Abstract
Bone fractures depend not only on bone density, but also on bone quality. Ultrasound (US) has been proposed as a technique for evaluating skeletal status. Speed of sound (SOS) and broadband ultrasound attenuation (BUA) are the US properties currently used to assess bone strength and fragility. In 304 postmenopausal women (age 58.8±5.5 years) we measured: bone mineral density (BMD) of the lumbar spine (by dual-energy X-ray absorptiometry), SOS, BUA and Stiffness in the os calcis (using an Achilles machine). In all subjects we performed lateral lumbar and thoracic radiographs. Morphometric parameters were derived by measuring the anterior, middle and posterior height of each vertebral body, to obtain a semiquantitative grading of vertebral fractures as follows: 0, no vertebral deformity; 1, any vertebral height reduced between 20% and 25%; 2, any vertebral height reduced between 25% and 40%; 3, any vertebral height reduced more than 40%. On the basis of the number and severity of vertebral deformities the women were divided into: group 1 (n=79), normal; group 2(n=80), mild; group 3 (n=85), moderate; and group 4 (n=60), severe. Mean values of SOS, BUA, Stiffness and BMD were significantly lower (p<0.001) in women with vertebral deformity than in normals. In the whole population SOS, BUA and Stiffness values were significantly correlated with BMD. SOS, BUA and Stiffness values were significantly decreased (p<0.001) with vertebral deformity, as was BMD. Receiver operating characteristic (ROC) curve analysis showed BMD to be slightly better than Stiffness in discriminating among groups. Logistic regression analysis showed that BMD, BUA, SOS and Stiffness were independent predictors of vertebral fracture risk. Ultrasound parameters were still significant independent predictors of vertebral fracture even after adjusting for BMD.
Similar content being viewed by others
References
Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al. Bone density at various sites for prediction of hip fractures: the study of osteoporotic fractures research group. Lancet 1993;341:72–5.
Hui SL, Slemenda CV, Johnston CC. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988;81:1804–9.
Cummings SR. Are patients with fractures more osteoporotic? Reviews of the evidence. Am J Med 1985;78:487–94.
Ott SM, Kilcoyne RF, Chesnut CH III. Comparisons among methods of measuring bone mass and relationships to severity of vertebral fractures in osteoporosis. J Clin Endocrinol Metab 1988;66:501–7.
Cooper C, Aihie A. Osteoporosis: recent advances in pathogene-sis and treatment. Q. J Med 1994;87:203–9.
Genant HK, Gluer CC, Lotz JC. Gender differences in bone density, skeletal geometry and fracture biomechanics. Radiology 1994;190:636–40.
Parfitt AM. Implications of architecture for the pathogenesis and prevention of vertebral fracture. Bone 1992;13:41–7.
Ross PD, Davis JW, Vogel JM, Wasnich RD. A critical review of bone mass and the risk of fractures in osteoporosis. Calcif Tissue Int 1990;46:149–61.
Gluer CC, Wu CY, Jergas M. Goldstein SA, Genant HK. Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994 ; 55:46–52.
Biot MD. Generalized theory of acoustic propagation in porous dissipative media. J Acoust Soc Am 1962;34:1254–64.
Langton CM, Palmer SB, Porter RW. The measurement of broadband ultrasound attenuation in cancellous bone. Eng Med 1984;13:89–91.
Langton CM, Evans GP, Hodgskinson R, Riggs CM. Ultrasonic, elastic and structural properties of cancellous bone. In: Ring EFG, editor. Current research in osteoporosis and bone mineral measurement. London: British Institute of Radiology, 1990:10–11.
Camporeale A, Cepollaro C, Zacchei F, Montagnani M, Agnusdei D, Gennari C. Ultrasound transmission velocity in normal and osteoporotic postmenopausal women. In: Christiansen C, Overgaard K, editors. Osteoporosis 90. Copenhagen: Osteopress ApS, 1990:670–2.
Lehmann R, Wapniarz M, Kvasnicka M, Klein K, Anoio B. Velocity of ultrasound at the patella: influence of age, menopause and estrogen replacement therapy. Osteoporosis Int 1993;3:308–13.
Waud CE, Lew R, Baran DT. The relationship between ultrasound and densitometric measurements of bone mass at the calcaneous in women. Calcif Tissue Int 1992;51:415–8.
Herd RJM, Ramalingham T, Ryan PJ, Fogelman I, Blake GM. Measurements of broadband ultrasonic attenuation in the calcaneus in premenopausal and postmenopausal women. Osteoporosis Int 1992;2:247–51.
Young H, Howey S, Purdie W. Broadband ultrasound attenuation compared with dual-energy X-ray absorptiometry in screening for postmenopausal low bone density. Osteoporosis Int 1993;3:160–4.
Yamada M, Ito M, Hayashi K, Nakamura T. Calcaneus as a site for assessment of bone mineral density: evaluation in cadavers and healthy volunteers. AJR 1993;161:621–7.
Ross PD, Wasnich RD, Vogel JM. Detection of fracture spinal osteoporosis using bone mineral absorptiometry. J Bone Miner Res 1988;3:1–11.
Agren M, Karellas A, Leahey D, Marks S, Baran D. Ultrasound attenuation at the calcaneus: a sensitive and specific discriminator of osteopenia in postmenopausal women. Calcif Tissue Int 1991;48:240–4.
Baran DT, Kelly AM, Karellas A, Gionet M, Price M, Leahey D, et al. Ultrasound attenuation of the os calcis in women with osteoporosis and hip fractures. Calcif Tissue Int 1988;43:138–42.
Massie A, Reid DM, Porter RW. Screening for osteoporosis: comparison between dual energy X-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporosis Int 1993;3:107–10.
Faulkner KG, McClung MR, Coleman LJ, Kingston-Sandahl E. Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites. Osteoporosis Int 1994;4:42–7.
Lees B, Stevenson JC. Preliminary evaluation of a new ultrasound bone densitometer. Calcif Tissue Int 1993;53:149–52.
Stewart A, Reid DM, Porter RW. Broadband ultrasound attenuation and dual energy X-ray absorptiometry in patients with hip fractures: which technique discriminates fracture risk? Calcif Tissue Int 1994;54:466–9.
Bauer DC, Gluer CC, Genant HK, Stone K. Quantitative ultrasound and vertebral fracture in postmenopausal women. J Bone Miner Res 1995;10:353–8.
Schott AM, Weill-Engerer S, Hans D, Duboeuf D, Delmas PD, Meunier PJ. Ultrasound discriminates patients with hip fracture equally well as dual-energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 1995;10:243–9.
Turner CH, Peacock M, Timmerman L, Neal JM, Johnston CC. Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporosis Int 1995;5:130–5.
Heaney RP, Avioli LV, Chesnut CH III, Lappe J, Recker RR, Brandenburger GH. Ultrasound velocity through bone predicts incident vertebral deformity. J Bone Miner Res 1995;10:341–5.
Cepollaro C, Zacchei F, Borracelli D, Palmieri R, Gonnelli S, Agnusdei D, Gennari C. Precision of new ultrasound bone densitometers: correlation with absorptiometry methods. In: Proceedings of ultrasonic assessment of bone II, 23 June 1992, p. 19.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.
Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same case. Radiology 1983;148:839–43.
Porter RW, Miller CG, Grainger D, Palmer SB. Prediction of hip fractures in elderly women: a prospective study. BMJ 1990;301:638–41.
Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton JM III. Classification of vertebral fractures. J Bone Miner Res 1991;6:207–15.
Melton LJ III, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–11.
Minne HW, Leidig G, Wuster C. A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 1988;3:335–49.
Hedlund LR, Gallagher JC. Vertebral morphometry in diagnosis of spinal fractures. Bone Miner 1988;5:59–67.
Genant HK, Wu CY, Van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137–48.
McCloskey EV, Spector TD, Eyres KS, Fern ED, O'Rourke N, Vasikaran S, Kanis JA. The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporosis Int 1993;3:138–47.
Smith-Bidman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991;6:25–34.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gonnelli, S., Cepollaro, C., Agnusdei, D. et al. Diagnostic value of ultrasound analysis and bone densitometry as predictors of vertebral deformity in postmenopausal women. Osteoporosis Int 5, 413–418 (1995). https://doi.org/10.1007/BF01626601
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01626601