
authors.initials: W
authors.lastname: Timm
authors.forename: Tilo
authors.initials: T
authors.lastname: Blenk
authors.forename: Gabi
authors.initials: G
authors.lastname: Armbrecht
authors.forename: Alison
authors.initials: A
authors.lastname: Stewart
authors.forename: Jackie
authors.initials: J
authors.lastname: Clowes
authors.forename: Friederike E
authors.initials: FE
authors.lastname: Thomasius
authors.forename: Sami
authors.initials: S
authors.lastname: Kolta
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000328:Adult; D000367:Age Factors; D000368:Aged; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography / Q000379:methods*