title: Screening for low bone mass with quantitative ultrasonography in a community without dual-energy X-ray absorptiometry: population-based survey.
abstract: BACKGROUND
  Dual-energy x-ray absorptiometry (DXA) is the criterion standard to identify low bone mineral density (BMD), but access to axial DXA may be limited or cost prohibitive. We screened for low bone mass with quantitative ultrasonography (QUS) in a community without DXA, analyzed its reliability and obtained reference values and estimated the prevalence of low QUS values.
  
  
  METHODS
  We enrolled 6493 residents of Kinmen, Taiwan, and a reference group (96 men and 70 women aged 20-29 years) for this cross-sectional, community-based study. All participants completed a questionnaire and underwent ultrasonographic measurements. Reliability and validity of QUS measurements were evaluated. Broadband ultrasound attenuation (BUA) values were obtained and statistically analyzed by age, sex and weight. Annual loss of BUA was determined. Trends in the prevalence of QUS scores were evaluated.
  
  
  RESULTS
  Two QUS were used and had a correlation coefficient of 0.90 (p < 0.001). Calcaneal BUA was significantly correlated with BMD in the femoral neck (r = 0.67, p < 0.001) and BMD of the total lumbar spine (r = 0.59, p < 0.001). BUAs in the reference group were 92.72 +/- 13.36 and 87.90 +/- 10.68 dB/MHz for men and women, respectively. Estimated annual losses of calcaneal BUA were 0.83% per year for women, 0.27% per year for men, and 0.51% per year for the total population. The prevalence of severely low QUS values (T-score = -2.5) tended to increase with aging in both sexes (p < 0.001). Across age strata, moderately low QUS values (-2.5 < T-score < -1.0) were 31.6-41.0% in men and 23.7-38.1% in women; a significant trend with age was observed in men (p < 0.001).
  
  
  CONCLUSIONS
  Age-related decreases in calcaneal ultrasonometry, which reflected the prevalence of low bone mass, were more obvious in women than in men.
authors.affiliation: Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Peitou, Taipei, ROC, Taiwan. g880703@ym.edu.tw
authors.forename: Nan-Ping
authors.initials: NP
authors.lastname: Yang
authors.forename: Ian
authors.initials: I
authors.lastname: Jen
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chuang
authors.forename: Shui-Hu
authors.initials: SH
authors.lastname: Chen
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D017677:Age Distribution; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000378:metabolism; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000378:metabolism; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology; D014463:Ultrasonography