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Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures

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Abstract

Summary

About 75% of patients suffering from osteoporosis are not diagnosed. This study describes a multi-site bone ultrasound method for osteoporosis diagnostics. In comparison with axial dual energy X-ray absorptiometry (DXA), the ultrasound method showed good diagnostic performance and could discriminate fracture subjects among elderly females.

Introduction

Axial DXA, the gold standard diagnostic method for osteoporosis, predicts fractures only moderately. At present, no reliable diagnostic methods are available at the primary health care level. Here, a multi-site ultrasound method is proposed for osteoporosis diagnostics.

Methods

Thirty elderly women were examined using the ultrasound backscatter measurements in proximal femur, proximal radius, proximal and distal tibia in vivo. First, we predicted the areal bone mineral density (BMD) at femoral neck by ultrasound measurements in tibia combined with specific subject characteristics (density index, DI) and, second, we tested the ability of ultrasound backscatter measurements at proximal femur to discriminate between individuals with previously fractured hips from those without fractures. Areal BMD was determined by axial DXA.

Results

Combined ultrasound parameters, cortical thickness at distal and proximal tibia, with age and weight of the subject, provided a significant estimate of BMDneck (r = 0.86, p < 0.001, n = 30). When inserted into FRAX (World Health Organization fracture risk assessment tool), the DI indicated the same treatment proposal as the BMDneck with 86% sensitivity and 100% specificity. The receiver operating characteristic analyses, with a combination of ultrasound parameters and patient characteristics, discriminated fracture subjects from the controls similarly as the model combining BMDneck and patient characteristics.

Conclusions

For the first time, ultrasound backscatter measurements of proximal femur were conducted in vivo. The results indicate that ultrasound parameters, combined with patient characteristics, may provide a means for osteoporosis diagnostics.

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Acknowledgments

Financial support from the Finnish Cultural Foundation, International Graduate School in Biomedical Engineering and Medical Physics (iBioMEP), Finnish Funding Agency for Technology and Innovation (TEKES/FinnWell 40464/05), Kuopio University Hospital, Kuopio, Finland (EVO, project 5199) are acknowledged. The authors thank Matti Timonen for the programming of the ultrasound measurement software (Labview) and Vesa Kiviniemi for his help in the statistical analyses. The authors would also like to thank Marianna Elo and Sirkka Harle for conducting the DXA examinations and Hanna Isaksson for her useful comments and revision.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland

    J. P. Karjalainen, O. Riekkinen, J. Töyräs & J. S. Jurvelin

  2. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 1777, 70211, Kuopio, Finland

    J. Töyräs

  3. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, POB 1777, 70211, Kuopio, Finland

    M. Hakulinen

  4. Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB 1777, 70211, Kuopio, Finland

    H. Kröger

  5. Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland

    H. Kröger, T. Rikkonen & K. Salovaara

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  1. J. P. Karjalainen
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  2. O. Riekkinen
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  3. J. Töyräs
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  8. J. S. Jurvelin
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Correspondence to J. P. Karjalainen.

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Karjalainen, J.P., Riekkinen, O., Töyräs, J. et al. Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 23, 1287–1295 (2012). https://doi.org/10.1007/s00198-011-1682-2

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  • DOI: https://doi.org/10.1007/s00198-011-1682-2

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