Osteoporosis International

, Volume 18, Issue 5, pp 629–639 | Cite as

Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound

  • A. Díez-Pérez
  • J. González-Macías
  • F. Marín
  • M. Abizanda
  • R. Alvarez
  • A. Gimeno
  • E. Pegenaute
  • J. Vila
  • for the ECOSAP study investigators
Original Article



The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk.


Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non-spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models.


5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporosis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture.


Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for any non-vertebral, hip, forearm/wrist, and humerus fractures were 1.31 (1.15–1.49), 1.40 (1.01–1.95), 1.50 (1.19–1.89) and 1.35 (0.97–1.87), respectively. Similar results were observed with other QUS variables. The best predictive models indicated that age, a history of falls, a previous low-trauma fracture, a family history of fracture, a calcium intake from dairy products of less than 250 mg/day, and lower values of QUS parameters were independently associated with the risk of non-spinal fractures.


Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures. A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain.


Bone densitometry Bone ultrasound Fractures Menopause Osteoporosis Risk factors 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • A. Díez-Pérez
    • 1
    • 9
  • J. González-Macías
    • 2
  • F. Marín
    • 3
  • M. Abizanda
    • 4
  • R. Alvarez
    • 5
  • A. Gimeno
    • 6
  • E. Pegenaute
    • 7
  • J. Vila
    • 8
  • for the ECOSAP study investigators
  1. 1.Bone Research Unit, Department of Internal Medicine, Hospital Universitario del MarUniversidad AutónomaBarcelonaSpain
  2. 2.Department of Internal MedicineHospital Universitario Marqués de ValdecillaSantanderSpain
  3. 3.Department of Medical ResearchEli Lilly and CompanyMadridSpain
  4. 4.Primary Care Centre Gran VíaBarcelonaSpain
  5. 5.Area XPrimary CareMadridSpain
  6. 6.Primary Care Centre La AlcudiaValenciaSpain
  7. 7.Primary Care Centre Coronel de PalmaMadridSpain
  8. 8.Statistics Support UnitInstitut Municipal d’Investigació Mèdica (IMIM)BarcelonaSpain
  9. 9.Unidad de Investigación en Fisiopatología Osea y ArticularHospital del Mar-IMIMBarcelonaSpain

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