Thomsen K, Jepsen D B, Matzen L, Hermann A P, Masud T, Ryg J
Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29 Entrance 112, 7th floor, 5000, Odense C, Denmark,
Osteoporos Int. 2015 May;26(5):1459-75. doi: 10.1007/s00198-014-3012-y. Epub 2015 Jan 30.
Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8%) and misclassification rates (0-12.4%) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used.
跟骨定量超声（QUS）作为骨质疏松症的预筛查工具颇具吸引力，可替代双能X线吸收法。我们对跟骨QUS可用性的文献进行了调查。我们发现研究之间存在很大异质性，且在临界值、设备和测量变量方面存在不确定性。尽管骨质疏松相关骨折是一个主要的健康问题，但骨质疏松症仍未得到充分诊断。目前，髋部或脊柱的双能X线吸收法（DXA）是诊断骨质疏松症的首选方法，但该方法因可及性低而受到限制。QUS是一种评估骨骼的方法，可替代DXA。本系统评价的目的是探讨QUS作为评估骨质疏松症的预筛查分层工具的可用性。纳入了以髋部或脊柱的DXA作为金标准评估跟骨QUS的研究。我们从纳入的研究中提取数据，以计算在等于高灵敏度和/或特异性的临界值下节省的DXA数量和错误分类率。节省的DXA数量和错误分类的人数百分比是可用性的衡量指标。我们纳入了31项研究。这些研究在研究特征方面存在异质性。分析表明，根据预筛查策略、研究特征、设备、测量变量和临界值的不同，节省的DXA百分比（2.7%-68.8%）和错误分类率（0%-12.4%）差异很大。跟骨QUS作为评估骨质疏松症的预筛查工具可能有用。然而，在设备、变量和临界值方面尚未达成共识。总体而言，没有足够的证据推荐一个特定的跟骨QUS临界值，其确定性水平足以确诊或排除骨质疏松症。在预筛查或分层算法中使用的跟骨QUS必须基于特定设备的临界值，这些临界值已在其预期使用的人群中得到验证。
