title: Comparison of the use of scapular ultrasonography, physical examination, and measurement of serum biomarkers of bone turnover versus scintigraphy for detection of bone fragility syndrome in horses.
abstract: OBJECTIVE
  To define scintigraphic, physical examination, and scapular ultrasonographic findings consistent with bone fragility syndrome (BFS) in horses; develop indices of BFS severity; and assess accuracy of physical examination, scapular ultrasonography, and serum biomarkers for BFS diagnosis.
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  48 horses (20 horses with BFS and 28 control horses).
  
  
  METHODS
  Horses underwent forelimb scintigraphic evaluation, physical examination, scapular ultrasonography, and serum collection. Scintigraphy was used as a reference standard to which physical examination, scapular ultrasonography, and concentrations of serum biomarkers (carboxy-terminal telopeptide of collagen crosslinks and bone-specific alkaline phosphatase activity) were compared for assessing accuracy in BFS diagnosis.
  
  
  RESULTS
  A diagnosis of BFS was strongly supported on scintigraphy by ≥ 2 regions of increased radiopharmaceutical uptake, including 1 region in the scapular spine and 1 region in the scapular body or ribs; on physical examination by lateral bowing of the scapulae; and on ultrasonography by widening of the scapular spine. None of the tests evaluated were accurate enough to replace scintigraphy for mild disease; however, physical examination and scapular ultrasonography were accurate in horses with moderate to severe BFS. Serum biomarkers were not accurate for BFS diagnosis.
  
  
  CONCLUSIONS
  Scintigraphy remained the most informative diagnostic modality for BFS, providing insight into disease severity and distribution; however, physical examination and scapular ultrasonographic abnormalities were diagnostic in horses with moderate to severe disease. Proposed severity indices classified the spectrum of disease manifestations. Clearly defined criteria for interpretation of diagnostic tests aid in the detection of BFS. Severity indices may be useful for assessing disease progression and response to treatment.
authors.affiliation: JD Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Arens
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Puchalski
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Whitcomb
authors.forename: Robin
authors.initials: R
authors.lastname: Bell
authors.forename: Ian A
authors.initials: IA
authors.lastname: Gardner
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stover
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood*; D001847:Bone Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000662:veterinary*; D016022:Case-Control Studies; D005260:Female; D006734:Horse Diseases / Q000097:blood* / Q000175:diagnosis; D006736:Horses; D008297:Male; D011877:Radionuclide Imaging / Q000662:veterinary*; D012540:Scapula / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D015415:Biomarkers