Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study.
To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not.


BACKGROUND
As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose.


METHODS
The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters.


RESULTS
From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s).


CONCLUSIONS
In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.
Krieg
Marc-Antoine
MA
Department of Internal Medicine, University Hospital, Lausanne, Switzerland. marc-antoine.krieg@chuv.ch
Cornuz
Jacques
J
Ruffieux
Christiane
C
Van Melle
Guy
G
Büche
Daniel
D
Dambacher
Maximilian A
MA
Hans
Didier
D
Hartl
Florian
F
Häuselmann
Hansjorg J
HJ
Kraenzlin
Marius
M
Lippuner
Kurt
K
Neff
Maurus
M
Pancaldi
Pierro
P
Rizzoli
Rene
R
Tanzi
Franco
F
Theiler
Robert
R
Tyndall
Alan
A
Wimpfheimer
Claus
C
Burckhardt
Peter
P
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015984:Causality; D005260:Female; D050278:Finger Phalanges / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006365:Heel / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods*