title: Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound.
abstract: The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk.
  
  
  BACKGROUND
  Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non-spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models.
  
  
  METHODS
  5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporosis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture.
  
  
  RESULTS
  Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for any non-vertebral, hip, forearm/wrist, and humerus fractures were 1.31 (1.15-1.49), 1.40 (1.01-1.95), 1.50 (1.19-1.89) and 1.35 (0.97-1.87), respectively. Similar results were observed with other QUS variables. The best predictive models indicated that age, a history of falls, a previous low-trauma fracture, a family history of fracture, a calcium intake from dairy products of less than 250 mg/day, and lower values of QUS parameters were independently associated with the risk of non-spinal fractures.
  
  
  CONCLUSIONS
  Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures. A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain.
authors.affiliation: Bone Research Unit, Department of Internal Medicine, Hospital Universitario del Mar, Universidad Autónoma, Barcelona, Spain. adiez@imas.imim.es
authors.forename: A
authors.initials: A
authors.lastname: Díez-Pérez
authors.forename: J
authors.initials: J
authors.lastname: González-Macías
authors.forename: F
authors.initials: F
authors.lastname: Marín
authors.forename: M
authors.initials: M
authors.lastname: Abizanda
authors.forename: R
authors.initials: R
authors.lastname: Alvarez
authors.forename: A
authors.initials: A
authors.lastname: Gimeno
authors.forename: E
authors.initials: E
authors.lastname: Pegenaute
authors.forename: J
authors.initials: J
authors.lastname: Vila
mesh_terms: D000368:Aged; D000465:Algorithms; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002111:Calcaneus / Q000000981:diagnostic imaging*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D013030:Spain / Q000453:epidemiology; D014463:Ultrasonography