Prediction of hip osteoporosis by DXA using a novel pulse echo ultrasound device
SummaryPulse echo ultrasonometry can be used as a pre screen for hip osteoporosis before dual energy x ray absorptiometry (DXA) potentially allowing DXA to be avoided for the majority of post menopausal women. Pulse echo ultrasound measures of tibia cortical thickness are also associated with radiographically confirmed prior fractures, independent of femoral neck bone mineral density.IntroductionTo estimate how well a pulse echo ultrasound device discriminates those who have from those who do not have hip osteoporosis (femoral neck bone mineral density [BMD] or total hip BMD T score 2.5) and to estimate the association of pulse echo ultrasound measures with prevalent (radiographically confirmed) clinical fractures.MethodsFive hundred fifty five post menopausal women age 50 to 89 had femoral neck and total hip BMD measured by dual energy x ray absorptiometry (DXA) and pulse echo ultrasound measures of distal radius, proximal tibia, distal tibia cortical thickness, and multi and single site density indices (DI) Using previously published threshold ultrasound values, we estimated the proportion of women who would avoid a follow up DXA after pulse echo ultrasonometry, and the sensitivity and specificity of this for the detection of hip osteoporosis. Logistic regression models were used to estimate the associations of pulse echo ultrasound measures with radiographically confirmed clinical fractures within the prior 5 years.ResultsUsing multi site and single site DI measures, follow up DXA could be avoided for 73 and 69 of individuals, respectively, while detecting hip osteoporosis with 80 82 sensitivity and 81 specificity. Radiographically confirmed prior fracture was associated with ultrasound measures of single site DI (odds ratio (OR) 1.55, 95 confidence interval (CI) 1.06 to 2.26) and proximal tibia cortical thickness (OR 1.47, 95 CI 1.10 to 1.96) adjusted for age, body mass index, and femoral neck BMD.ConclusionsPulse echo ultrasonometry can be used as an initial screening test for hip osteoporosis. Prospective studies of how well pulse echo ultrasound measures predict subsequent clinical fractures are warranted.
Osteoporosis International