[Bone mineral density in postmenopausal women with proximal femoral fractures--comparative study between quantitative ultrasonometry and gold standard DXA].
BACKGROUND
Osteoporosis associated proximal femoral fracture is a major public health problem. Diagnostic assessment includes patients history, laboratory testings and bone mineral density measurements. Hereby, dual X-ray absorptiometry (DXA) is regarded as the "Goldstandard". Quantitative ultrasonometry (QUS) of bone is a safe, simple, free of radiation, portable, cost-effective and therefore powerful diagnostic tool. QUS should be taken in account for primary assessment in patients with supposed osteoporosis in clinical practice.


OBJECTIVE
We performed this cross sectional pilot study to evaluate the ability of two different QUS-devices (os calcis) in comparison to DXA (lumbar spine and femoral neck) to discriminate postmenopausal women with proximal femoral fractures from healthy, age- and BMI-matched controls.


METHODS
All together, 44 postmenopausal women were included. Of these, 22 suffered a proximal femoral fracture and were compared with 22 healthy, age- and BMI-matched controls. Bone assessments were performed by DXA (femoral neck and lumbar spine) and QUS of the heel using Achilles and Insight.


RESULTS
T- and Z-Score of DXA (femoral neck) were significantly lower in women with hip fracture compared to controls (p < 0.008 and p < 0.01). QUS-Insight also revealed significantly lower values of T- and Z-Score in women with hip fracture compared to controls (p < 0.01 and p < 0.005). QUS-Achilles measurement results also comprised significant differences between the groups (T-Score und Z-Score: p < 0.02). In accordance to the T-Score (femoral neck), all three devices (DXA femoral neck, Achilles and Insight) showed an equal significant correlation (p < 0.001). The correlation in between both QUS-devices was higher (0.956; p < 0.0001) than in between DXA-results (femoral neck vs. lumbar spine, 0.577; p < 0.01). The Z-Score also showed a significant correlation. DXA (lumbar spine) didn't show any significant differences in T- and Z-Score.


CONCLUSIONS
In comparison to the gold standard DXA (femoral neck), both QUS-devices showed an equal ability to significantly discriminate postmenopausal women with proximal femoral fractures from healthy, age- and BMI-matched controls. If our results are confirmed by more cross-sectional and longitudinal studies, QUS could be a helpful and valuable technique in clinical practice. Finally, all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment must be instituted.
Schnabel
M
M
Klinik für Unfall-, Wiederherstellungs- und Handchirurgie der Philipps-Universität Marburg. schnabem@mailer.uni-marburg.de
Eser
G
G
Ziller
V
V
Mann
D
D
Mann
E
E
Hadji
P
P
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis; D006620:Hip Fractures / Q000175:diagnosis*; D006801:Humans; D016555:Matched-Pair Analysis; D008432:Mathematical Computing; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis*; D010865:Pilot Projects; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography