title: Utility of heel dual-energy X-ray absorptiometry in diagnosing osteoporosis.
abstract: Although peripheral dual-energy X-ray absorptiometry measurements have been found to predict fractures in population studies of white subjects, little is known about their utility in other races and in patients with greater risk of fracture. In a cross-sectional study of 874 women referred for bone mineral density (BMD) testing, we examined the utility of heel BMD in African-American (AA) compared with Caucasian (CA) women and in women using glucocorticoids. The ability of heel T-score to predict central osteoporosis was similar in AA and CA women (odds ratio [OR] per 1 unit decrease in T-score of 2.79 [95% confidence interval {CI} 2.16-3.60] and 3.15 [95% CI 2.53-3.92], respectively). The association between heel T-score and prevalent vertebral fractures was also similar in the 2 groups (OR 1.46 [95% CI 1.15-1.85] in AA and 1.42 [95% CI 1.16-1.74] in CA). In women using glucocorticoids heel T-score was better than central T-score in predicting vertebral fractures (OR 1.38 [95% CI 1.03-1.85] and 1.22 [95% CI 0.86-1.73], respectively). We conclude that in a multiracial referral population heel BMD predicts central osteoporosis and prevalent vertebral fractures equally well in AA as in CA women and may be better than central BMD in assessing fragility in glucocorticoid users.
authors.affiliation: Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, USA.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Chou
authors.affiliation: Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hwang
authors.affiliation: Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, USA; Queens Diabetes and Endocrinology Associates, Flushing, NY, USA.
authors.forename: Siu-Ling
authors.initials: SL
authors.lastname: Ma
authors.affiliation: Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, IL, USA. Electronic address: tvokes@medicine.bsd.uchicago.edu.
authors.forename: Tamara
authors.initials: T
authors.lastname: Vokes
mesh_terms: D015502:Absorptiometry, Photon; D001741:Black or African American; D000368:Aged; D015519:Bone Density; D002111:Calcaneus; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000208:ethnology; D011237:Predictive Value of Tests; D015995:Prevalence; D016103:Spinal Fractures / Q000453:epidemiology*; D044465:White People
chemical_list: D005938:Glucocorticoids
keywords: Heel bone mineral density; osteoporosis; peripheral bone densitometry; racial differences