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Quantitative ultrasound or clinical risk factors - which best identifies women at risk of osteoporosis?

BRITISH JOURNAL OF RADIOLOGY 2000年第866期73卷 165-171页

作者： Stewart, A Reid, DM Univ Aberdeen Dept Med & Therapeut Osteoporosis Res Unit Aberdeen Scotland

Dual energy X-ray absorptiometry (DXA) is the current technique of choice to assess risk of future fracture and to diagnose osteoporosis as defined by bone mineral density (BMD). Guidelines for bone densitometry referral have been published listing clinical risk factors that might be considered grounds for assessment. However, these factors are known to be poorly predictive of subsequent BMD measurement and, accordingly, new inexpensive methods of selecting subjects for assessment should be sought. Quantitative ultrasound (QUS) of bone may be such a technique. Women (n=250) considered by their general practitioners to be at risk of osteoporosis and who had been referred for DXA measurements of the spine and hip were recruited into the study. All underwent a QUS scan of the heel using a McCue CUBA Clinical machine, which measures broadband ultrasound attenuation (BUA) and velocity of sound (VOS), a clinical risk factor questionnaire, and spine and hip BMD measurement by a Norland XR-26 bone densitometer. Patients were categorized according to published diagnostic criteria for BMD, and these were also applied to the QUS parameters. Risk factors were arbitrarily categorized into "low", "medium" and "high" risk groups. Kappa scores were calculated to analyse the agreement between different techniques. Receiver operator characteristic (ROC) analyses were undertaken to demonstrate the technique with the best sensitivity and specificity for the detection of low BMD at the spine and hip. Analysis of the bone mass data demonstrated only moderate agreement (kappa 0.33) between femoral neck and spine BMD with femoral neck BMD and BUA showing a very similar level of agreement (kappa 0.31). ROC analysis demonstrated that VOS followed by BUA was the best predictor of low BMD, with risk factors alone being significantly poorer;QUS parameters are better predictors than clinical risk factors for women with low BMD and could be used effectively at the primary care level to indicate t

关键词：骨密度骨和骨组织/放射摄影术骨和骨组织/超声检查骨质疏松绝经后/病因学骨质疏松绝经后/放射摄影术骨质疏松绝经后/超声检查试验预期值 ROC曲线危险因素敏感性与特异性成年人老年人女(雌)性人类中年人

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Comparison of an imaging heel quantitative ultrasound device (DTU-one) with densitometric and ultrasonic measurements

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BRITISH JOURNAL OF RADIOLOGY 2000年第865期73卷 23-30页

作者： Diessel, E Fuerst, T Njeh, CF Hans, D Cheng, S Genant, HK Univ San Francisco Osteoporosis & Arthrit Res Grp San Francisco CA 94117 USA

The purpose of this study was to evaluate a new imaging ultrasound scanner for the heel, the DTU-one (Osteometer MediTech, Denmark), by comparing quantitative ultrasound (QUS) results with bone mineral density (BMD) of the heel and femur from dual X-ray absorptiometry (DXA), and by comparing the DTU-one with another QUS device, the UBA 575+. The regions of interest in the DXA heel scan were matched with the regions evaluated by the two QUS devices. 134 healthy and 16 osteoporotic women aged 30-84 years old were enrolled in the study. In vivo short-term precision of the DTU-one for broadband ultrasound attenuation (BUA) and speed of sound (SOS) was 2.9% and 0.1%, respectively, and long-term precision was 3.8% and 0.2%, respectively. Highest correlations (r) between QUS and BMD measurements were achieved when comparing DTU-one results with BMD in matched regions of the DXA heel scan. Correlation coefficients (r) were 0.81 for BUA and SOS. Highest correlations with the UBA 575+ were 0.68 and 0.72, respectively. The comparison of BMD in different femoral sites with BUA and SOS (DTU-one) varied from 0.62 to 0.69 when including the entire study population. The correlation between BMD values within different sites of the femur tended to be higher (from r=0.81 to 0.93). When comparing BUA with BUA and SOS with SOS on the two QUS devices, the absolute QUS Values differed significantly. However, correlations were relatively high, with 0.76 for BUA and 0.82 for SOS. In conclusion, the results of the new quantitative ultrasound device, the DTU-one, are highly correlated (r=0.8) with results obtained using the UBA 575+ and with BMD in the heel. The precision of the DTU-one is comparable to other QUS devices for BUA and is high for SOS.

关键词：评价研究跟/放射摄影术跟/超声检查骨质疏松绝经后/放射摄影术骨质疏松绝经后/超声检查敏感性与特异性超声检查/方法成年人老年人老年人 80以上女(雌)性人类中年人

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Comparison of bone mineral density and quantitative ultrasound of the calcaneus: site-matched correlation and discrimination of axial BMD status

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BRITISH JOURNAL OF RADIOLOGY 2000年第865期73卷 31-35页

作者： Langton, CM Langton, DK Univ Hull Ctr Metab Bone Dis Hull HU3 2RW N Humberside England Hull Royal Infirm Royal Hull Hosp NHS Trust Hull HU3 2RW N Humberside England

The performance of quantitative ultrasound (QUS) and dual energy X-ray absorptiometry (DXA) bone densitometry of the calcaneus have been compared, both in terms of site-matched correlation and their discriminatory ability to identify osteoporotic and osteoporotic or osteopenic subjects. 91 female subjects (aged 56.9+/-9.6 years, 31-84 years) who were routinely referred for axial BMD assessment of the lumbar spine and femoral neck by DXA (Lunar DPX-L), consented to have additional measurements of QUS (McCue CubaClinical Mk II) and DXA (Lunar PIXI) of their left calcaneus. The site-matched correlation between calcaneal BMD with QUS parameters were: (a) broadband ultrasound attenuation (BUA) alone, adj-R-2=62.7%, p<0.0001;(b) velocity (VOS) alone, adj-R-2=48.4%, p<0.0001;and (c) BUA and VOS combined, adj-R-2=65.2%, p<0.0001. The site-matched correlations are towards the higher end of data reported by other researchers, indicative of the exacting measurement protocol implemented here. 30 subjects were categorized as normal, 38 being osteopenic and 23 being osteoporotic. Optimum accuracies and odds ratios were obtained using logistic regression. The differences in accuracy between calcaneal BMD and calcaneal QUS parameters were statistically insignificant, with zero included within the confidence intervals, for the identification of both (a) osteoporotic and (b) osteoporotic or osteopenic subjects. The odds ratios for the discrimination of subject status achieved with calcaneal BMD were higher, although statistically insignificant, than achieved with the QUS parameters. Receiver operator characteristic (ROC) analysis for the identification of subjects into the categories (a) and (b) above was performed. Areas under the ROC curve (AUC) (95% confidence intervals) for the legit of the probability that a subject would be osteoporotic were: 0.814 (0.700, 0.928) for calcaneal BMD;0.791 (0.673, 0.909) for BUA;0.717 (0.588, 0.846) for VOS;and 0.793 (0.675, 0.911) for BUA and VOS

关键词：骨疾病代谢性/放射摄影术骨疾病代谢性/超声检查跟骨/放射摄影术跟骨/超声检查比值比骨质疏松绝经后/放射摄影术骨质疏松绝经后/超声检查 ROC曲线敏感性与特异性成年人老年人老年人 80以上女(雌)性人类中年人

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Quantitative heel ultrasound as a predictor for osteoporosis

MEDICAL JOURNAL OF AUSTRALIA

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MEDICAL JOURNAL OF AUSTRALIA 1999年第6期171卷 297-300页

作者： Naganathan, V March, L Hunter, D Pocock, NA Markovey, J Sambrook, PN Royal N Shore Hosp Dept Rheumatol Sydney NSW Australia St Vincents Hosp Dept Nucl Med Sydney NSW 2010 Australia

Objective: To determine the diagnostic value of quantitative ultrasound (QUS) to predict bone mineral density (BMD) categories as defined by dual-energy x-ray absorptiometry. Design: Cross-sectional survey. Setting: Rheumatology department of a tertiary care hospital (Royal North Shore Hospital, Sydney, NSW), 1997-1998. Subjects: 326 healthy women aged 45-80 years who had volunteered for a twin study. Our study included both members of non-identical twin pairs but only one randomly selected member of identical twin pairs. Main outcome measures: BMD categories as defined by dual-energy x-ray absorptiometry of lumbar spine and left hip, and QUS of calcaneus;sensitivity, specificity and likelihood ratios (LRs) of QUS parameters to diagnose osteoporosis as defined by BMD. Results: The sensitivity of QUS to diagnose BMD osteoporosis varied between 9% and 47%, depending on the QUS parameter. The specificity of QUS was high (88%-100%). If all QUS parameters were normal, osteoporosis was unlikely (LR, 0-0.2). One QUS parameter, broadband ultrasound attenuation (BUA), was highly predictive of osteoporosis by BMD when in the osteoporotic range (LR, infinity), but had low sensitivity (9%). QUS results in the osteoporotic range for other parameters and all QUS results in the osteopenic range were less predictive (LR, 1.0-5.2) of osteoporotic BMD. Conclusion: These results suggest that, for most of those tested for osteoporosis by QUS in the community, uncertainty remains about expected BMD.

关键词：骨密度骨疾病代谢性/放射摄影术骨疾病代谢性/超声检查跟骨/超声检查似然函数骨质疏松绝经后/放射摄影术骨质疏松绝经后/超声检查敏感性与特异性老年人老年人 80以上女(雌)性人类中年人

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Diagnosing osteoporosis: the value of quantitative ultrasound

MEDICAL JOURNAL OF AUSTRALIA

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MEDICAL JOURNAL OF AUSTRALIA 1999年第6期171卷 295-296页

作者： Prince, RL Univ Perth Sir Charles Gairdner Hosp Dept Med Perth WA Australia

Currently, screening by quantitative ultrasound does not appear to be a good deal

关键词：骨折/病因学骨质疏松绝经后/并发症骨质疏松绝经后/放射摄影术骨质疏松绝经后/超声检查危险因素老年人女(雌)性人类中年人

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