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Heel bone ultrasound predicts non-spine fracture in Japanese men and women

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A number of prospective studies in the USA and Europe have demonstrated that quantitative ultrasound (QUS) measurements predict fracture risk. To our knowledge, there has been no such study in a Japanese population, and very few studies have measured the prognostic value of QUS measurements among men, even in the USA and Europe. We performed a three-center prospective study to investigate the relationship between baseline heel QUS measurements and non-spine fracture risk. There were 4,028 subjects (1,004 men and 3,024 women), 67.5±8.9 years [mean ± standard deviation (SD)] of age), who underwent heel QUS (Achilles device) at three centers between 1993 and 2000. In 2002, the subjects were mailed a standardized questionnaire that asked about their history of fracture. The mean follow-up period was approximately 5 years. The Achilles measured speed of sound (SOS) and broadband ultrasound attenuation (BUA). We used Cox regression analysis to determine the hazard ratio (HR), using weighted coefficients. SOS, BUA, and stiffness index (SI) predicted self-reported hip, wrist, and total non-spine fractures. After we had adjusted for age, gender, and weight, the HRs of total non-spine fracture were 1.54 [95% confidence interval (CI) 1.39–1.69], 1.53 (1.37–1.70), and 1.80 (1.62–1.98) for 1 SD decrease in SOS, BUA, and SI, respectively. In men, SOS and SI also predicted total non-spine fractures with HRs similar to those in women. The HR of prediction for hip fracture by SOS and SI was better in the short term than in the long term, and the prediction for hip, wrist, and non-spine fracture remained significant between 5 to 10 years of follow-up. Measurements obtained from heel QUS predicted non-spine fracture in Japanese men and women, and the HRs of Japanese of both genders was similar to the risk ratio (RR) of Caucasian men and women. QUS parameters can predict hip, wrist, and non-spine fracture up to 10 years.

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This study was conducted by an ad hoc committee for “Assessment and Clinical Application of Devices of Measuring Bone Strength” of the Japan Osteoporosis Society. We thank Drs. Takami Miki (Osaka City University Graduate School of Medicine, Department of Geriatric Medicine), and Hirotoshi Morii (Osaka Osteoporosis Network) for their contributions to this study. The Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan, is a private, non-profit foundation funded by the Japanese Ministry of Health, Labor and Welfare and the US Department of Energy, the latter through the National Academy of Sciences. This publication was supported by RERF Research Protocol RP 3-89 and by a grant from the Japan Osteoporosis Foundation.

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Correspondence to S. Fujiwara.

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Fujiwara, S., Sone, T., Yamazaki, K. et al. Heel bone ultrasound predicts non-spine fracture in Japanese men and women. Osteoporos Int 16, 2107–2112 (2005).

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