Osteoporosis International

, Volume 20, Issue 2, pp 257–264 | Cite as

Relationship between bone quantitative ultrasound and mortality: a prospective study

  • J. González-Macías
  • F. Marín
  • J. Vila
  • E. Carrasco
  • P. Benavides
  • M. V. Castell
  • J. E. Magaña
  • F. Chavida
  • A. Díez-Pérez
  • for the ECOSAP investigators
Original Article



In a cohort of 5,201 women [72.3 ± 5.3 years] from 58 primary care centers in Spain, followed for three years, no relationship between heel QUS parameters and overall mortality was found. However, a significant relationship between a low speed of sound (SOS) and vascular mortality was observed.


An inverse relationship between mortality and bone mineral density measured by dual-energy absorption densitometry or quantitative bone ultrasound (QUS) has been described. The aim of the present study was to test this relationship in the ECOSAP cohort, a 3-year prospective study designed to assess the ability of heel QUS and clinical risk factors to predict non-vertebral fracture risk in women over 64.


A cohort of 5,201 women [72.3 ± 5.3 years] was studied. QUS was assessed with the Sahara® bone sonometer. Women attended follow-up visits every 6 months. Physicians recorded if the patient died and cause of death. Hazard rates (HR) of all-cause and vascular mortality per one standard deviation reduction in QUS parameters were determined.


One hundred (1.9%) women died during a median of 36.1 months follow-up, for a total of 14,999 patient-years, 42 because of vascular events (both cardiovascular and cerebrovascular). After adjusting for age, none of the QUS variables showed statistically significant differences between the patients who died and the survivors. In the final multivariate model, adjusted for age, current thyroxine and hypoglycaemic drug use, chronic obstructive pulmonary disease and decreased visual acuity, SOS was marginally non-significant: (HR: 1.19; 0.97–1.45). However, each 1 SD reduction in SOS was associated with a 39% increase in vascular mortality (HR: 1.39; 1.15–1.66).


In our cohort, SOS was related with vascular mortality, but not overall mortality.


Bone densitometry Bone ultrasound Menopause Mortality Osteoporosis Vascular 


  1. 1.
    Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMedGoogle Scholar
  2. 2.
    Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR, Osteoporotic Fractures Research Group (1999) Vertebral fractures and mortality in older women: a prospective study. Arch Inter Med 159:1215–1220CrossRefGoogle Scholar
  3. 3.
    Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260PubMedCrossRefGoogle Scholar
  4. 4.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42PubMedCrossRefGoogle Scholar
  5. 5.
    Empana JP, Dargent-Molina P, Bracart G, EPIDOS Group (2004) Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. J Am Geriatr Soc 52:685–690PubMedCrossRefGoogle Scholar
  6. 6.
    Hasserius R, Karlsson MK, Jonsson B et al (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly: a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76:235–242PubMedCrossRefGoogle Scholar
  7. 7.
    Browner WS, Seeley DG, Vogt TM et al (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358PubMedCrossRefGoogle Scholar
  8. 8.
    Johansson C, Black D, Johnell O et al (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196PubMedCrossRefGoogle Scholar
  9. 9.
    Kado DM, Browner WS, Blackwell T et al (2000) Rate of bone loss is associated with mortality in older women: a prospective study. J Bone Miner Res 15:1974–1980PubMedCrossRefGoogle Scholar
  10. 10.
    Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12:259–265PubMedCrossRefGoogle Scholar
  11. 11.
    Marín F, González-Macías J, Díez-Pérez A et al (2006) Relationship between bone quantitative ultrasound and fractures: a meta-analysis. J Bone Miner Res 21:1126–1135PubMedCrossRefGoogle Scholar
  12. 12.
    Turner CH, Peacock M, Timmerman L et al (1995) Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporos Int 5:130–135PubMedCrossRefGoogle Scholar
  13. 13.
    Schott AM, Weill-Engerer S, Hans D et al (1995) Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 10:243–249PubMedCrossRefGoogle Scholar
  14. 14.
    Bouxsein ML, Radloff SE (1997) Quantitative ultrasound of the calcaneus reflects the mechanical properties of calcaneal trabecular bone. J Bone Miner Res 12:839–846PubMedCrossRefGoogle Scholar
  15. 15.
    Bauer DC, Palermo L, Black D et al (2002) Quantitative ultrasound and mortality: a prospective study. Osteoporos Int 13:606–612PubMedCrossRefGoogle Scholar
  16. 16.
    Pinhero MM, Castro CM, Szejnfeld VL (2006) Low femoral bone mineral density and quantitative ultrasound are risk factors for new osteoporotic fracture and total and cardiovascular mortality: a 5-year population-based study of Brazilian elderly women. J Gerontol A Biol Sci Med Sci 61:196–203Google Scholar
  17. 17.
    Díez-Pérez A, González-Macías J, Marín F et al (2007) Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound. Osteoporos Int 18:629–639PubMedCrossRefGoogle Scholar
  18. 18.
    Hernández JL, Marín F, González-Macías J et al (2004) Discriminative capacity of calcaneal quantitative ultrasound and fracture risk factors in postmenopausal women with osteoporotic fractures. Calcif Tissue Int 74:357–365PubMedCrossRefGoogle Scholar
  19. 19.
    von Stetten E, Ouellet H, Wilson KE et al (1998) European caucasian female reference data values for the Sahara clinical bone sonometer. Bone 23(Suppl 5):S637 AbstractGoogle Scholar
  20. 20.
    Marín F, Vila J, González-Macías J, on behalf the ECOSAP project investigators (2003) Quantitative bone ultrasound: impact of the application of two different reference databases to a population of 5195 postmenopausal women. Med Clin (Barc) 121:250–252CrossRefGoogle Scholar
  21. 21.
    Sosa M, Saavedra P, Muñoz-Torres M et al (2002) Quantitative ultrasound calcaneous measurements: normative data and precision in the spanish population. Osteoporos Int 13:487–492PubMedCrossRefGoogle Scholar
  22. 22.
    Lin J, Zhang D, Davidian M (2006) Smoothing Spline-based score tests for proportional hazards models. Biometrics 62:803–812PubMedCrossRefGoogle Scholar
  23. 23.
    R Development Core Team (2006) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available at: http://www.R-project.org, accessed: 29 December, 2007
  24. 24.
    von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:273–278CrossRefGoogle Scholar
  25. 25.
    Mussolino ME, Madans JH, Gillum RF (2003) Bone mineral density and mortality in women and men: the NHANES I epidemiologic follow-up study. Ann Epidemiol 13:692–697PubMedCrossRefGoogle Scholar
  26. 26.
    van der Klift M, Pols HAP, Geleijnse JM et al (2002) Bone mineral density and mortality in elderly men and women: the Rotterdam study. Bone 30:643–648CrossRefGoogle Scholar
  27. 27.
    Browner WS, Pressman AR, Nevitt MC et al (1993) Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke 24:940–946PubMedGoogle Scholar
  28. 28.
    Uyama O, Yoshimoto Y, Yamamoto Y et al (1997) Bone changes and carotid atherosclerosis in postmenopausal women. Stroke 28:1730–1732PubMedGoogle Scholar
  29. 29.
    Jorgensen L, Engstad T, Jacobsen BK (2001) Bone mineral density in acute stroke patients: low bone mineral density may predict first stroke in women. Stroke 32:47–51PubMedGoogle Scholar
  30. 30.
    Tanko LB, Bagger YZ, Christiansen C (2003) Low bone mineral density in the hip as a marker of advanced atherosclerosis in elderly women. Calcif Tissue Int 73:15–20PubMedCrossRefGoogle Scholar
  31. 31.
    Tanko LB, Christiansen C, Cox DA et al (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920PubMedCrossRefGoogle Scholar
  32. 32.
    Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194PubMedCrossRefGoogle Scholar
  33. 33.
    Stewart A, Kumar V, Reid DM (2006) Long-term fracture prediction by DXA and QUS: a 10-year prospective study. J Bone Miner Res 21:413–418PubMedCrossRefGoogle Scholar
  34. 34.
    World Health Organization. http://www.who.int/countries. Accessed: 18 January 2008
  35. 35.
    Bauer DC, Rodondi N, Stone KL et al (2007) Thyroid hormone use, hyperthyroidism and mortality in older women. Am J Med 120:343–349PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • J. González-Macías
    • 1
  • F. Marín
    • 2
  • J. Vila
    • 3
  • E. Carrasco
    • 4
  • P. Benavides
    • 5
  • M. V. Castell
    • 6
  • J. E. Magaña
    • 7
  • F. Chavida
    • 8
  • A. Díez-Pérez
    • 9
  • for the ECOSAP investigators
  1. 1.Department of Internal Medicine, Hospital Marqués de ValdecillaUniversity of CantabriaSantanderSpain
  2. 2.Department of Medical ResearchEli Lilly and CompanyMadridSpain
  3. 3.Statistics Support UnitInstitut Municipal d’Investigació Mèdica (IMIM)BarcelonaSpain
  4. 4.Centro de Salud AbaránMurciaSpain
  5. 5.Centro de Salud PumarínOviedoSpain
  6. 6.Centro de Salud PeñagrandeMadridSpain
  7. 7.Centro de Salud EstaciónToledoSpain
  8. 8.Centro de Salud de BrihuegaGuadalajaraSpain
  9. 9.Department of Internal Medicine, Hospital Universitario del MarAutonomous UniversityBarcelonaSpain

Personalised recommendations