Skip to main content

Advertisement

SpringerLink
Log in

Quantitative ultrasound measurements and vitamin D status in the assessment of hip fracture risk in a nationally representative population sample

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Adjusted for age, gender, height and weight, calcaneal quantitative ultrasound (QUS) and serum 25-hydroxyvitamin D (S-25(OH)D) proved to be significant predictors of hip fracture among subjects aged ≥50 years. Even if their contribution to the predictive power was modest, they may be useful in the assessment of hip fracture risk in the elderly.

Introduction

This study assessed calcaneal QUS measurements, S-25(OH)D and several other factors for the prediction of hip fracture risk in a nationally representative population sample.

Methods

The study population consisted of 3,305 subjects (1,872 women), aged 50 years or over, who had participated in a comprehensive health survey. QUS measurements were made by means of the Hologic Sahara device. S-25(OH)D was measured by radioimmunoassay. Emerging cases of hip fracture were identified from the National Hospital Discharge Register.

Results

During a mean follow-up of 8.4 years, 95 subjects sustained a hip fracture. After adjusting for age, gender, height, weight and each other, a 1 standard deviation increment in the quantitative ultrasound index (QUI) (21.7) and in S-25(OH)D (17.5 nmol/L) reduced the risk of hip fracture by 40 % (hazard ratio [HR] = 0.60, 95 % confidence interval [CI] = 0.42–0.86) and by 31 % (HR = 0.69, 95 % CI = 0.55–0.87), respectively. The predictive power of a model including age, gender, height and weight was improved by about 8 % after the addition of QUI and S-25(OH)D. Among subjects aged 75 years or over, the corresponding improvement was about 130 %.

Conclusions

QUI and S-25(OH)D were significant and independent predictors of hip fracture. However, their ability to increase the predictive power of a statistical model including readily available simple variables such as age, gender, height and weight was rather modest. Still, our findings suggest that QUI and S-25(OH)D may be of clinical use in the assessment of hip fracture risk particularly in the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42

    Google Scholar 

  2. Nurmi I, Narinen A, Lüthje P, Tanninen S (2003) Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 123(10):551–554

    Article  PubMed  Google Scholar 

  3. Lüthje P, Kataja M, Nurmi I, Santavirta S, Avikainen V (1995) Four-year survival after hip fractures—an analysis in two Finnish health care regions. Ann Chir Gynaecol 84(4):395–401

    PubMed  Google Scholar 

  4. Melton LJ, Gabriel SE, Crowson CS, Tosteson ANA, Johnell O, Kanis JA (2003) Cost-equivalence of different osteoporotic fractures. Osteoporos Int 14(5):383–388

    Article  PubMed  Google Scholar 

  5. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936

    Article  PubMed  Google Scholar 

  6. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley JC, Black D, Vogt TM (1995) Risk factors for hip fracture in White women. N Engl J Med 332(12):767–773

    Article  PubMed  CAS  Google Scholar 

  7. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jönsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16(6):581–589

    Google Scholar 

  8. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ, 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046. doi:10.1007/s00198-007-0343-y

    Google Scholar 

  9. Hans D, Schott AM, Duboeuf F, Durosier C, Meunier PJ (2004) Does follow-up duration influence the ultrasound and DXA prediction of hip fracture? The EPIDOS prospective study. Bone 35(2):357–363

    Article  PubMed  CAS  Google Scholar 

  10. Fujiwara S, Sone T, Yamazaki K, Yoshimura N, Nakatsuka K, Masunari N, Fujita S, Kushida K, Fukunaga M (2005) Heel bone ultrasound predicts non-spine fracture in Japanese men and women. Osteoporos Int 16(12):2107–2112

    Article  PubMed  CAS  Google Scholar 

  11. Hans D, Durosier C, Kanis JA, Johansson H, Schott-Pethelaz AM, Krieg MA (2008) Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women. J Bone Miner Res 23(7):1045–1051. doi:10.1359/jbmr.080229

    Article  PubMed  Google Scholar 

  12. Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO, Delmas PD, Pouilles JM, Breart G, Meunier PJ (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348(9026):511–514

    Article  PubMed  CAS  Google Scholar 

  13. Krieg MA, Cornuz J, Ruffieux C, Van Melle G, Buche D, Dambacher MA, Hans D, Hartl F, Hauselmann HJ, Kraenzlin M, Lippuner K, Neff M, Pancaldi P, Rizzoli R, Tanzi F, Theiler R, Tyndall A, Wimpfheimer C, Burckhardt P (2006) Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study. J Bone Miner Res 21(9):1457–1463

    Article  PubMed  Google Scholar 

  14. Bauer DC, Ewing SK, Cauley JA, Ensrud KE, Cummings SR, Orwoll ES (2007) Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study. Osteoporos Int 18:771–777

    Article  PubMed  CAS  Google Scholar 

  15. Diéz-Pérez A, Gonzalez-Macias J, Marin F, Abizanda M, Alvarez R, Gimeno A, Pegenaute E, Vila J (2007) Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound. Osteoporos Int 18(5):629–639. doi:10.1007/s00198-006-0297-5

    Google Scholar 

  16. Engelke K, Glüer CC (2006) Quality and performance measures in bone densitometry: part 1: errors and diagnosis. Osteoporos Int 17(9):1283–1292. doi:10.1007/s00198-005-0039-0

  17. Njeh CF, Hans D, Li J, Fan B, Fuerst T, He YQ, Tsuda-Futami E, Lu Y, Wu CY, Genant HK (2000) Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimination. Osteoporos Int 11(12):1051–1062

    Article  PubMed  CAS  Google Scholar 

  18. Moayyeri A, Adams JE, Adler RA, Krieg MA, Hans D, Compston J, Lewiecki EM (2012) Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis. Osteoporos Int 23(1):143–153. doi:10.1007/s00198-011-1817-5

    Google Scholar 

  19. Heistaro S (ed) (2008) Methodology report: health 2000 survey. National Public Health Institute, Publications of the National Public Health Institute B26/2008, Helsinki. Available at http://www.terveys2000.fi/doc/methodologyrep.pdf

  20. Kauppi M, Impivaara O, Mäki J, Heliövaara M, Marniemi J, Montonen J, Jula A (2009) Vitamin D status and common risk factors for bone fragility as determinants of quantitative ultrasound variables in a nationally representative population sample. Bone 45(1):119–124. doi:10.1016/j.bone.2009.03.659

    Google Scholar 

  21. Aromaa A, Koskinen S (eds) (2004) Health and functional capacity in Finland. Baseline results of the health 2000 health examination survey. National Public Health Institute, Publications of the National Public Health Institute B12/2004, Helsinki. Available at http://www.terveys2000.fi/julkaisut/baseline.pdf

  22. (2005) Finnish current care guideline for treatment of alcohol abuse. Duodecim 121:788–803. Updated 15 April 2010

  23. Haara MM, Arokoski JP, Kröger H, Kärkkäinen A, Manninen P, Knekt P, Impivaara O, Heliövaara M (2005) Association of radiological hand osteoarthritis with bone mineral mass: a population study. Rheumatol (Oxford) 44(12):1549–1554

    Article  CAS  Google Scholar 

  24. Royston P (2006) Explained variation for survival models. Stata J 6(1):83–96

    Google Scholar 

  25. Nurmi I, Kaukonen JP, Lüthje P, Naboulsi H, Tanninen S, Kataja M, Kallio ML, Leppilampi M (2005) Half of the patients with an acute hip fracture suffer from hypovitaminosis D: a prospective study in southeastern Finland. Osteoporos Int 16(12):2018–2024

    Article  PubMed  CAS  Google Scholar 

  26. Partanen J, Heikkinen J, Jämsä T, Jalovaara P (2002) Characteristics of lifetime factors, bone metabolism, and bone mineral density in patients with hip fracture. J Bone Miner Metab 20(6):367–375

    Google Scholar 

  27. Looker AC, Mussolino ME (2008) Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. White adults. J Bone Miner Res 23(1):143–150. doi:10.1359/jbmr.071003

    Article  PubMed  CAS  Google Scholar 

  28. Cauley JA, LaCroix AZ, Wu L, Horwitz M, Danielson ME, Bauer DC, Lee JS, Jackson RD, Robbins JA, Wu C, Stanczyk FZ, LeBoff MS, Wactawski-Wende J, Sarto G, Ockene J, Cummings SR (2008) Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 149(4):242–250

    Article  PubMed  Google Scholar 

  29. Cauley JA, Parimi N, Ensrud KE, Bauer DC, Cawthon PM, Cummings SR, Hoffman AR, Shikany JM, Barrett-Connor E, Orwoll E (2010) Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res 25(3):545–553. doi:10.1359/jbmr.090826

    Google Scholar 

  30. Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ 339:b4229

    Article  PubMed  Google Scholar 

  31. Collins GS, Mallett S, Altman DG (2011) Predicting risk of osteoporotic and hip fracture in the United Kingdom: prospective independent and external validation of QFractureScores. BMJ 342:d3651

    Article  PubMed  Google Scholar 

  32. Byberg L, Gedeborg R, Cars T, Sundstrom J, Berglund L, Kilander L, Melhus H, Michaelsson K (2012) Prediction of fracture risk in men: a cohort study. J Bone Miner Res 27(4):797–807. doi:10.1002/jbmr.1498

    Google Scholar 

  33. 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):251–258

    PubMed  CAS  Google Scholar 

  34. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16(7):713–716

    Article  PubMed  CAS  Google Scholar 

  35. Lips P, Chapuy MC, Dawson-Hughes B, Pols HAP, Holick MF (1999) An international comparison of serum 25-hydroxyvitamin D measurements. Osteoporos Int 9(5):394–397

    Article  PubMed  CAS  Google Scholar 

  36. Farahmand BY, Michaëlsson K, Baron JA, Persson PG, Ljunghall S (2000) Body size and hip fracture risk. Epidemiology 11(2):214–219

    Google Scholar 

  37. Trimpou P, Landin-Wilhelmsen K, Odén A, Rosengren A, Wilhelmsen L (2010) Male risk factors for hip fracture-a 30-year follow-up study in 7,495 men. Osteoporos Int 21(3):409–416. doi:10.1007/s00198-009-0961-7

    Google Scholar 

  38. Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137(11):1203–1211

    PubMed  CAS  Google Scholar 

  39. Faulkner KG, Cummings SR, Black D, Palermo L, Glüer CC, Genant HK (1993) Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 8(10):1211–1217. doi:10.1002/jbmr.5650081008

    Google Scholar 

  40. Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18(11):827–835

    Article  PubMed  Google Scholar 

  41. Khaw KT, Reeve J, Luben R, Bingham S, Welch A, Wareham N, Oakes S, Day N (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):197–202

    Article  PubMed  Google Scholar 

  42. Sund R, Nurmi-Lüthje I, Lüthje P, Tanninen S, Narinen A, Keskimäki I (2007) Comparing properties of audit data and routinely collected register data in case of performance assessment of hip fracture treatment in Finland. Methods Inf Med 46(5):558–566

    PubMed  CAS  Google Scholar 

  43. Lüthje P, Nurmi I, Kataja M, Heliövaara M, Santavirta S (1995) Incidence of pelvic fractures in Finland in 1988. Acta Orthop Scand 66(3):245–248

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was partly funded by a research grant from the Juho Vainio Foundation, Helsinki, Finland.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Peltolantie 3, 20720, Turku, Finland

    M. Kauppi, O. Impivaara, J. Mäki & A. Jula

  2. Population Health Research Unit, Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland

    M. Heliövaara

Authors
  1. M. Kauppi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Impivaara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Mäki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Heliövaara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Jula
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Kauppi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kauppi, M., Impivaara, O., Mäki, J. et al. Quantitative ultrasound measurements and vitamin D status in the assessment of hip fracture risk in a nationally representative population sample. Osteoporos Int 24, 2611–2618 (2013). https://doi.org/10.1007/s00198-013-2355-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-013-2355-0

Keywords

Search

Navigation