Association between low-frequency ultrasound and hip fractures - comparison with DXA-based BMD

BMC Musculoskeletal Disorders

Timo Jämsä⁵  Raija Korpelainen¹  Pasi Pulkkinen³  Jussi Timonen⁴  Petro Moilanen⁴  Mikko Määttä² 

[1] Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland;Infotech Oulu, University of Oulu, Oulu, Finland;Department of Medical Technology, University of Oulu, Institute of Biomedicine, PO Box 5000, FI-90014 Oulu, Finland;Department of Physics, University of Jyväskylä, Jyväskylä, Finland;Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland

关键词: Cortical bone;    Hip fracture;    Osteoporosis;    Speed of sound;    Quantitative ultrasound;   

Others  :  1125542
DOI  :  10.1186/1471-2474-15-208

 received in 2013-08-28, accepted in 2014-06-10,  发布年份 2014

【 摘 要 】

Background

New methods for diagnosing osteoporosis and evaluating fracture risk are being developed. We aim to study the association between low-frequency (LF) axial transmission ultrasound and hip fracture risk in a population-based sample of older women.

Methods

The study population consisted of 490 community-dwelling women (78–82 years). Ultrasound velocity (V_LF) at mid-tibia was measured in 2006 using a low-frequency scanning axial transmission device. Bone mineral density (BMD) at proximal femur measured using dual-energy x-ray absorptiometry (DXA) was used as the reference method. The fracture history of the participants was collected from December 1997 until the end of 2010. Lifestyle-related risk factors and mobility were assessed at 1997.

Results

During the total follow-up period (1997–2010), 130 women had one or more fractures, and 20 of them had a hip fracture. Low V_LF (the lowest quartile) was associated with increased hip fracture risk when compared with V_LF in the normal range (Odds ratio, OR = 3.3, 95% confidence interval (CI) 1.3-8.4). However, V_LF was not related to fracture risk when all bone sites were considered. Osteoporotic femoral neck BMD was associated with higher risk of a hip fracture (OR = 4.1, 95% CI 1.6-10.5) and higher risk of any fracture (OR = 2.4, 95% CI 1.6-3.8) compared to the non-osteoporotic femoral neck BMD. Decreased V_LF remained a significant risk factor for hip fracture when combined with lifestyle-related risk factors (OR = 3.3, 95% CI 1.2-9.0).

Conclusion

Low V_LF was associated with hip fracture risk in older women even when combined with lifestyle-related risk factors. Further development of the method is needed to improve the measurement precision and to confirm the results.

【 授权许可】

   
2014 Määttä et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E: FRAX and its applications to clinical practice. Bone 2009, 44(5):734-743.
• [2]Glüer CC: A new quality of bone ultrasound research. IEEE Trans Ultrason Ferroelectr Freq Control 2008, 55(7):1524-1528.
• [3]Marín F, González-Macías J, Díez-Pérez A, Palma S, Delgado-Rodríguez M: Relationship between bone quantitative ultrasound and fractures: a meta-analysis. J Bone Miner Res 2006, 21(7):1126-1135.
• [4]Lewiecki EM, Compston JE, Miller PD, Adachi JD, Adams JE, Leslie WD, Kanis JA, Moayyeri A, Adler RA, Hans DB, Kendler DL, Díez-Pérez A, Krieg MA, Masri BK, Lorenc RR, Bauer DC, Blake GM, Josse RG, Clark P, Khan AA, FRAX® Position Development Conference Members: Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom 2011, 14(3):226-236.
• [5]Kilappa V, Moilanen P, Xu L, Nicholson PH, Timonen J, Cheng S: Low-frequency axial ultrasound velocity correlates with bone mineral density and cortical thickness in the radius and tibia in pre- and postmenopausal women. Osteoporos Int 2011, 22(4):1103-1113.
• [6]Moilanen P, Nicholson PH, Kärkkäinen T, Wang Q, Timonen J, Cheng S: Assessment of the tibia using ultrasonic guided waves in pubertal girls. Osteoporos Int 2003, 14(12):1020-1027.
• [7]Nicholson PH, Moilanen P, Kärkkäinen T, Timonen J, Cheng S: Guided ultrasonic waves in long bones: modelling, experiment and in vivo application. Physiol Meas 2002, 23(4):755-768.
• [8]Määttä M, Moilanen P, Nicholson P, Cheng S, Timonen J, Jämsä T: Correlation of Tibial Low-Frequency Ultrasound Velocity with Femoral Radiographic Measurements and BMD in Elderly Women. Ultrasound Med Biol 2009, 35(6):903-911.
• [9]Määttä M, Terho E, Jokinen H, Pulkkinen P, Korpelainen J, Heikkinen J, Keinänen-Kiukaanniemi S, Jämsä T, Korpelainen R: Lifestyle factors and site-specific risk of hip fracture in community dwelling older women – a 13-year prospective population-based cohort study. BMC Musculoskelet Disord 2012, 13(1):173. BioMed Central Full Text
• [10]Korpelainen R, Korpelainen J, Heikkinen J, Väänänen K, Keinänen-Kiukaanniemi S: Lifestyle factors are associated with osteoporosis in lean women but not in normal and overweight women: a population-based cohort study of 1222 women. Osteoporos Int 2003, 14(1):34-43.
• [11]Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39(2):142-148.
• [12]Orgee JM, Foster H, McCloskey EV, Khan S, Coombes G, Kanis JA: A precise method for the assessment of tibial ultrasound velocity. Osteoporos Int 1996, 6(1):1-7.
• [13]Report of a WHO Study Group: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser 1994, 843:1-129.
• [14]Nguyen TV, Center JR, Eisman JA: Bone mineral density-independent association of quantitative ultrasound measurements and fracture risk in women. Osteoporos Int 2004, 15(12):942-947.
• [15]Damilakis J, Papadokostakis G, Vrahoriti H, Tsagaraki I, Perisinakis K, Hadjipavlou A, Gourtsoyiannis N: Ultrasound velocity through the cortex of phalanges, radius, and tibia in normal and osteoporotic postmenopausal women using a new multisite quantitative ultrasound device. Invest Radiol 2003, 38(4):207-211.
• [16]Hans D, Srivastav SK, Singal C, Barkmann R, Njeh CF, Kantorovich E, Glüer CC, Genant HK: Does combining the results from multiple bone sites measured by a new quantitative ultrasound device improve discrimination of hip fracture? J Bone Miner Res 1999, 14(4):644-651.
• [17]Hans D, Genton L, Allaoua S, Pichard C, Slosman DO: Hip fracture discrimination study: QUS of the radius and the calcaneum. J Clin Densitom 2003, 6(2):163-172.
• [18]Weiss M, Ben-Shlomo A, Hagag P, Ish-Shalom S: Discrimination of proximal hip fracture by quantitative ultrasound measurement at the radius. Osteoporos Int 2000, 11(5):411-416.
• [19]Stegman MR, Heaney RP, Travers-Gustafson D, Leist J: Cortical ultrasound velocity as an indicator of bone status. Osteoporos Int 1995, 5(5):349-353.
• [20]Augat P, Fan B, Lane NE, Lang TF, LeHir P, Lu Y, Uffmann M, Genant HK: Assessment of bone mineral at appendicular sites in females with fractures of the proximal femur. Bone 1998, 22(4):395-402.
• [21]Talmant M, Kolta S, Roux C, Haguenauer D, Vedel I, Cassou B, Bossy E, Laugier P: In vivo performance evaluation of bi-directional ultrasonic axial transmission for cortical bone assessment. Ultrasound Med Biol 2009, 35(6):912-919.
• [22]Durosier C, Hans D, Krieg MA, Ruffieux C, Cornuz J, Meunier PJ, Schott AM: Combining clinical factors and quantitative ultrasound improves the detection of women both at low and high risk for hip fracture. Osteoporos Int 2007, 18(12):1651-1659.
• [23]Karjalainen JP, Riekkinen O, Töyräs J, Hakulinen M, Kröger H, Rikkonen T, Salovaara K, Jurvelin JS: Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 2012, 23(4):1287-1295.
• [24]Hans D, Durosier C, Kanis JA, Johansson H, Schott-Pethelaz AM, Krieg MA: 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 2008, 23(7):1045-1051.
• [25]Knapp KM, Blake GM, Spector TD, Fogelman I: Multisite quantitative ultrasound: precision, age- and menopause-related changes, fracture discrimination, and T-score equivalence with dual-energy X-ray absorptiometry. Osteoporos Int 2001, 12(6):456-464.
• [26]Moilanen P, Määttä M, Kilappa V, Xu L, Nicholson PH, Alén M, Timonen J, Jämsä T, Cheng S: Discrimination of fractures by low-frequency axial transmission ultrasound in postmenopausal females. Osteoporos Int 2012, 24(2):723-730.