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Combining clinical factors and quantitative ultrasound improves the detection of women both at low and high risk for hip fracture

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Abstract

Summary

We hypothesized that combining clinical risk factors (CRF) with the heel stiffness index (SI) measured via quantitative ultrasound (QUS) would improve the detection of women both at low and high risk for hip fracture. Categorizing women by risk score improved the specificity of detection to 42.4%, versus 33.8% using CRF alone and 38.4% using the SI alone. This combined CRF-SI score could be used wherever and whenever DXA is not readily accessible.

Introduction and hypothesis

Several strategies have been proposed to identify women at high risk for osteoporosis-related fractures; we wanted to investigate whether combining clinical risk factors (CRF) and heel QUS parameters could provide a more accurate tool to identify women at both low and high risk for hip fracture than either CRF or QUS alone.

Methods

We pooled two Caucasian cohorts, EPIDOS and SEMOF, into a large database named “EPISEM”, in which 12,064 women, 70 to 100 years old, were analyzed. Amongst all the CRF available in EPISEM, we used only the ones which were statistically significant in a Cox multivariate model. Then, we constructed a risk score, by combining the QUS-derived heel stiffness index (SI) and the following seven CRF: patient age, body mass index (BMI), fracture history, fall history, diabetes history, chair-test results, and past estrogen treatment.

Results

Using the composite SI-CRF score, 42% of the women who did not report a hip fracture were found to be at low risk at baseline, and 57% of those who subsequently sustained a fracture were at high risk. Using the SI alone, corresponding percentages were 38% and 52%; using CRF alone, 34% and 53%. The number of subjects in the intermediate group was reduced from 5,400 (including 112 hip fractures) and 5,032 (including 111 hip fractures) to 4549 (including 100 including fractures) for the CRF and QUS alone versus the combination score.

Conclusions

Combining clinical risk factors to heel bone ultrasound appears to correctly identify more women at low risk for hip fracture than either the stiffness index or the CRF alone; it improves the detection of women both at low and high risk.

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Acknowledgements

We want to thank the EPIDOS and SEMOF study groups for making their databases available to us. The EPIDOS study was supported by a contract INSERM-MSD-Chibret. This analysis was partly funded by a research grant provided by Geneva University Hospital.

Members of the EPIDOS study group: Coordinators: G. Bréart, P. Dargent-Molina, P.J. Meunier, A.M. Schott, D. Hans, P.D. Delmas. Principal investigators (center): C. Baudoin, J.L. Sebert (Amiens); M.C. Chapuy, A.M. Schott (Lyon); F. Favier, C. Marcelli (Montpellier); E. Hausherr, C.J. Menkes, C. Cormier (Paris); H. Grandjean, C. Ribot (Toulouse).

Members of the SEMOF study group: M-A. Krieg, J. Cornuz, C. Ruffieux, G. Van Melle, D. Büche, M. A. Dambacher, F. Hartl, H. J Häuselmann, M. Kraenzlin, K. Lippuner, M. Neff, P. Pancaldi, R. Rizzoli, F. Tanzi, R. Theiler, A. Tyndall, C. Wimpfheimer, P. Burckhardt.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Geneva University Hospital, 1211, Geneva 14, Switzerland

    C. Durosier & D. Hans

  2. Clinical Epidemiology Unit, Medical Information, Hospices Civils of Lyon, Lyon, France

    C. Durosier & A. M. Schott

  3. Outpatient Clinic, University Hospital, Lausanne, Switzerland

    M. A. Krieg, C. Ruffieux & J. Cornuz

  4. Edouard Herriot Hospital, Inserm U403, Lyon, France

    P. J. Meunier & A. M. Schott

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  1. C. Durosier
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  2. D. Hans
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Correspondence to D. Hans.

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Durosier, C., Hans, D., Krieg, M.A. et al. Combining clinical factors and quantitative ultrasound improves the detection of women both at low and high risk for hip fracture. Osteoporos Int 18, 1651–1659 (2007). https://doi.org/10.1007/s00198-007-0414-0

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  • DOI: https://doi.org/10.1007/s00198-007-0414-0

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