title: Predictive values of calcaneal quantitative ultrasound and dual energy X ray absorptiometry for non-vertebral fracture in older men: results from the MrOS study (Hong Kong).
abstract: Calcaneal QUS is comparable to DXA in predicting non-vertebral fractures in older Chinese men.
  
  
  BACKGROUND
  The predictive values of calcaneal quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA) for non-vertebral fractures in older Chinese men were examined.
  
  
  METHODS
  One thousand nine hundred twenty-one Chinese men aged 65-92 years had calcaneal QUS and axial DXA bone mineral density (BMD) measurements. The incidence of non-vertebral fractures was documented. Cox regression and receiver operating curve (ROC) analysis were used to examine the associations of QUS parameters and BMD with the incidence of non-vertebral fractures.
  
  
  RESULTS
  The duration of follow-up was (mean ± SD) 6.5 ± 1.7 years. One hundred thirty-one non-vertebral fractures were recorded, 71 of which were major fragility fractures. Broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) were significantly associated with non-vertebral fractures and major fragility fractures, with age and fracture history-adjusted hazard ratio (95% CI) of 1.23 (1.03, 1.47) and 1.32 (1.10, 1.59) per standard deviation reduction, respectively, for non-vertebral fractures; 1.32 (1.04, 1.68) and 1.43 (1.11, 1.84), respectively, for major fragility fractures. Age and fracture history-adjusted areas under ROC curves of hip or spine BMDs were significantly greater than that of BUA or QUI in predicting major fragility fractures, but not in predicting all non-vertebral fractures. The addition of BUA or QUI had no effect on AUCs of total hip BMD alone.
  
  
  CONCLUSIONS
  The ability of calcaneal QUS to predict non-vertebral fractures was comparable to that of axial BMD by DXA, but was inferior to BMD in predicting major fragility fractures in older Chinese men.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China. tkwok@cuhk.edu.hk
authors.forename: T
authors.initials: T
authors.lastname: Kwok
authors.forename: C C
authors.initials: CC
authors.lastname: Khoo
authors.forename: J
authors.initials: J
authors.lastname: Leung
authors.forename: A
authors.initials: A
authors.lastname: Kwok
authors.forename: L
authors.initials: L
authors.lastname: Qin
authors.forename: J
authors.initials: J
authors.lastname: Woo
authors.forename: P C
authors.initials: PC
authors.lastname: Leung
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005272:Femur Neck / Q000503:physiopathology; D050723:Fractures, Bone / Q000453:epidemiology; D006621:Hip Joint / Q000503:physiopathology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D014463:Ultrasonography