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Osteoporosis International

, Volume 18, Issue 6, pp 771–777 | Cite as

Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study

  • D. C. Bauer
  • S. K. Ewing
  • J. A. Cauley
  • K. E. Ensrud
  • S. R. Cummings
  • E. S. Orwoll
  • Osteoporotic Fractures in Men (MrOS) Research Group
Original Article

Abstract

Summary

Quantitative ultrasound (QUS) is associated with fracture risk in women, but there are few data in men. We studied 5,607 older men and found that QUS predicts hip and any non-spine fracture risk nearly as well as BMD. Combined measurements of QUS and BMD are not superior to either measurement alone.

Introduction

Quantitative ultrasound (QUS) predicts fracture risk among older women, but there are few prospective studies among older men. We studied the ability of QUS and BMD measurements to predict hip and other non-spine fractures in a population-based study of older men.

Methods

Calcaneal QUS and hip BMD were measured in 5,607 men aged ≥65 years recruited from six US centers. At baseline duplicate QUS measurements with repositioning were obtained, and subsequent hip and other non-spine fractures were documented by review of x-rays or x-ray reports. The relationships between QUS and fractures were examined with proportional hazard models adjusted for age and clinic. We used receiver operating characteristic curves and predicted fracture risk models to determine the utility of QUS alone, BMD alone or the combination of QUS+BMD.

Results

During a mean follow-up of 4.2 years with 99% complete follow-up, 239 men suffered a non-spine fracture, including 49 hip fractures. Each standard deviation reduction in broadband ultrasonic attenuation (BUA) was associated with an increased risk of hip (relative hazard=2.0, CI: 1.5, 2.8) and any non-spine fracture (relative hazard=1.6, CI: 1.4, 1.8). The area under the receiver operating characteristic curve and the predicted probability of fracture were similar for BUA alone, BMD alone and the combination of BUA+BMD, indicating that once BUA or BMD is known, the other measurement does not add useful information. Other QUS parameters gave similar results.

Conclusions

QUS measurements predict the risk of hip and any non-spine fracture in older men, and do so nearly as well as hip BMD measurements. Combined measurements of QUS and BMD are not superior to either measurement alone.

Keywords

BMD Broadband ultrasonic attenuation Cohort Fracture Quantitative ultrasound 

Notes

Conflict of interest statement

None of the authors have any conflict of interest.

References

  1. 1.
    Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO et al (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348:511–514PubMedCrossRefGoogle Scholar
  2. 2.
    Huopio J, Kroger H, Honkanen R, Jurvelin J, Saarikoski S, Alhava E (2004) Calcaneal ultrasound predicts early postmenopausal fractures as well as axial BMD. A prospective study of 422 women. Osteoporos Int 15(3):190–195PubMedCrossRefGoogle Scholar
  3. 3.
    Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK et al (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157(6):629–634PubMedCrossRefGoogle Scholar
  4. 4.
    Nguyen TV, Center JR, Eisman JA (2004) Bone mineral density-independent association of quantitative ultrasound measurements and fracture risk in women. Osteoporos Int 15(12):942–947PubMedCrossRefGoogle Scholar
  5. 5.
    Hans D, Schott AM, Arlot ME, Sornay E, Delmas PD, Meunier PJ (1995) Influence of anthropometric parameters on ultrasound measurements of os calcis. Osteoporos Int 5:371–376PubMedCrossRefGoogle Scholar
  6. 6.
    Hans D, Arlot ME, Schott AM, Roux JP, Kotzki PO, Meunier PJ (1995) Do ultrasound measurements on the os calcis reflect more the microarchitecture than the bone mass?: a two-dimensional histomorphometric study. Bone 16(3):295–300PubMedCrossRefGoogle Scholar
  7. 7.
    Cortet B, Boutry N, Dubois P, Legroux-Gerot I, Cotten A, Marchandise X (2004) Does quantitative ultrasound of bone reflect more bone mineral density than bone microarchitecture? Calcif Tissue Int 74(1):60–67PubMedCrossRefGoogle Scholar
  8. 8.
    Laugier P, Giat P, Berger G (1994) Broadband ultrasonic attenuation imaging: a new imaging technique of os calcis. Calcif Tissue Int 54(2):83–86PubMedCrossRefGoogle Scholar
  9. 9.
    Wuster C, Hadji P (2001) Use of quantitative ultrasound densitometry (QUS) in male osteoporosis. Calcif Tissue Int 69(4):225–228PubMedCrossRefGoogle Scholar
  10. 10.
    Blank JB, Cawthon PM, Carrion-Petersen ML, Harper L, Johnson JP, Mitson E et al (2005) Overview of recruitment for the osteoporotic fractures in men study (MrOS). Contemp Clin Trials 26(5):557–568PubMedCrossRefGoogle Scholar
  11. 11.
    Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study–a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26(5):569–585PubMedCrossRefGoogle Scholar
  12. 12.
    Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ et al (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause 11(3):264–274PubMedCrossRefGoogle Scholar
  13. 13.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP et al (1995) Proximal femur bone mineral levels of US adults. Osteoporos Int 5(5):389–409PubMedCrossRefGoogle Scholar
  14. 14.
    Efron B, Tibshirani R (1993) An introduction to the bootstrap. Chapman & Hall, New YorkGoogle Scholar
  15. 15.
    Hui S, Slemenda C, Carey M, Johnston C (1996) Choosing between predicors of fractures. J Bone Min Res 10(11):1816–1822CrossRefGoogle Scholar
  16. 16.
    McNeil BJ, Hanley JA (1984) Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Making 4(2):137–150PubMedCrossRefGoogle Scholar
  17. 17.
    Faulkner KG, von Stetten E, Miller P (1999) Discordance in patient classification using T-scores. J Clin Densitom 2(3):343–350PubMedCrossRefGoogle Scholar
  18. 18.
    Orwoll ES, Ettinger M, Weiss S, Miller P et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610PubMedCrossRefGoogle Scholar
  19. 19.
    Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A et al (2003) The effect of teriparatide [human parathyroid hormone (1–34)] therapy on bone density in men with osteoporosis. J Bone Miner Res 18(1):9–17PubMedCrossRefGoogle Scholar
  20. 20.
    Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM (2003) The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 349(13):1216–1226PubMedCrossRefGoogle Scholar
  21. 21.
    Pluijm SM, Graafmans WC, Bouter LM, Lips P (1999) Ultrasound measurements for the prediction of osteoporotic fractures in elderly people. Osteoporos Int 9(6):550–556PubMedCrossRefGoogle Scholar
  22. 22.
    Varenna M, Sinigaglia L, Adami S, Giannini S, Isaia G, Maggi S et al (2005) Association of quantitative heel ultrasound with history of osteoporotic fractures in elderly men: The ESOPO study. Osteoporos Int 16(12):1749–1754PubMedCrossRefGoogle Scholar
  23. 23.
    Gonnelli S, Cepollaro C, Gennari L, Montagnani A, Caffarelli C, Merlotti D et al (2005) Quantitative ultrasound and dual-energy X-ray absorptiometry in the prediction of fragility fracture in men. Osteoporos Int 16(8):963–968PubMedCrossRefGoogle Scholar
  24. 24.
    Khaw KT, Reeve J, Luben R, Bingham S, Welch A, Wareham N et al (2004) Prediction of total and hip fracture risk in men and women by quantitative ultrasound of the calcaneus: EPIC-Norfolk prospective population study. Lancet 363(9404):197–202PubMedCrossRefGoogle Scholar
  25. 25.
    Fujiwara S, Sone T, Yamazaki K, Yoshimura N, Nakatsuka K, Masunari N et al (2005) Heel bone ultrasound predicts non-spine fracture in Japanese men and women. Osteoporos Int 16(12):2107–2112PubMedCrossRefGoogle Scholar
  26. 26.
    Hans D, Hartl F, Krieg MA (2003) Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland. Osteoporos Int 14(3):251–258PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • D. C. Bauer
    • 1
    • 2
  • S. K. Ewing
    • 2
  • J. A. Cauley
    • 3
  • K. E. Ensrud
    • 4
  • S. R. Cummings
    • 1
  • E. S. Orwoll
    • 5
  • Osteoporotic Fractures in Men (MrOS) Research Group
  1. 1.UCSFSan FranciscoUSA
  2. 2.University of CaliforniaSan FranciscoUSA
  3. 3.University of PittsburghPittsburghUSA
  4. 4.University of MinnesotaMinneapolisUSA
  5. 5.Oregon Health Sciences UniversityPortlandUSA

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