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Ten-year probabilities of clinical vertebral fractures according to phalangeal quantitative ultrasonography

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Abstract

The objectives of the present study were to estimate 10-year probabilities of clinical vertebral fractures in women, according to age and bone mineral assessment using phalangeal quantitative ultrasound (QUS). Risks were computed from UK derived data on the incidence of a first symptomatic vertebral fracture and mortality rates for each year of age using Poisson models. The 10-year probability of vertebral fracture was determined as the proportion of individuals fracture-free at that site from the age of 45 years. We assumed that the risk of fracture increased with decreasing QUS as assessed by an independent re-analysis of a previously published, multicenter cross-sectional study. For amplitude-dependent speed of sound (AD-SoS) information was available from 8,502 women, and vertebral fracture risk increased 1.7-fold for each SD decrease in measurement. For fast wave amplitude (FWA), available in 6,573 women, the risk gradient was 2.4/SD. In a subset of the population ( n =1,572) in whom bone mineral density was measured at the lumbar spine, the gradient of risk was 2.3/SD, with similar gradients of risk noted for AD-SoS (1.8/SD) and FWA (2.6/SD). Ten-year probabilities increased with age and decreasing Z -score. The use of absolute risk permits information from different types of bone mineral measurements to be applied for the assessment of patients, either alone or in combination with other independent risk factors.

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References

  1. Njeh CF, Boivin CM, Langton CM (1997) The role of ultrasound in the assessment of osteoporosis: a review. Osteoporos Int 7:7–22

    Article  CAS  PubMed  Google Scholar 

  2. Genant HK, Engelke K, Fuerst T et al (1996) Non-invasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 11:707–730

    CAS  PubMed  Google Scholar 

  3. Gluer CC, for the International Quantitative Ultrasound Consensus Group (1997) Quantitative ultrasound technique for the assessment of osteoporosis. J Bone Miner Res 12:1280–1288

    CAS  PubMed  Google Scholar 

  4. Wuster C, Albanese C, DeAloysio D, Duboef F, Gambacciani M, Gonnelli S, Gluer CC, Hans D, Joly J, Reginster JY, deTerlizzi F, Cadossi R, and the Phalangeal Osteosonogrammetry Study Group (2000) Age-related changes, diagnostic sensitivity and discrimination power. J Bone Miner Res 15:1603–1614

    CAS  PubMed  Google Scholar 

  5. Giardino R, Rotini R, Noia F, Veronesi CA, Carpi A, Nicolini A, deTerlizzi F, Fini M, Giavaresi G (2002) Phalangeal ultrasonography in forearm fracture discrimination. Biomed Pharmacother 56:332–338

    Article  CAS  PubMed  Google Scholar 

  6. Guglielmi G, Cammisa M, De Serio A, Scillitani A, Chiodini I, Carnevale V, Fusilli S (1999) Phalangeal US velocity discriminates between normal and vertebral fractured patients. Eur Radiol 9:1632–1637

    Article  CAS  PubMed  Google Scholar 

  7. Alenfeld FE, Wuster C, Funck C, Pereira-Lima JFS, Fritz T, Meeder PJ, Ziegler R (1998) Ultrasound measurements at the proximal phalanges in healthy women and patients with hip fracture. Osteoporos Int 8:393–398

    Article  CAS  PubMed  Google Scholar 

  8. Benitez CL, Schneider DL, Barret-Connor E, Sartorio DJ (2000) Hand ultrasound for osteoporosis screening in postmenopausal women. Osteoporos Int 11:203–210

    Article  CAS  PubMed  Google Scholar 

  9. Camozzi V, Lumachi F, Mantero F, Piccolo M, Luisetto G (2003) Phalangeal quantitative ultrasound technology and dual energy-X-ray densitometry in patients with primary hyperparathyroidism: influence of sex and menopausal status. Osteoporos Int 14:602–608

    Article  CAS  PubMed  Google Scholar 

  10. Mauloni M, Rovati LC, Cadossi R, de Terlizzi F, Ventura V, de Aloysio D (2000) Monitoring bone effect of transdermal hormone replacement therapy by ultrasound investigation at the phalanx: a four-year follow-up study. Menopause 7:402–412

    Article  CAS  PubMed  Google Scholar 

  11. De Aloysio D, Rovati LC, Cadossi R, Paltrinieri F, Mauloni M, Mura M, Peviarchios P, Ventura V (1997) Bone effects of transdermal hormone replacement therapy in postmenopausal women as evaluated by means of ultrasound: an open one-year prospective study. Maturitas 27:61–68

    Article  PubMed  Google Scholar 

  12. Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H (2001) DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female fracture patients from controls: a comparison between four different methods. Osteoporos Int 12:185–191

    Article  CAS  PubMed  Google Scholar 

  13. Hartl F, Tyndell A, Kraenzlin M, Bachmeier C, Guckel C, Senn U, Hans D, Theiler R (2002) Discriminatory ability of quantitative ultrasound parameters and bone mineral density in a population-based sample of postmenopausal women with vertebral fractures: results of the Basel Osteoporosis Study. J Bone Miner Res 17:321–330

    CAS  PubMed  Google Scholar 

  14. Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H (2002) Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fracture from control subjects. A comparison of four different methods. J Clin Densitom 5:79–85

    Article  PubMed  Google Scholar 

  15. Mele R, Masei G, Ventura V, de Aloysis D, Bicocchi M, Cadossi R (1997) Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population. Osteoporos Int 7:550–557

    CAS  PubMed  Google Scholar 

  16. Zitzmann M, Brunne M, Veith V, Nieschlag E (2002) Monitoring bone density in hypogonadal men by quantitative phalangeal ultrasound. Bone 31:422–429

    Article  CAS  PubMed  Google Scholar 

  17. World Health Organization (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. WHO, Geneva

  18. Royal College of Physicians (1999) Osteoporosis: clinical guidelines for prevention and treatment. RCP, London

  19. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843. WHO, Geneva

  20. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D, on behalf of the European Foundation for Osteoporosis and Bone Disease (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos International 7:390–406

    CAS  Google Scholar 

  21. National Osteoporosis Foundation (1998) Osteoporosis: Review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8 [suppl 4]:1–88

    Google Scholar 

  22. Kanis JA, Glüer C-C, for the Committee of Scientific Advisors, International Osteoporosis Foundation (2000) An update on the diagnosis and assessment of osteoporosis. Osteoporos Int 11:192–202

    Article  CAS  PubMed  Google Scholar 

  23. Marshall D, Johnell O, Weder H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporosis fractures. Br Med J 312:1254–1259

    CAS  Google Scholar 

  24. Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA, Finn JC et al (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724

    PubMed  Google Scholar 

  25. Van der Klift M, De Laet CEDH, McCloskey EV, Hofman A, Pols HAP (2002) The incidence of vertebral fractures in men and women: The Rotterdam Study. J Bone Miner Res 17:1051–1056

    PubMed  Google Scholar 

  26. McCloskey EV, Spector T, Eyres KS, Fern DE, O’Rourke N, Vasikaran S, Kanis JA (1993) Definition of vertebral deformity—a semi-automated method for use in population studies and clinical trials. Osteoporos Int 3:138–147

    CAS  PubMed  Google Scholar 

  27. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2003) The risk and burden of vertebral fractures in Sweden. Osteoporos Int (in press)

  28. Lindsay RL, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk for new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  CAS  PubMed  Google Scholar 

  29. Montagnani A, Gonnelli S, Capollaro C, Mangeri M, Monaco R, Bruni D, Gennari C (2000) Quantitative ultrasound at the phalanges in healthy Italian men. Osteoporos Int 11:499–504

    Article  CAS  PubMed  Google Scholar 

  30. Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8:599–603

    Article  CAS  PubMed  Google Scholar 

  31. Guglielmi G, Njeh CF, de Terlizzi F, De Serio A, Scilitani A, Cammisa M, Fan B, Lu Y, Gennant HK (2003) Phalangeal quantitative ultrasound, phalangeal morphometric variables, and vertebral fracture discrimination. Calcif Tissue Int 72:469–477

    Article  CAS  PubMed  Google Scholar 

  32. Drozdzowska B, Pluskiewicz W, de Terlizzi F (2003) The usefulness of quantitative ultrasound at the hand phalanges in the detection of the different types of non-traumatic fractures. Ultrasound Med Biol 29:1545–1550

    Article  PubMed  Google Scholar 

  33. Kreig MA, Corunz J, Ruffieux C, Sandini L, Buche D, Dambacher MA, Hartl F, Hauselmann HJ, Kraenzlin M, Lippuner K, Neff M, Pancaldi P, Rizzoli R, Tanzi F, Thieler R, Tyndall A, Wimpeimer K, Burckhardt P (2003) Comparison of three bone ultrasounds for the discrimination of subjects with and without osteoporotic fracture among 7,562 elderly women. J Bone Miner Res 18:1261–1266

    CAS  PubMed  Google Scholar 

  34. Gluer C, Eastell R, Reid DM, Felsenberg D, Roux C, Barkmann R, Timm W, Blank T, Armbrecht G, Stewart A, Clowes J, Thomasius E, Kolta S (2004) Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS study. J Bone Miner Res 19:782–739

    PubMed  Google Scholar 

  35. Stegman MR, Recker RR, Davies KM, Ryan RA, Heaney RP (1992) Fracture risk as determined by prospective and retrospective study designs. Osteoporos Int 2:290–297

    CAS  PubMed  Google Scholar 

  36. Kanis JA, Johnell O, Oden A, Jonsson B, deLaet C, Dawson A (2000) Prediction of fracture from low bone mineral density measurements overestimates risk. Bone 26:387–391

    Article  CAS  PubMed  Google Scholar 

  37. Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Oglesby A (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244

    PubMed  Google Scholar 

  38. Committee for Proprietary Medicinal Products (CPMP) (1997) Note for guidance on involutional osteoporosis in women. European Agency for the Evaluation of Medicinal Products, London (CPMP/EWP/552/95)

  39. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

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Acknowledgement

We are grateful to IGEA for their unrestricted support of this work

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Authors and Affiliations

  1. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield , S10 2RX, UK

    J. A. Kanis

  2. Department of Orthopaedics, Malmo General Hospital, 214 01 , Malmo, Sweden

    O. Johnell

  3. Consulting Statistician, Gothenburg, Sweden

    A. Oden

  4. Department of Public Health, Erasmus University, 3000 DR , Rotterdam, The Netherlands

    C. De Laet

  5. IGEA srl, Carpi, Italy

    F. de Terlizzi

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  1. J. A. Kanis
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  2. O. Johnell
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  3. A. Oden
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  4. C. De Laet
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  5. F. de Terlizzi
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Correspondence to J. A. Kanis.

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Kanis, J.A., Johnell, O., Oden, A. et al. Ten-year probabilities of clinical vertebral fractures according to phalangeal quantitative ultrasonography. Osteoporos Int 16, 1065–1070 (2005). https://doi.org/10.1007/s00198-004-1805-0

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  • DOI: https://doi.org/10.1007/s00198-004-1805-0

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