Osteoporosis International

, Volume 16, Issue 8, pp 963–968

Quantitative ultrasound and dual-energy X-ray absorptiometry in the prediction of fragility fracture in men

  • Stefano Gonnelli
  • Chiara Cepollaro
  • Luigi Gennari
  • Andrea Montagnani
  • Carla Caffarelli
  • Daniela Merlotti
  • Stefania Rossi
  • Alice Cadirni
  • Ranuccio Nuti
Original Article

Abstract

Fragility fractures in men represent a major health problem, and this prompts a necessity for reliable tools for the identification of men at risk of fracture. In order to assess the ability of dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) in the prediction of fracture risk in men and whether their combination might be useful in a clinical setting, we studied 401 men (age range 45–82 years, mean 60.3±12.5), of whom 133 had osteoporotic fractures and 268 did not. In all subjects we measured bone mineral density at the lumbar spine (BMD-LS) and at the femur, calculating thereafter the standard femoral subregions: neck (BMD-FN), total hip (BMD-T), trochanter (BMD-TR), intertrochanter (BMD-ITR), and Ward’s triangle (BMD-W), by DXA. We also performed ultrasound parameters at the calcaneus: speed of sound (SOS), broadband ultrasound attenuation (BUA) and Stiffness, by Achilles plus, and at the phalanxes: amplitude dependent speed of sound (AD-SoS) and the parameters of the graphic trace: bone transmission time (BTT), fast wave amplitude (FWA), signal dynamic (SDy) and ultrasound bone profile index (UBPI), by Bone Profiler. All DXA and QUS parameters, apart from FWA, were significantly (P<0.001) lower in patients with a history of fracture. BMD at the proximal femur showed the best ability in discriminating men with or without fractures. QUS at the heel showed discriminatory ability significantly better than QUS at the fingers. By logistic regression analysis, adjusted for age and BMI, BMD-T showed the best association with fragility fracture [odds ratio (OR)=3.43, 95% confidence interval (CI)=2.47–4.77]. Among QUS parameters, the highest value of the OR was shown by stiffness (OR=3.18, CI=2.27–4.48). FWA and SDy were not associated with fragility fractures in men. If DXA and QUS were combined, the prediction of the OR of fragility fracture events in men increases; in fact Stiffness was able to increase the OR when added to BMD-LS (OR=5.44, CI=3.16–10.13) and BMD-T (OR=6.08, CI=2.63–14.27). SOS and BUA showed a similar pattern. AD-SoS improved the prediction of fracture only when combined with BMD-LS (OR=4.36, CI=1.99–9.57). If BMD-LS and BMD-FN or BMD-T were combined, the value of the OR increases (OR=4.59, CI=2.27–9.25 and OR=4.68, CI=2.24–9.76), respectively. Our study supports the effectiveness of QUS in the identification of osteoporotic fractures in men. QUS seems to play an independent and complementary role, with respect to DXA, in order to enhance the power for predicting osteoporotic fractures in men.

Keywords

Bone mineral density Fragility fractures Men Quantitative ultrasound 

References

  1. 1.
    Cooper C, Campion G, Melton LJ III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289PubMedGoogle Scholar
  2. 2.
    Melton LJ III, Lane AW, Cooper C, Eastell R, O’Fallon WM, Riggs BL (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3:113–119PubMedGoogle Scholar
  3. 3.
    O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:152–157Google Scholar
  4. 4.
    Center JR, Nguyen TV, Schneider D, Sarnbrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882CrossRefPubMedGoogle Scholar
  5. 5.
    Orwoll E (2000) Perspective. Assessing bone density in men. J Bone Miner Res 15:1867–1870PubMedGoogle Scholar
  6. 6.
    Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307:1111–1115PubMedGoogle Scholar
  7. 7.
    Mussolino ME, Looker AC, Madans JH, Langlois JA, Orwoll ES (1998) Risk factors for hip fracture in white men: The NHANES I epidemiologic follow-up study. J Bone Miner Res 13:918–924PubMedGoogle Scholar
  8. 8.
    De Laet CEDH, Van Hout BA, Burger H, Weel AEAM, Hofman A, Pols HAP (1998) Hip fracture prediction in elderly men and women: validation of the Rotterdam Study. J Bone Miner Res 13:1587–1593PubMedGoogle Scholar
  9. 9.
    De Laet C.D.H, Van Der Klift M, Hofman A, Pols HAP (2002) Osteoporosis in men and women: a story about bone mineral density threshold and hip fracture risk. J Bone Miner Res 17:2231–2236PubMedGoogle Scholar
  10. 10.
    Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553PubMedGoogle Scholar
  11. 11.
    The European Prospective Osteoporosis Study (EPOS Group) (2002) The relationship between bone density and incident fractures in men and women. J Bone Miner Res 17:2214–2221PubMedGoogle Scholar
  12. 12.
    Melton LJ, Orwoll ES, Wasnich RD (2001) Does bone density predict fracture comparable in men and women? Osteoporos Int 12:707–709CrossRefPubMedGoogle Scholar
  13. 13.
    Faulkner GK, Orwoll E (2002) Implications in the use of T-scores for the diagnosis of osteoporosis in men. J Clin Densitom 5:87–93CrossRefPubMedGoogle Scholar
  14. 14.
    Binkley NC, Schmeer P, Wasnich RD, Lenchik L (2002) What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-caucasians? J Clin Densitom 5:19–27CrossRefGoogle Scholar
  15. 15.
    Legrand E, Chappard D, Pascaretti C, Duquenne M, Rondeau C, Simon Y, Rohmer V, Basle MF, Audran M (1999). Bone mineral density and vertebral fracture in men. Osteoporos Int 10:265–270CrossRefPubMedGoogle Scholar
  16. 16.
    Njeh CF, Fuerst T, Diessel E, Genant HK (2001) Is quantitative ultrasound dependent on bone structure? A reflection. Osteoporos Int 12:1–15CrossRefPubMedGoogle Scholar
  17. 17.
    Pluskiewicz W, Drozdowska B (1999) Ultrasound measurements at the calcaneus in men: differences between healthy and fractured persons and the influence of age and anthropometric features on ultrasound parameters. Osteoporos Int 10:47–51CrossRefPubMedGoogle Scholar
  18. 18.
    Montagnani A, Gonnelli S, Cepollaro C, Mangeri M, Monaco R, Gennari L, Gennari C (2001) Usefulness of bone quantitative ultrasound in management of osteoporosis in men. J Clin Densitom 4:231–237CrossRefPubMedGoogle Scholar
  19. 19.
    Mulleman D, Legroux-Gerot I, Duquesnoy B, Marchandise X, Delcambre B, Cortet B (2002) Quantitative ultrasound of bone in male osteoporosis. Osteoporos Int 13:388–393CrossRefPubMedGoogle Scholar
  20. 20.
    Goemaere S, Zmierczak H, Van Pottelbergh I, Kaufman JM (2002) Ability of peripheral bone assessments to predict areal bone mineral density at hip in community-dwelling elderly men. J Clin Densitom 3:219–228CrossRefGoogle Scholar
  21. 21.
    Ekman A, Michaelsson K, Petern-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. J Clin Densitom 1:79–85CrossRefGoogle Scholar
  22. 22.
    Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO, Delmas PD, Pouilles JM, Breart G, Meunier PJ, for the EPIDOS prospective study group (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348:511–514CrossRefPubMedGoogle Scholar
  23. 23.
    Cepollaro C, Gonnelli S, Pondrelli C, Martini S, Montagnani A, Rossi S, Gennari L, Gennari C. (1997) The combined use of ultrasound and densitometry in the prediction of vertebral fracture. Br J Radiol 70:691–696PubMedGoogle Scholar
  24. 24.
    Frost ML, Blake GM, Fogelman I (2001) Does the combination of quantitative ultrasound and dual energy X-ray absorptiometry improve fracture discrimination? Osteoporos Int 12:471–477CrossRefPubMedGoogle Scholar
  25. 25.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMedGoogle Scholar
  26. 26.
    Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM, for the study of osteoporotic fractures research group (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women: a prospective study. Arch Intern Med 157:629–634CrossRefPubMedGoogle Scholar
  27. 27.
    Wuster C, Albanese C, De Aloysio D, Duboef F, Gambacciani M, Gonnelli S, Gluer CC, Hans D, Joly J, Regynster JY, De Terlizzi F, Cadossi R (2000) Phalangeal Osteosonogrammetry Study: age-related changes, diagnostic sensitivity, and discrimination power. J Bone Miner Res 15:1603–1614PubMedGoogle Scholar
  28. 28.
    Hans D, Srivastav SK, Singal C, Barkmann R, Njeh CF, Kantorovich E, Gluer CC, Genant HK (1999) Does combining the results from multiple bone sites measured by a new quantitative ultrasound device improve discrimination of hip fracture? J Bone Miner Res 14:644–651PubMedGoogle Scholar
  29. 29.
    Peretz A, De Maertelaer V, Moris M, Wouters M, Bergmann P (1999) Evaluation of quantitative ultrasound and dual X-ray absorptiometry measurements in women with and without fractures. J Clin Densitom 2:127–133CrossRefPubMedGoogle Scholar
  30. 30.
    The Writing Group for the ISCD Position Development Conference (2004) Diagnosis of osteoporosis in men, premenopausal women, and children. J Clin Densitom 7:17–26CrossRefPubMedGoogle Scholar
  31. 31.
    Seeman E, Bianchi G, Adami S, Kanis J, Khosla S, Orwoll E (2004) Osteoporosis in men—consensus is premature. Calcif Tissue Int 75:120–122PubMedGoogle Scholar
  32. 32.
    Langton CM, Langton DK (2000) Comparison of bone mineral density and quantitative ultrasound of the calcaneus: site-matched correlation and discrimination of axial BMD status. Br J Radiol 73:31–35PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Stefano Gonnelli
    • 1
  • Chiara Cepollaro
    • 1
  • Luigi Gennari
    • 1
  • Andrea Montagnani
    • 1
  • Carla Caffarelli
    • 1
  • Daniela Merlotti
    • 1
  • Stefania Rossi
    • 2
  • Alice Cadirni
    • 1
  • Ranuccio Nuti
    • 1
  1. 1.Department of Internal MedicineEndocrine-Metabolic Science and Biochemistry, University of Siena, Policlinico Le ScotteSienaItaly
  2. 2.Department of PhysiopathologyExperimental Medicine and Public Health, University of SienaSienaItaly

Personalised recommendations