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Identifying osteoporosis in a primary care setting with quantitative ultrasound: relationship to anthropometric and lifestyle factors

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Abstract

Dual-energy X-ray absorptiometry (DXA), the “gold standard” for diagnosis of osteoporosis, is not recommended for population screening, and thus quantitative ultrasound (QUS) of the calcaneus is gaining popularity. The aim of the present study was to evaluate the relationship between QUS values and anthropometric and lifestyle factors, and to assess the diagnostic performance of QUS in predicting DXA-defined osteoporosis. Eight hundred and thirty-two women and 87 men aged 40–88 years were included in the study. Anthropometric measurements, the questionnaire, and QUS and DXA measurements were performed by trained physicians. Both QUS and DXA T-scores were lower for women than for men. Postmenopausal women had significantly lower QUS T-scores compared to premenopausal women (P < 0.001). Age over 50, female sex, sedentary lifestyle, fracture history, presence of chronic disease, and ≥5 years since menopause were associated with QUS T-scores lower than −1.00 by multivariate analysis. Low QUS T-scores were related to lack of direct sun exposure, high parity, fair skin color, and no education by univariate analysis (P < 0.005). A weak correlation was found between calcaneal QUS and DXA T-scores at lumbar spine (r = 0.310, P < 0.001) and femoral neck (r = 0.288, P < 0.001). The sensitivity and specificity of the QUS test were 73.7% and 57.4%, respectively, regarding the identification of osteoporotic patients. Lower QUS T-scores were associated with several osteoporotic risk factors, and the sensitivity and specificity of QUS for predicting DXA-defined osteoporosis were at optimum values at ages between 50 and 59 years. We conclude that, even though the accuracy of QUS for predicting DXA-defined osteoporosis is not remarkably high, it can be applied to identify subjects at risk in this age group in developing countries and rural districts who should be the focus of fracture prevention.

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References

  1. InstitutionalAuthorNameNIH Consensus Development Panel (2001) ArticleTitleOsteoporosis prevention, diagnosis, and therapy JAMA 285 785–795 Occurrence Handle10.1001/jama.285.6.785

    Article  Google Scholar 

  2. SH Prins HL Jorgensen LV Jorgensen C Hassager (1998) ArticleTitleThe role of quantitative ultrasound in the assessment of bone: a review Clin Physiol 18 3–17 Occurrence Handle9545615 Occurrence Handle10.1046/j.1365-2281.1998.00067.x Occurrence Handle1:STN:280:DyaK1c3gslahtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. JA Kanis P Delmas P Burckhardt C Cooper D Torgerson (1997) ArticleTitleGuidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease Osteoporos Int 7 390–406 Occurrence Handle9373575 Occurrence Handle10.1007/BF01623782 Occurrence Handle1:STN:280:DyaK1c%2FktV2jtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. DC Bauer CC Gluer JA Cauley TM Vogt KE Ensrud HK Genant DM Black (1997) ArticleTitleBroadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group Arch Intern Med 157 629–634 Occurrence Handle9080917 Occurrence Handle10.1001/archinte.157.6.629 Occurrence Handle1:STN:280:DyaK2s3jsF2qug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. D Hans P Dargent-Molina AM Schott JL Sebert C Cormier PO Kotzki PD Delmas JM Pouilles G Breart PJ Meinuer (1996) ArticleTitleUltrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study Lancet 348 511–514 Occurrence Handle8757153 Occurrence Handle10.1016/S0140-6736(95)11456-4 Occurrence Handle1:STN:280:DyaK28zkslOrsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  6. J Huopio H Kroger R Honkanen J Jurvelin S Saarikoski E Alhava (2004) ArticleTitleCalcaneal ultrasound predicts early postmenopausal fractures as well as axial BMD. A prospective study of 422 women Osteoporos Int 15 190–195 Occurrence Handle14727012 Occurrence Handle10.1007/s00198-003-1534-9 Occurrence Handle1:STN:280:DC%2BD2c7hsVGlsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. S Boonen J Nijs H Borghs H Peeters D Vanderschueren FP Luyten (2005) ArticleTitleIdentifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study Osteoporos Int 16 93–100 Occurrence Handle15197540 Occurrence Handle10.1007/s00198-004-1660-z

    Article  PubMed  Google Scholar 

  8. A Cetin H Erturk R Celiker A Sivri Z Hascelik (2001) ArticleTitleThe role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry Rheumatol Int 20 55–59 Occurrence Handle11269533 Occurrence Handle10.1007/PL00006857 Occurrence Handle1:STN:280:DC%2BD3M7mslChug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. V Naganathan L March D Hunter NA Pocock J Markovey PN Sambrook (1999) ArticleTitleQuantitative heel ultrasound as a predictor for osteoporosis Med J Aust 171 297–300 Occurrence Handle10560444 Occurrence Handle1:STN:280:DC%2BD3c%2FisVagtg%3D%3D

    PubMed  CAS  Google Scholar 

  10. Report of a World Health Organization (WHO) Scientific Group (2003) Prevention and management of osteoporosis. Technical report series 921. WHO, Geneva

  11. InstitutionalAuthorNameExpert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults (1998) ArticleTitleClinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary Am J Clin Nutr 68 899–917

    Google Scholar 

  12. Report of a World Health Organisation (WHO) Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report 843. WHO, Geneva

  13. S Adami S Giannini R Giorgino GC Isaia S Maggi L Sinigaglia P Filipponi G Crepaldi (2004) ArticleTitleEffect of age, weight and lifestyle factors on calcaneal quantitative ultrasound in premenopausal women: the ESOPO study Calcif Tissue Int 74 317–321 Occurrence Handle15255067 Occurrence Handle10.1007/s00223-003-0036-2 Occurrence Handle1:CAS:528:DC%2BD2cXjslWrtLw%3D

    Article  PubMed  CAS  Google Scholar 

  14. E Babaroutsi F Magkos Y Manios LS Sidossis (2005) ArticleTitleLifestyle factors affecting heel ultrasound in Greek females across different life stages Osteoporos Int 16 552–561 Occurrence Handle15688124 Occurrence Handle10.1007/s00198-004-1720-4

    Article  PubMed  Google Scholar 

  15. ML Frost GM Blake I Fogelman (2001) ArticleTitleQuantitative ultrasound and bone mineral density are equally strongly associated with risk factors for osteoporosis J Bone Miner Res 16 406–416 Occurrence Handle11204441 Occurrence Handle10.1359/jbmr.2001.16.2.406 Occurrence Handle1:STN:280:DC%2BD3M3ht1Wltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. CM Langton DK Langton (1997) ArticleTitleMale and female normative data for ultrasound measurement of the calcaneus within the UK adult population Br J Radiol 70 580–585 Occurrence Handle9227250 Occurrence Handle1:STN:280:DyaK2szntFShtw%3D%3D

    PubMed  CAS  Google Scholar 

  17. A Welch J Camus N Dalzell S Oakes J Reeve KT Khaw (2004) ArticleTitleBroadband ultrasound attenuation (BUA) of the heel bone and its correlates in men and women in the EPIC-Norfolk cohort: a cross-sectional population-based study Osteoporos Int 15 217–225 Occurrence Handle14745486 Occurrence Handle10.1007/s00198-003-1410-7

    Article  PubMed  Google Scholar 

  18. W Pluskiewicz B Drozdzowska (1999) ArticleTitleUltrasonic measurement of the calcaneus in Polish normal and osteoporotic women and men Bone (NY) 24 611–617 Occurrence Handle1:STN:280:DyaK1MzgtFOnsg%3D%3D

    CAS  Google Scholar 

  19. M Sosa P Saavedra M Munoz-Torres J Alegre C Gomez J Gonzales-Macias N Guanabens F Hawkins C Lozano M Martinez J Mosquera R Perez-Cano M Qesada E Salas InstitutionalAuthorNameGiumo Study Group (2002) ArticleTitleQuantitative ultrasound calcaneus measurements: normative data and precision in the Spanish population Osteoporos Int 13 487–492 Occurrence Handle12107663 Occurrence Handle10.1007/s001980200059 Occurrence Handle1:STN:280:DC%2BD38zmsFOrsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. C Blanchet Y Giguere D Prud'homme L Turcot-Lemay M Dumont G Leduc S Cote N Laflamme F Rousseau S Dodin (2003) ArticleTitleLeisure physical activity is associated with quantitative ultrasound measurements independently of bone mineral density in postmenopausal women Calcif Tissue Int 73 339–349 Occurrence Handle12874703 Occurrence Handle10.1007/s00223-002-1091-9 Occurrence Handle1:CAS:528:DC%2BD3sXos1als7w%3D

    Article  PubMed  CAS  Google Scholar 

  21. J Damilakis K Perisinakis G Kontakis E Vagios N Gourtsoyiannis (1999) ArticleTitleEffect of lifetime occupational physical activity on indices of bone mineral status in healthy postmenopausal women Calcif Tissue Int 64 112–116 Occurrence Handle9914317 Occurrence Handle10.1007/s002239900588 Occurrence Handle1:CAS:528:DyaK1MXnvVagsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. WC Graafmans LM Bouter P Lips (1998) ArticleTitleThe influence of physical activity and fractures on ultrasound parameters in elderly people Osteoporos Int 8 449–454 Occurrence Handle9850353 Occurrence Handle10.1007/s001980050090 Occurrence Handle1:STN:280:DyaK1M%2Fmsleguw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  23. EW Gregg AM Kriska LM Salamone RL Wolf MM Roberts RE Ferrell SJ Anderson LH Kuller JA Cauley (1999) ArticleTitleCorrelates of quantitative ultrasound in the Women's Healthy Lifestyle Project Osteoporos Int 10 416–424 Occurrence Handle10591840 Occurrence Handle10.1007/s001980050248 Occurrence Handle1:STN:280:DC%2BD3c7ht1Ojtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  24. A Heinonen P Oja H Sievanen M Pasanen I Vuori (1998) ArticleTitleEffect of two training regimens on bone mineral density in healthy perimenopausal women: a randomized controlled trial J Bone Miner Res 13 483–490 Occurrence Handle9525349 Occurrence Handle10.1359/jbmr.1998.13.3.483 Occurrence Handle1:STN:280:DyaK1c7osValsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  25. J Yamaguchi G Truman ID Cameron (2000) ArticleTitleLifestyle factors affecting bone ultrasonometry of the calcaneus in Japanese women Calcif Tissue Int 66 43–46 Occurrence Handle10602843 Occurrence Handle10.1007/s002230050008 Occurrence Handle1:CAS:528:DC%2BD3cXltFylug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. O Louis L Kaufman M Osteaux (2000) ArticleTitleQuantitative ultrasound of the calcaneus with parametric imaging: correlation with bone mineral density at different sites and with anthropometric data in menopausal women Eur J Radiol 35 65–69 Occurrence Handle10930769 Occurrence Handle10.1016/S0720-048X(99)00147-3 Occurrence Handle1:STN:280:DC%2BD3cvnt1Snug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  27. VW Hung L Qin SK Au WY Choy KS Leung PC Leung JC Cheng (2004) ArticleTitleCorrelations of calcaneal QUS with pQCT measurements at distal tibia and non-weight-bearing distal radius J Bone Miner Metab 22 486–490 Occurrence Handle15316870 Occurrence Handle10.1007/s00774-004-0511-5

    Article  PubMed  Google Scholar 

  28. M Lunt P Masaryk C Scheidt-Nave J Nijs G Poor H Pols JA Falch G Hammermeister DM Reid L Benevolenskaya K Weber J Cannata TW O'Neill D Felsenberg AJ Silman J Reeve (2001) ArticleTitleThe effects of lifestyle, dietary dairy intake and diabetes on bone density and vertebral deformity prevalence: the EVOS study Osteoporos Int 12 688–698 Occurrence Handle11580083 Occurrence Handle10.1007/s001980170069 Occurrence Handle1:STN:280:DC%2BD3MrjtlWltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  29. DM Naves TW O'Neill AJ Silman (1997) ArticleTitleThe influence of alcohol consumption on the risk of vertebral deformity. European Vertebral Osteoporosis Study Group Osteoporos Int 7 65–71 Occurrence Handle10.1007/BF01623463

    Article  Google Scholar 

  30. TV Nguyen JR Center JA Eisman (2000) ArticleTitleOsteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index J Bone Miner Res 15 322–331 Occurrence Handle10703935 Occurrence Handle10.1359/jbmr.2000.15.2.322 Occurrence Handle1:CAS:528:DC%2BD3cXhtlGns74%3D

    Article  PubMed  CAS  Google Scholar 

  31. ML Frost GM Blake I Fogelman (1999) ArticleTitleContact quantitative ultrasound: an evaluation of precision, fracture discrimination, age-related bone loss and applicability of the WHO criteria Osteoporos Int 10 441–449 Occurrence Handle10663343 Occurrence Handle10.1007/s001980050252 Occurrence Handle1:STN:280:DC%2BD3c7ltlaqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  32. F Lopez-Rodriguez P Mezquita-Raya LJ de Dios F Escobar-Jimenez M Munoz-Torres (2003) ArticleTitlePerformance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit Bone (NY) 32 571–578 Occurrence Handle1:STN:280:DC%2BD3s3jtVGgtw%3D%3D

    CAS  Google Scholar 

  33. P Thompson J Taylor A Fisher R Oliver (1998) ArticleTitleQuantitative heel ultrasound in 3180 women between 45 and 75 years of age: compliance, normal ranges and relationship to fracture history Osteoporos Int 8 211–214 Occurrence Handle9797904 Occurrence Handle10.1007/s001980050056 Occurrence Handle1:STN:280:DyaK1M%2FhsVKgug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  34. KM Fox SR Cummings K Powell-Threets K Stone (1998) ArticleTitleFamily history and risk of osteoporotic fracture. Study of Osteoporotic Fractures Research Group Osteoporos Int 8 557–562 Occurrence Handle10326061 Occurrence Handle10.1007/s001980050099 Occurrence Handle1:STN:280:DyaK1M3lsl2isw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  35. R Rowe (1999) ArticleTitleThe management of osteoporosis in general practice: results of a national survey Osteoporos Rev 7 1–3

    Google Scholar 

  36. JA Kanis CC Gluer (2000) ArticleTitleAn update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation Osteoporos Int 11 192–202 Occurrence Handle10824234 Occurrence Handle10.1007/s001980050281 Occurrence Handle1:STN:280:DC%2BD3c3osVanug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  37. K Lippuner G Fuchs AG Ruetsche R Perrelet JP Casez I Neto (2000) ArticleTitleHow well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine or hip? A cost-effectiveness analysis J Clin Densitom 3 241–249 Occurrence Handle11090231 Occurrence Handle10.1385/JCD:3:3:241 Occurrence Handle1:STN:280:DC%2BD3M%2FovVCnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  38. InstitutionalAuthorNameNational Osteoporosis Foundation (1999) Physician's guide to prevention and treatment of osteoporosis Excerpta Medica Belle Mead, NJ

    Google Scholar 

  39. EV McCloskey SA Murray C Miller D Charlesworth W Tindale DP O'Doherty DR Bickerstaff NA Hamdy JA Kanis (1990) ArticleTitleBroadband ultrasound attenuation in the os calcis: relationship to bone mineral at other skeletal sites Clin Sci 78 227–233 Occurrence Handle2155753 Occurrence Handle1:STN:280:DyaK3c7otlansA%3D%3D

    PubMed  CAS  Google Scholar 

  40. YQ He B Fan D Hans J Li CY Wu CF Njeh S Zhao Y Lu E Tsuda-Futami T Fuerst HK Genant (2000) ArticleTitleAssessment of a new quantitative ultrasound calcaneus measurement: precision and discrimination of hip fractures in elderly women compared with dual X-ray absorptiometry Osteoporos Int 11 354–360 Occurrence Handle10928226 Occurrence Handle10.1007/s001980070125 Occurrence Handle1:STN:280:DC%2BD3czptFKjtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  41. CM Langton DK Langton (2000) ArticleTitleComparison of bone mineral density and quantitative ultrasound of the calcaneus: site-matched correlation and discrimination of axial BMD status Br J Radiol 73 31–35 Occurrence Handle10721317 Occurrence Handle1:STN:280:DC%2BD3c7os1Sqtw%3D%3D

    PubMed  CAS  Google Scholar 

  42. JL Cunningham JN Fordham TA Hewitt CA Speed (1996) ArticleTitleUltrasound velocity and attenuation at different skeletal sites compared with bone mineral density measured using dual energy X-ray absorptiometry Br J Radiol 69 25–32 Occurrence Handle8785618 Occurrence Handle1:STN:280:DyaK283ks1Wnuw%3D%3D Occurrence Handle10.1259/0007-1285-69-817-25

    Article  PubMed  CAS  Google Scholar 

  43. ML Frost GM Blake I Fogelman (2000) ArticleTitleDoes quantitative ultrasound imaging enhance precision and discrimination? Osteoporos Int 11 425–433 Occurrence Handle10912845 Occurrence Handle10.1007/s001980070110 Occurrence Handle1:STN:280:DC%2BD3cvgvFeksA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  44. DR Taaffe C Duret CS Cooper R Marcus (1999) ArticleTitleComparison of calcaneal ultrasound and DXA in young women Med Sci Sports Exerc 31 1484–1489 Occurrence Handle10527324 Occurrence Handle10.1097/00005768-199910000-00020 Occurrence Handle1:STN:280:DyaK1MvlsVCnug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  45. SS Yeap D Pearson SA Cawte DJ Hosking (1998) ArticleTitleThe relationship between bone mineral density and ultrasound in postmenopausal and osteoporotic women Osteoporos Int 8 141–146 Occurrence Handle9666937 Occurrence Handle1:STN:280:DyaK1czjtFGlsA%3D%3D

    PubMed  CAS  Google Scholar 

  46. C Roux B Fournier P Laugier C Chappard S Kolta M Dougados G Berger (1996) ArticleTitleBroadband ultrasound attenuation imaging: a new imaging method in osteoporosis J Bone Miner Res 11 1112–1118 Occurrence Handle8854247 Occurrence Handle1:STN:280:DyaK2s%2Fgs12ksA%3D%3D Occurrence Handle10.1002/jbmr.5650110810

    Article  PubMed  CAS  Google Scholar 

  47. LM Salamone EA Krall S Harris B Dawson-Hughes (1994) ArticleTitleComparison of broadband ultrasound attenuation to single X-ray absorptiometry measurements at the calcaneus in postmenopausal women Calcif Tissue Int 54 87–90 Occurrence Handle8012876 Occurrence Handle10.1007/BF00296056 Occurrence Handle1:STN:280:DyaK2c3ot1KmtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  48. S Panichkul M Sripramote N Sriussawaamorn (2004) ArticleTitleDiagnostic performance of quantitative ultrasound calcaneus measurement in case finding for osteoporosis in Thai postmenopausal women J Obstet Gynaecol Res 30 418–426 Occurrence Handle15566455 Occurrence Handle10.1111/j.1447-0756.2004.00224.x

    Article  PubMed  Google Scholar 

  49. R Brunader DK Shelton (2002) ArticleTitleRadiologic bone assessment in the evaluation of osteoporosis Am Fam Physician 65 1357–1364 Occurrence Handle11996418

    PubMed  Google Scholar 

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  1. Department of Family Medicine, Adnan Menderes University, Medical Faculty, Aydin, Turkey

    Ayfer Gemalmaz, Guzel Discigil, Nazli Sensoy & Okay Basak

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  1. Ayfer Gemalmaz
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  2. Guzel Discigil
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  3. Nazli Sensoy
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  4. Okay Basak
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Correspondence to Ayfer Gemalmaz.

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Gemalmaz, A., Discigil, G., Sensoy, N. et al. Identifying osteoporosis in a primary care setting with quantitative ultrasound: relationship to anthropometric and lifestyle factors. J Bone Miner Metab 25, 184–192 (2007). https://doi.org/10.1007/s00774-006-0741-9

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