Huopio J, Kröger H, Honkanen R, Jurvelin J, Saarikoski S, Alhava E
Department of Surgery, Kuopio University Hospital, PO Box 1777, 70211, Kuopio, Finland.
Osteoporos Int. 2004 Mar;15(3):190-5. doi: 10.1007/s00198-003-1534-9. Epub 2004 Jan 16.
Low calcaneal ultrasound measurement (quantitative ultrasound, QUS) has been shown to predict fractures in elderly women. However, only a few studies have examined its ability to predict perimenopausal and early postmenopausal fractures. We conducted a prospective population-based cohort study to assess the capability of QUS as compared to axial BMD measurement to predict early postmenopausal fractures at that age. Four hundred and twenty-two women (mean age 59.6, range 53.7-65.3) from the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) were randomly chosen to undergo a calcaneal ultrasound measurement. In all, 9.4% of these women were premenopausal at the time of measurement. Thirty-two follow-up fractures were reported during the mean follow-up of 2.6 years (SD 0.7). These were validated with patient record perusal. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were significantly lower among women with than without fracture ( P-values 0.028, 0.001 and 0.001, respectively). Mean T-score adapted from SI was -1.5 (95% CI -1.7 to -1.2) for fracture group and -1.0 (95% CI -1.1 to -0.9) for the non-fracture group. All QUS measurements predicted fractures even after adjusting for age, weight, height, previous fracture history, femoral neck BMD and use of hormone replacement therapy according to Cox regression. The adjusted hazard ratios (HR, 95% confidence interval) of a follow-up fracture for a 1 SD decrease were 1.80 (1.27-2.56), 1.72 (1.21-2.45) and 1.43 (1.01-2.03) for SOS, SI and BUA, respectively. Similarly, the adjusted HR for a 1 SD decrease of spinal BMD was 1.27 (0.85-1.94) and for that of femoral neck BMD 1.14 (0.78-1.70). In receiver operator analyses, the area under the curve (AUC) was greatest for QUS measurements: SOS (AUC=0.68), stiffness (AUC=0.67), BUA (AUC=0.62) and least for lumbar BMD (AUC=0.56), while and femoral neck BMD (AUC=0.59). The difference between AUCs was statistically significant between SI and lumbar BMD ( P=0.02, Duncan's P=0.07). We conclude that low calcaneal QUS predicts early postmenopausal fractures as well as or even better than axial BMD.
低跟骨超声测量（定量超声，QUS）已被证明可预测老年女性的骨折情况。然而，仅有少数研究考察了其预测围绝经期和绝经后早期骨折的能力。我们开展了一项基于人群的前瞻性队列研究，以评估与轴向骨密度测量相比，QUS预测该年龄段绝经后早期骨折的能力。从库奥皮奥骨质疏松危险因素与预防研究（OSTPRE）中随机选取422名女性（平均年龄59.6岁，范围53.7 - 65.3岁）进行跟骨超声测量。测量时，这些女性中9.4%处于绝经前状态。在平均2.6年（标准差0.7）的随访期间，共报告了32例随访骨折。通过查阅患者记录进行验证。骨折女性的宽带超声衰减（BUA）、声速（SOS）和硬度指数（SI）显著低于未骨折女性（P值分别为0.028、0.001和0.001）。骨折组根据SI调整后的平均T值为 -1.5（95%可信区间 -1.7至 -1.2），非骨折组为 -1.0（95%可信区间 -1.1至 -0.9）。根据Cox回归分析，即使在调整年龄、体重、身高、既往骨折史、股骨颈骨密度和激素替代疗法使用情况后，所有QUS测量指标仍可预测骨折。SOS、SI和BUA每降低1个标准差，随访骨折的调整后风险比（HR，95%置信区间）分别为1.80（1.27 - 2.56）、1.72（1.21 - 2.45）和1.43（1.01 - 2.03）。同样，脊柱骨密度每降低1个标准差的调整后HR为1.27（0.85 - 1.94），股骨颈骨密度为1.14（0.78 - 1.70）。在接受者操作分析中，QUS测量指标的曲线下面积（AUC）最大：SOS（AUC = 0.68）、硬度（AUC = 0.67）、BUA（AUC = 0.62），而腰椎骨密度（AUC = 0.56）和股骨颈骨密度（AUC = 0.59）最小。SI与腰椎骨密度之间的AUC差异具有统计学意义（P = 0.02，邓肯P = 0.07）。我们得出结论，低跟骨QUS预测绝经后早期骨折的能力与轴向骨密度相当，甚至更好。
