School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7QE, UK.
Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, M1 7EL, Manchester, UK.
Arch Osteoporos. 2023 May 30;18(1):77. doi: 10.1007/s11657-023-01287-x.
This large cohort study investigated reliability and validity of heel ultrasound to estimate bone mineral density in adults. Reliability calculated between left and right heels was relatively poor and so was criterion validity assessed relative to dual-energy X-ray absorptiometry. Heel ultrasound should be used cautiously when estimating bone mineral density.
Calcaneal quantitative ultrasound (QUS) may be used as a safe, low cost, and portable means to estimate bone mineral density (BMD) in large cohorts. The purpose of this study was to quantify the reliability and validity of QUS in comparison to dual-energy X-ray absorptiometry (DXA), which is the reference method for BMD measurement and diagnoses of osteopenia and osteoporosis.
Bone outcomes measured on the large UK Biobank cohort were used. The reliability of QUS estimated BMD was quantified by comparing values obtained from the left and right heel measured in the same session. Criterion validity was assessed through agreement between QUS and DXA, quantifying correlations, and sensitivity and specificity of osteopenia and osteoporosis diagnoses.
Reliability calculations were made using data from over 216,000 participants demonstrating similar QUS BMD values between left and right heels in the absolute scale (Sd of difference for men: 0.12 and 0.07 g·cm). However, when expressed in relative scales, including concordance of quartiles, reliability was poor. Agreement between QUS and DXA was quantified using data from 5042 participants. Low to modest correlations (r = 0.29 to 0.44) were obtained between multiple QUS variables and DXA BMD, with sensitivity identified as very poor (0.05 to 0.23) for osteoporosis, and poor (0.37 to 0.62) for osteopenia diagnoses.
The findings of this large comparative analysis identify that whilst calcaneal QUS has the potential to produce reliable absolute BMD measurements and demonstrate modest associations with DXA BMD measures, use of that information to make relative statements about participants in the context of the larger population or to appropriately diagnose osteopenia or osteoporosis may be severely limited.
本大规模队列研究调查了足跟超声估计成年人骨密度的可靠性和有效性。左、右足跟之间的可靠性计算相对较差，与双能 X 射线吸收法相比，标准效度也较差。在估计骨密度时，应谨慎使用足跟超声。
跟骨定量超声（QUS）可作为一种安全、低成本、便携式的方法来估计大样本量中的骨密度（BMD）。本研究的目的是定量比较 QUS 与双能 X 射线吸收法（DXA）的可靠性和有效性，DXA 是 BMD 测量和骨质疏松症诊断的参考方法。
使用来自英国生物库大样本的骨量结果。通过比较同一部位左、右足跟测量的 QUS 估计 BMD 值来量化 QUS 估计 BMD 的可靠性。通过 QUS 与 DXA 的一致性、相关性以及骨质疏松症和骨量减少症诊断的灵敏度和特异性来评估标准效度。
使用来自超过 216000 名参与者的数据进行可靠性计算，结果表明男性左、右足跟的 QUS BMD 值在绝对尺度上相似（差异 Sd：0.12 和 0.07 g·cm）。然而，当以相对尺度表示时，包括四分位的一致性，可靠性较差。使用来自 5042 名参与者的数据来量化 QUS 和 DXA 之间的一致性。在 QUS 多个变量与 DXA BMD 之间获得了低到中度的相关性（r = 0.29 至 0.44），骨质疏松症的灵敏度为非常低（0.05 至 0.23），骨量减少症的灵敏度为较差（0.37 至 0.62）。
本大规模比较分析的结果表明，虽然跟骨 QUS 具有产生可靠的绝对 BMD 测量值的潜力，并与 DXA BMD 测量值具有中度相关性，但在更大的人群中，将该信息用于对参与者进行相对陈述或适当诊断骨质疏松症或骨量减少症的用途可能会受到严重限制。
