Prospective evaluation of risk of vertebral fractures using quantitative ultrasound measurements and bone mineral density in a population-based sample of postmenopausal women: results of the Basel Osteoporosis Study.
OBJECTIVE
Prospective studies have shown that quantitative ultrasound (QUS) techniques predict the risk of fracture of the proximal femur with similar standardised risk ratios to dual-energy x-ray absorptiometry (DXA). Few studies have investigated these devices for the prediction of vertebral fractures. The Basel Osteoporosis Study (BOS) is a population-based prospective study to assess the performance of QUS devices and DXA in predicting incident vertebral fractures.


METHODS
432 women aged 60-80 years were followed-up for 3 years. Incident vertebral fractures were assessed radiologically. Bone measurements using DXA (spine and hip) and QUS measurements (calcaneus and proximal phalanges) were performed. Measurements were assessed for their value in predicting incident vertebral fractures using logistic regression.


RESULTS
QUS measurements at the calcaneus and DXA measurements discriminated between women with and without incident vertebral fracture, (20% height reduction). The relative risks (RRs) for vertebral fracture, adjusted for age, were 2.3 for the Stiffness Index (SI) and 2.8 for the Quantitative Ultrasound Index (QUI) at the calcaneus and 2.0 for bone mineral density at the lumbar spine. The predictive value (AUC (95% CI)) of QUS measurements at the calcaneus remained highly significant (0.70 for SI, 0.72 for the QUI, and 0.67 for DXA at the lumbar spine) even after adjustment for other confounding variables.


CONCLUSIONS
QUS of the calcaneus and bone mineral density measurements were shown to be significant predictors of incident vertebral fracture. The RRs for QUS measurements at the calcaneus are of similar magnitude as for DXA measurements.
Hollaender
R
R
Departmant of Rheumatology, Felix Platter-Hospital, University of Basel, Bugfelderstrasse 101, CH-4012 Basel, Switzerland. Rebecca.Hollaender@unibas.ch
Hartl
F
F
Krieg
M-A
MA
Tyndall
A
A
Geuckel
C
C
Buitrago-Tellez
C
C
Manghani
M
M
Kraenzlin
M
M
Theiler
R
R
Hans
D
D
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging; D004812:Epidemiologic Methods; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D050278:Finger Phalanges / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011379:Prognosis; D016103:Spinal Fractures / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000503:physiopathology; D014463:Ultrasonography