Osteoporosis International

, Volume 16, Issue 12, pp 1565–1575

Comparison of questionnaire and quantitative ultrasound techniques as screening tools for DXA

Original Article
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Abstract

The aim of the study is to assess the sensitivity and specificity of different techniques and their ability to act as screening tools in relation to dual energy X-ray absorptiometry (DXA) in a group of 208 postmenopausal women. In this study we examined eight screening systems for the diagnosis of osteoporosis, the osteoporosis self-assessment tool (OST), the osteoporosis risk assessment instrument (ORAI), the osteoporosis index of risk (OSIRIS), a risk index derived using data from the study of osteoporotic fractures (SOFSURF), the simple calculated osteoporosis risk estimation (SCORE), patient body weight (pBW), along with two ultrasound based systems, the Sunlight Omnisense (Sunlight Medical, Rehovot, Israel) and the CUBA Clinical (McCue plc, Winchester, UK). The sensitivity and specificity of the different techniques in relation to DXA were plotted as receiver-operating characteristic (ROC) curves at three different levels (DXA T-score −2.5 osteoporosis, −2 and −1 osteopenia). The areas under the curves (AUC) were calculated and showed broadband ultrasound attenuation (BUA) at the calcaneus to provide consistently the highest AUC (0.77–0.81). The velocity of sound (VOS) of the calcaneus (AUC =0.72–0.76) was equally good, but was out-performed by some of the questionnaire systems (AUC =0.66–0.79). Both the questionnaire systems and the CUBA Clinical out-perform the Sunlight Omnisense (AUC =0.58–0.7), which showed comparable performance with body weight (AUC =0.66–0.69). The results show that QUS is capable of selecting patients with low bone density as measured by DXA. A patient displaying a low QUS value should be followed up with a DXA scan to confirm the diagnosis.

Keywords

DXA Osteoporosis Screening Sensitivity Specificity Ultrasound scanners 

References

  1. 1.
    Geusens P, Hochberg MC, van der Voort DJM, et al (2002) Performance of risk indicies for identifying low bone density in postmenopausal women. Mayo Clin Proc 77:629–637PubMedGoogle Scholar
  2. 2.
    Koh LKH, Sedrine WB, Torralba TP, et al (2001) A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705CrossRefPubMedGoogle Scholar
  3. 3.
    Fujiwara S, Masunari N, Suzuki G, et al (2001) Performance of osteoporosis risk indices in a Japanese population. 62:586–594Google Scholar
  4. 4.
    Adler RA, Tran MT, Petkov VI (2003) Performance of the Osteoporosis Self-assessment Screening Tool for osteoporosis in American men. Mayo Clin Proc 78:723–727PubMedGoogle Scholar
  5. 5.
    Kung AWC, Ho AYY, Sedrine WB, et al (2003) Comparison of a simple clinical risk index and quantitative bone ultrasound for identifying women at increased risk of osteoporosis. Osteoporos Int 14:716–721CrossRefPubMedGoogle Scholar
  6. 6.
    Richy F, Gourlay M, Ross PD, et al (2004) Validation and comparative evaluation of the Osteoporosis Self-Assessment Tool (OST) in a Caucasian population from Belgium. Q J Med 97:39–46Google Scholar
  7. 7.
    Park HM, Sedrine WB, Reginster JY, et al (2003) Korean experience with the OSTA Risk Index for Osteoporosis. J Clin Densitom 6:247–250CrossRefPubMedGoogle Scholar
  8. 8.
    Cadarette SM, Jaglal SB, Kreiger N, et al (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. Can Med Assoc J 162:1289–1294Google Scholar
  9. 9.
    Von Mühlen D, Lunde AV, Barrett-Connor E, et al (1999) Evaluation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) in older Caucasian women: The Rancho Bernardo Study. Osteoporos Int 10:79–84CrossRefPubMedGoogle Scholar
  10. 10.
    Sedrine WB, Devogelaer JP, Kaufman JM, et al (2001) Evaluation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) in a sample of White women from Belgium. Bone 29:374–380CrossRefPubMedGoogle Scholar
  11. 11.
    Cadarette SM, Jaglal SB, Murray TM (1999) Validation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) for patient selection for bone densitometry. Osteoporos Int 10:85–90CrossRefPubMedGoogle Scholar
  12. 12.
    Falasca GF, Dunston C, Banglawala YA (2003) Further validation of a questionnaire to identify women likely to have low bone density. J Clin Densitom 6:231–236CrossRefPubMedGoogle Scholar
  13. 13.
    Ungar WJ, Josse R, Lee S, et al (2000) The Canadian Score Questionnaire. J Clin Densitom 3:269–280CrossRefPubMedGoogle Scholar
  14. 14.
    Sedrine WB, Chevallier T, Zegels B, et al (2002) Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol 16:245–250PubMedGoogle Scholar
  15. 15.
    Reginster JY, Sedrine WB, Viethel P, et al (2004) Validation of OSIRIS, a prescreening tool for the identification of women with an increased risk of osteoporosis. Gynecol Endocrinol 18:3–8CrossRefPubMedGoogle Scholar
  16. 16.
    Black DM, Steinbuch M, Palermo L, et al (2001) An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 12:519–528CrossRefPubMedGoogle Scholar
  17. 17.
    Randell AG, Bhalerao N, Nguyen TV, et al (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire. J Rheumatol 25:1171–1179PubMedGoogle Scholar
  18. 18.
    Gerber V, Krieg MA, Cornuz J, et al (2003) Nutritional status using the Mini Nutritional Assessment Questionnaire and its relationship with bone quality in a population of institutionalized elderly women. J Nutr Health Aging 7:140–145PubMedGoogle Scholar
  19. 19.
    Goemaere S, Zegels B, Toye K, et al (1999) Limited clinical utility of a self-evaluating risk assessment scale for postmenopausal osteoporosis: lack of predictive value of lifestyle-related factors. Calcif Tissue Int 65:354–358CrossRefPubMedGoogle Scholar
  20. 20.
    Michaëlsson K, Bergström R, Mallmin H, et al (1996) Screening for osteopenia and osteoporosis: selection by body composition. Osteoporos Int 6:120–126CrossRefPubMedGoogle Scholar
  21. 21.
    Greenhalgh T (1997) How to read a paper: papers that report diagnostic or screening tests. BMJ 315:540–543PubMedGoogle Scholar
  22. 22.
    Glas AS, Lijmer JG, Prins MH, et al (2003) The diagnostic odd ratios: a single indicator of test performance. J Clin Epidemiol 56:1129–1135CrossRefPubMedGoogle Scholar
  23. 23.
    Grimes DA, Schulz KF (2002) Uses and abuses of screening tests. Lancet 359:881–884CrossRefPubMedGoogle Scholar
  24. 24.
    Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293PubMedGoogle Scholar
  25. 25.
    Leib ES, Lewiecki EM, Binkley N, et al (2004) Official positions of the international society for clinical densitometry. J Clin Densitom 7:1–6CrossRefPubMedGoogle Scholar
  26. 26.
    Greenspan SL, Bouxsein ML, Melton ME, et al (1997) Precision and discriminatory ability of calcaneal bone assessment technologies. J Bone Miner Res 12:1303–1313PubMedGoogle Scholar
  27. 27.
    Brooke-Wavell K, Jones PR, Pye DW (1995) Ultrasound and dual X-ray absorptiometry measurement of the calcaneus: influence of region of interest location. Calcif Tissue Int 57:20–24CrossRefPubMedGoogle Scholar
  28. 28.
    Johansen A, Evans W, Stone M (1999) Bone assessment in elderly women: what does a low bone ultrasound result tell us about bone mineral density? Arch Gerontol Geriatr 28:239–246CrossRefPubMedGoogle Scholar
  29. 29.
    Njeh CF, Hans D, Li J, et al (2000) Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimination. Osteoporos Int 11:1051–1062CrossRefPubMedGoogle Scholar
  30. 30.
    Herd RJM, Blake GM, Miller CG, et al (1994) The ultrasonic assessment of osteopenia as defined by dual X-ray absorptiometry. Br J Radiol 67:631–635PubMedGoogle Scholar
  31. 31.
    Graafmans WC, Lingen AV, Ooms ME, et al (1996) Ultrasound measurements in the calcaneus: precision and its relation with bone mineral density of the heel and the lumber spine. Bone 19:97–100CrossRefPubMedGoogle Scholar
  32. 32.
    Knapp KM, Blake GM, Spector TD, et al (2001) Multisite quantitative ultrasound: precision, age- and menopause- related changes, fracture discrimination, and t -score equivalence with dual-energy X-ray absorptiometry. Osteoporos Int 12:456–464CrossRefPubMedGoogle Scholar
  33. 33.
    Damilakis JE, Papadokostakis G, Vrahoriti H, et al (2003) Ultrasound velocity through the cortex of phalanges, radius, and tibia in normal and osteoporotic postmenopausal women using a new multisite quantitative ultrasound device. Invest Radiol 38:207–211CrossRefPubMedGoogle Scholar
  34. 34.
    Nicholson PHF, Strelitzki R, Cleveland RO, et al (2000) Scattering of ultrasound in cancellous bone: predictions from a theoretical model. J Biomech 33:503–506CrossRefPubMedGoogle Scholar
  35. 35.
    Stewart A, Reid DM (2000) Quantitative ultrasound or clinical risk factors—which best identifies women at risk of osteoporosis? Br J Radiol 73:165–171PubMedGoogle Scholar
  36. 36.
    Adler RA, Funkhouser HL, Holt CM (2001) Utility of heel ultrasound bone density in men. J Clin Densitom 4:225–230CrossRefPubMedGoogle Scholar
  37. 37.
    Ekman A, Michaëlsson K, Petrén-Mallmin M, et al (2002) Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fractures from control subjects. J Clin Densitom 5:79–85CrossRefPubMedGoogle Scholar
  38. 38.
    Sørensen HA, Jørgensen NR, Jensen J-EB, et al (2001) Comparison of quantitative ultrasound and dual X-ray absorptiometry in estrogen-treated early postmenopausal women. J Clin Densitom 4:97–104CrossRefPubMedGoogle Scholar
  39. 39.
    Falgarone G, Porcher R, Duché A, et al (2004) Discrimination of osteoporotic patients with quantitative ultrasound using imaging or non-imaging device. Joint Bone Spine (corrected proof)Google Scholar
  40. 40.
    Damilakis JE, Papadokostakis G, Perisinakis K, et al (2003) Can Radial bone mineral density and quantitative ultrasound measurements reduce the number of women who need axial density skeletal assessment? Osteoporos Int 14:688–693CrossRefPubMedGoogle Scholar
  41. 41.
    Knapp KM, Blake GM, Spector TD, et al (2004) Can the WHO definition of osteoporosis be applied to the multi-site axial transmission quantitative ultrasound? Osteoporos Int 15:367–374CrossRefPubMedGoogle Scholar
  42. 42.
    Gambacciani M, de Aloysio D, Elia D, et al (2003) Quantitative ultrasound (qus) of bone in the management of postmenopausal women. Maturitas 47:139–149CrossRefGoogle Scholar
  43. 43.
    Hans D, Hartl F, Krieg MA (2003) Device-specific weighted T-score for two quantitative ultrasounds: operational proportions for the management of osteoporosis for 65 years and older women in Switzerland. Osteoporos Int 14:251–258PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • R. B. Cook
    • 1
  • D. Collins
    • 2
  • J. Tucker
    • 3
  • P. Zioupos
    • 1
  1. 1.Department of Materials and Medical SciencesCranfield University Postgraduate Medical SchoolShrivenhamUK
  2. 2.Department of RheumatologyGreat Western HospitalSwindonUK
  3. 3.Department of RadiologyGreat Western HospitalSwindonUK

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