title: Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures.
abstract: About 75% of patients suffering from osteoporosis are not diagnosed. This study describes a multi-site bone ultrasound method for osteoporosis diagnostics. In comparison with axial dual energy X-ray absorptiometry (DXA), the ultrasound method showed good diagnostic performance and could discriminate fracture subjects among elderly females.
  
  
  BACKGROUND
  Axial DXA, the gold standard diagnostic method for osteoporosis, predicts fractures only moderately. At present, no reliable diagnostic methods are available at the primary health care level. Here, a multi-site ultrasound method is proposed for osteoporosis diagnostics.
  
  
  METHODS
  Thirty elderly women were examined using the ultrasound backscatter measurements in proximal femur, proximal radius, proximal and distal tibia in vivo. First, we predicted the areal bone mineral density (BMD) at femoral neck by ultrasound measurements in tibia combined with specific subject characteristics (density index, DI) and, second, we tested the ability of ultrasound backscatter measurements at proximal femur to discriminate between individuals with previously fractured hips from those without fractures. Areal BMD was determined by axial DXA.
  
  
  RESULTS
  Combined ultrasound parameters, cortical thickness at distal and proximal tibia, with age and weight of the subject, provided a significant estimate of BMD(neck) (r = 0.86, p < 0.001, n = 30). When inserted into FRAX (World Health Organization fracture risk assessment tool), the DI indicated the same treatment proposal as the BMD(neck) with 86% sensitivity and 100% specificity. The receiver operating characteristic analyses, with a combination of ultrasound parameters and patient characteristics, discriminated fracture subjects from the controls similarly as the model combining BMD(neck) and patient characteristics.
  
  
  CONCLUSIONS
  For the first time, ultrasound backscatter measurements of proximal femur were conducted in vivo. The results indicate that ultrasound parameters, combined with patient characteristics, may provide a means for osteoporosis diagnostics.
authors.affiliation: Department of Applied Physics, University of Eastern Finland, POB 1627, 70211 Kuopio, Finland. janne.p.karjalainen@iki.fi
authors.forename: J P
authors.initials: JP
authors.lastname: Karjalainen
authors.forename: O
authors.initials: O
authors.lastname: Riekkinen
authors.forename: J
authors.initials: J
authors.lastname: Töyräs
authors.forename: M
authors.initials: M
authors.lastname: Hakulinen
authors.forename: H
authors.initials: H
authors.lastname: Kröger
authors.forename: T
authors.initials: T
authors.lastname: Rikkonen
authors.forename: K
authors.initials: K
authors.lastname: Salovaara
authors.forename: J S
authors.initials: JS
authors.lastname: Jurvelin
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000503:physiopathology; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011884:Radius / Q000000981:diagnostic imaging / Q000503:physiopathology; D013977:Tibia / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography