van Daele P L, Burger H, Hofman A, Grobbee D E, Birkenhäger J C, Pols H A
Erasmus Universiteit, Instituut Epidemiologie en Biostatistiek, Rotterdam.
Ned Tijdschr Geneeskd. 1996 Jul 6;140(27):1398-402.
To examine whether ultrasound measurements of the calcaneus can help to identify subjects with a risk for non-vertebral fractures.
Cross-sectional survey.
The suburb of Ommoord in Rotterdam, the Netherlands.
1421 subjects (631 men, 790 women) underwent both ultrasound measurements of the calcaneus and bone mineral density measurement of the femoral neck by dual energy X-ray absorptiometry (DXA). At the calcaneus speed of sound (SOS in m/s) and broadband ultrasound attenuation (BUA in dB/MHz) were measured. In addition, all subjects were asked about fractures in the preceding 5 years. The frequency of non-vertebral fractures was examined per tertile of SOS and BUA. In addition, we examined whether there was a trend in the number of fractures per tertile of SOS or BUA, within tertiles of femoral neck bone mineral density.
The measures of SOS, BUA and bone mineral density (DXA-measured) are comparable as predictors of fractures. Subjects with values of SOS, BUA or bone mineral density in the lowest tertiles were all found to report two to three times as many fractures as subjects with values for these variables in the highest tertiles. Within tertiles of bone mineral density, subjects with a low SOS reported more fractures than subjects with a high SOS. For BUA a similar but less pronounced pattern was visible. Nevertheless, the area under the receiver operating characteristic (ROC) curve was 0.63 for SOS and 0.64 for BUA, comparable to 0.62 for bone mineral density of the proximal femur. Combining ultrasound and bone mineral density measurements had limited effect on the area under the ROC curve (0.65).
Subjects with lower values of ultrasound parameters are at increasing risk of fracture, especially if low ultrasound values are accompanied by a lower bone mineral density. It remains to be seen whether ultrasound parameters are useful for screening.
研究跟骨的超声测量是否有助于识别有非椎体骨折风险的受试者。
横断面调查。
荷兰鹿特丹的奥莫德郊区。
1421名受试者（631名男性，790名女性）接受了跟骨的超声测量以及通过双能X线吸收法（DXA）进行的股骨颈骨密度测量。测量了跟骨的声速（SOS，单位为m/s）和宽带超声衰减（BUA，单位为dB/MHz）。此外，询问了所有受试者在过去5年中的骨折情况。按SOS和BUA的三分位数检查非椎体骨折的频率。此外，我们还研究了在股骨颈骨密度的三分位数范围内，SOS或BUA每三分位数的骨折数量是否存在趋势。
SOS、BUA和骨密度（DXA测量）作为骨折预测指标具有可比性。SOS、BUA或骨密度处于最低三分位数的受试者报告的骨折数量是这些变量处于最高三分位数的受试者的两到三倍。在骨密度的三分位数范围内，SOS较低的受试者报告的骨折比SOS较高的受试者更多。对于BUA，也可见类似但不太明显的模式。然而，受试者工作特征（ROC）曲线下面积对于SOS为0.63，对于BUA为0.64，与近端股骨骨密度的0.62相当。联合超声和骨密度测量对ROC曲线下面积的影响有限（0.65）。
超声参数值较低的受试者骨折风险增加，特别是如果超声值低同时伴有较低的骨密度。超声参数是否有助于筛查仍有待观察。
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