Drozdzowska Bogna, Pluskiewicz Wojciech
Department of Pathomorphology, Silesian School of Medicine, Zabrze, Poland.
Ultrasound Med Biol. 2002 Nov-Dec;28(11-12):1491-7. doi: 10.1016/s0301-5629(02)00619-1.
The aim of the cross-sectional study was to determine if ultrasound (US) measurements of the calcaneus have the ability to predict the risk for fractures and to discriminate between postmenopausal women with and without different types of nontraumatic fractures. All women (n = 1,129, age range 40 to 87 years) were divided into group 1, created by 656 women with 956 nontraumatic past fractures, and group 2, consisting of 473 women without fractures. Group 1 was divided into subgroups: with hip fractures, with vertebral (nonhip) fractures, with wrist (nonhip and nonspine) fractures and with other (nonhip, nonspine and nonwrist) fractures. The speed of sound (SOS; m/s) and broadband ultrasound attenuation (BUA; dB/MHz) were measured with the Achilles system (Lunar), which also calculates stiffness index (SI; %). US values were significantly lower in group 1 (1,481.4 +/- 20.2 m/s, 98.7 +/- 9.4 dB/MHz, 61.1 +/- 11.0%; p < 0.000001) and in subgroups (p < 0.000001), and these women had a higher mean age and longer postmenopausal period than women without fractures (1508.2 +/- 26.5 m/s, 107.7 +/- 9.9 dB/MHz, 74.2 +/- 13.0%). Women with hip fractures had the lowest US values (1464.6 +/- 18.6 m/s, 89.9 +/- 8.7 dB/MHz, 50.6 +/- 10.5%), women with vertebral fractures had intermediate values (1473.6 +/- 17.4 m/s, 94.8 +/- 8.9 dB/MHz, 56.4 +/- 10.0%), and women with wrist (1,484.3 +/- 19.8 m/s, 99.9 +/- 9.3 dB/MHz, 62.7 +/- 10.7%) and other fractures (1,483.3 +/- 21.0 m/s, 100.4 +/- 8.6 dB/MHz, 62.7 +/- 10.6%) had the highest values. The US values differed significantly between subgroups with fractures (p < 0.05), with no significant differences between women with wrist and other fractures. ROC analysis showed SOS to have the best sensitivity and specificity in detecting fracture cases. All US parameters revealed the greatest areas under the ROC curve (AUCs) for hip fracture (0.92 to 0.93) in comparison to smaller AUCs for vertebral fractures (ranging from 0.84 to 0.87), and the smallest AUCs for wrist and other fractures (ranging from 0.72 to 0.77 and 0.72 to 0.78, respectively). Generally, the SOS measurement presented greater odds ratio (OR) than BUA and SI: 4.1 (3.09 to 5.43) for any fracture, 11.66 (3.09 to 43.96) for hip fracture, 6.51 (3.61 to 11.73) for vertebral fracture, 3.32 (2.41 to 4.58) for wrist fracture and 4.2 (2.7 to 6.54) for other fracture. The present study demonstrates the ability of calcaneal QUS to discriminate between healthy individuals and subjects with different types of nontraumatic fractures. Calcaneal US parameters show the best sensitivity and specificity in discriminating the hip fracture patients from the controls. Generally, the SOS parameter is a better discriminator than SI and BUA and estimates the highest OR for fractures.
这项横断面研究的目的是确定跟骨的超声（US）测量是否有能力预测骨折风险，并区分有不同类型非创伤性骨折和无骨折的绝经后女性。所有女性（n = 1129，年龄范围40至87岁）被分为两组：第1组由656名有956次既往非创伤性骨折的女性组成，第2组由473名无骨折的女性组成。第1组又被分为亚组：髋部骨折组、椎体（非髋部）骨折组、腕部（非髋部和非脊柱）骨折组和其他（非髋部、非脊柱和非腕部）骨折组。使用跟腱系统（Lunar）测量声速（SOS；米/秒）和宽带超声衰减（BUA；分贝/兆赫），该系统还可计算硬度指数（SI；%）。第1组（1481.4±20.2米/秒，98.7±9.4分贝/兆赫，61.1±11.0%；p < 0.000001）及其亚组（p < 0.000001）的US值显著低于无骨折女性（1508.2±26.5米/秒，107.7±9.9分贝/兆赫，74.2±13.0%），且这些女性的平均年龄和绝经后年限均高于无骨折女性。髋部骨折女性的US值最低（1464.6±18.6米/秒，89.9±8.7分贝/兆赫，50.6±10.5%），椎体骨折女性的US值居中（1473.6±17.4米/秒，94.8±8.9分贝/兆赫，56.4±10.0%），腕部骨折（1484.3±19.8米/秒，99.9±9.3分贝/兆赫，62.7±10.7%）和其他骨折（1483.3±21.0米/秒，100.4±8.6分贝/兆赫，62.7±10.6%）女性的US值最高。骨折亚组之间的US值差异显著（p < 0.05），腕部骨折和其他骨折女性之间无显著差异。ROC分析显示SOS在检测骨折病例方面具有最佳的敏感性和特异性。与椎体骨折（AUC范围为0.84至0.87）和腕部及其他骨折（AUC范围分别为0.72至0.77和0.72至0.78）较小的AUC相比，所有US参数显示髋部骨折的ROC曲线下面积（AUC）最大（0.92至0.93）。一般来说，SOS测量的优势比（OR）大于BUA和SI：任何骨折的OR为4.1（3.09至5.43），髋部骨折为11.66（3.09至43.96），椎体骨折为6.51（3.61至11.73），腕部骨折为3.32（2.41至4.58），其他骨折为4.2（2.7至6.54）。本研究证明跟骨定量超声有能力区分健康个体和患有不同类型非创伤性骨折的个体。跟骨US参数在区分髋部骨折患者与对照组方面显示出最佳的敏感性和特异性。一般来说，SOS参数比SI和BUA是更好的区分指标，且对骨折的OR估计最高。
