Pulse-echo ultrasound method for detection of post-menopausal women with osteoporotic BMD
Tóm tắt
We lack effective diagnostics of osteoporosis at the primary health care level. An ultrasound device was used to identify subjects in the osteoporotic range as defined by DXA. A case finding strategy combining ultrasound results with DXA measurements for patients with intermediate ultrasound results is presented. We lack effective screening and diagnostics of osteoporosis at primary health care. In this study, a pulse-echo ultrasound (US) method is investigated for osteoporosis screening. A total of 1091 Caucasian women (aged 50–80 years) were recruited for the study and measured with US in the tibia and radius. This method measures cortical thickness and provides an estimate of bone mineral density (BMD) and density index (DI). BMD assessment of the hip was available for 988 women. A total of 888 women had one or more risk factors for osteoporosis (OP
susp
), and 100 women were classified healthy. Previously determined thresholds for the DI were evaluated for assessment of efficacy of the technique to detect hip BMD at osteoporotic range (T-score at or below − 2.5). In the OP
susp
group, the application of thresholds for the DI showed that approximately 32% of the subjects would require an additional DXA measurement. The multi-site ultrasound (US) measurement-based DI showed 93.7% sensitivity and 81.6% specificity, whereas the corresponding values for single-site US measurement-based DI were 84.7 and 82.0%, respectively. The ultrasound measurements showed a high negative predictive value 97.7 to 99.2% in every age decade examined (ages 50–59, 60–69, 70–79 years). The study data demonstrate that a strategy of combining ultrasound measurement with added DXA measurements in cases with intermediate ultrasound results (about 30%) can be useful for identifying subjects at risk for a low bone mineral density in the osteoporotic range.
Tài liệu tham khảo
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936. https://doi.org/10.1016/S0140-6736(02)08761-5
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882. https://doi.org/10.1016/S0140-6736(98)09075-8
Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307(6914):1248–1250. https://doi.org/10.1136/bmj.307.6914.1248
National Osteoporosis Foundation (2013) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC
Hans DB, Shepherd JA, Schwartz EN, Reid DM, Blake GM, Fordham JN, Fuerst T, Hadji P, Itabashi A, Krieg MA, Lewiecki EM (2008) Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 11(1):188–206. https://doi.org/10.1016/j.jocd.2007.12.012
Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Barquero L et al (2008) Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom 11(1):163–187. https://doi.org/10.1016/j.jocd.2007.12.011
Blake GM, Chinn DJ, Steel SA, Patel R, Panayiotou E, Thorpe J, Fordham JN, National Osteoporosis Society Bone Densitometry Forum (2005) A list of device-specific thresholds for the clinical interpretation of peripheral x-ray absorptiometry examinations. Osteoporos Int 16(12):2149–2156. https://doi.org/10.1007/s00198-005-2018-x
Karjalainen J, Riekkinen O, Töyräs J, Hakulinen M, Kröger H, Rikkonen T et al (2012) Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 23(4):1287–1295. https://doi.org/10.1007/s00198-011-1682-2
Karjalainen J, Riekkinen O, Töyräs J, Jurvelin JS, Kroger H (2016) New method for point-of-care osteoporosis screening and diagnostics. Osteoporos Int 27(3):971–977. https://doi.org/10.1007/s00198-015-3387-4
Gluer CC, Blake GM, Lu Y, Blunt A, Jergas M, Genant HK (1995) Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int 5(4):262–270. https://doi.org/10.1007/BF01774016
Shepherd JA, Lu Y, Wilson K, Fuerst T, Genant HK, Hangartner TN et al (2006) Cross-calibration and minimum precision standards for dual-energy X-ray absorptiometry: the 2005 ISCD Official Positions. J Clin Densitom 9(1):31–36. https://doi.org/10.1016/j.jocd.2006.05.005
Patel R, Blake GM, Fordham JN, McCrea D, Ryan P (2011) Peripheral X-ray absorptiometry in the management of osteoporosis. National Osteoporosis Society - Practical Guides. https://nos.org.uk/media/2069/pdxa-in-the-management-of-osteoporosis.pdf. Accessed 1 July 2017
Schousboe JT, Riekkinen O, Karjalainen JP (2016) Prediction of hip osteoporosis by DXA using a novel pulse-echo ultrasound device. Osteoporos Int 28(1):85–93. https://doi.org/10.1007/s00198-016-3722-4
Shepherd JA, Fan B, Lu Y, Lewiecki EM, Miller P, Genant HK (2006) Comparison of BMD precision for Prodigy and Delphi spine and femur scans. Osteoporos Int 17(9):1303–1308. https://doi.org/10.1007/s00198-006-0127-9
Henzell S, Dhaliwal S, Pontiflex R, Gill F, Price R, Retallack R et al (2000) Precision error of fan-beam dual X-ray absorptiometry scans at the spine, hip, and forearm. J Clin Densitom 3(4):359–364. https://doi.org/10.1385/JCD:3:4:359
Kiebzak GM, Faulkner KG, Wacker W, Hamdy R, Seier E, Watts NB (2007) Effect of precision error on T-scores and the diagnostic classification of bone status. J Clin Densitom 10(3):239–243. https://doi.org/10.1016/j.jocd.2007.03.002
Clowes J, Peel NFA, Eastell R (2006) Device-specific thresholds to diagnose osteoporosis at the proximal femur: an approach to interpreting peripheral bone measurements in clinical practice. Osteoporos Int 17(9):1293–1302. https://doi.org/10.1007/s00198-006-0122-1