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Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria

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Abstract

Summary

This study sought to determine the association between calcaneal quantitative ultrasound (QUS) and fracture risk in individuals without osteoporosis according to the World Health Organization criteria (i.e., BMD T-score > −2.5). We found that calcaneal QUS is an independent predictor of fracture risk in women with non-osteoporotic bone mineral density (BMD).

Introduction

More than 50 % of women and 70 % of men who sustain a fragility fracture have BMD above the osteoporotic threshold (T-score > −2.5). Calcaneal QUS is associated with fracture risk. This study aimed to test the hypothesis that low calcaneal QUS is associated with increased fracture risk in individuals with non-osteoporotic BMD.

Methods

We included 312 women and 390 men aged 62–90 years with BMD T-score > −2.5 at femoral neck. QUS was measured in broadband ultrasound attenuation (BUA) at the calcaneus using a CUBA sonometer. BMD was measured at the femoral neck (FNBMD) by dual energy X-ray absorptiometry using GE Lunar DPX-L densitometer. The incidences of any fragility fracture were ascertained by X-ray reports during the follow-up period from 1994 to 2011.

Results

Of the 702 participants, 26 % of women (n = 80/312) and 14 % of men (n = 53/390) experienced at least one fragility fracture during the follow-up period. In women, after adjusting for covariates, increased risk of any fracture was significantly associated with decreased BUA (HR = 1.50; 95 % CI, 1.13–1.99). Compared with that of FNBMD, the models with BUA, in women, had greater AUC (0.71, 0.85, 0.71 for any, hip and vertebral fracture, respectively), and yielded a net reclassification improvement of 16.4 % (P = 0.009) when combined with FNBMD. In men, BUA was not significantly associated with fracture risk before and after adjustment.

Conclusion

These results suggest that calcaneal BUA is an independent predictor of fracture risk in women with non-osteoporotic BMD.

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Acknowledgments

We gratefully acknowledge the assistance of Sr Janet Watters, Donna Reeves, and Shaye Field for the interview, data collection, and measurement of bone mineral density. We also appreciate the invaluable help of the staff of Dubbo Base Hospital. We thank Mr. J. McBride, Dania Mang, and the IT group of the Garvan Institute of Medical Research for the management of the database. The study was partly supported by the Australia National Health and Medical Research Council. N.D.N. is supported by a fellowship from the AMBeR (Australian Medical Bioinformatics Resource). T.V.N. is supported by a senior research fellowship from the Australian National Health and Medical Research Council.

Conflicts of interest

Professor J.A. Eisman has served as consultant on the Scientific Advisory Board for Amgen, Eli Lilly, Merck Sharp & Dohme, Novartis, Sanofi-Aventis, Servier, and deCode. He was the editor-in-chief for the Journal of Bone and Mineral Research from 2003 to 2007 and was a committee member of Department of Health and Aging, Australian Government and Royal Australasian College of General Practitioners. Dr. Jacqueling R. Center has given educational talks for Eli Lilly, Merck Sharp and Dohme, and Sanofi-Aventis. Professor T.V. Nguyen has received honorarium for consulting and speaking in symposia sponsored by MSD, Roche, Servier, Sanofi-Aventis, and Novartis. Other authors have no conflicts of interest.

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Authors and Affiliations

  1. Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, 384 Victoria Street, Sydney, NSW, 2010, Australia

    M. Y. Chan, N. D. Nguyen, J. R. Center, J. A. Eisman & T. V. Nguyen

  2. St Vincent’s Clinical School, Sydney, NSW, Australia

    J. R. Center, J. A. Eisman & T. V. Nguyen

  3. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

    T. V. Nguyen

Authors
  1. M. Y. Chan
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  2. N. D. Nguyen
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  3. J. R. Center
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  4. J. A. Eisman
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  5. T. V. Nguyen
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Correspondence to T. V. Nguyen.

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Chan, M.Y., Nguyen, N.D., Center, J.R. et al. Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria. Osteoporos Int 24, 1015–1022 (2013). https://doi.org/10.1007/s00198-012-2001-2

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  • DOI: https://doi.org/10.1007/s00198-012-2001-2

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