Validation of Quantitative Ultrasonography for Osteoporosis Diagnosis in Postmenopausal Women Compared to Dual-Energy X-Ray Absorptiometry (DEXA) (original) (raw)
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Role of DEXA and ultrasonometry in the evaluation of osteoporotic risk in postmenopausal women
Maturitas, 2002
Background/aim: The aim of this study was to compare the role of quantitative ultrasonography (QUS) and dual energy X-ray absorptiometry (DEXA) in the assessment of osteoporosis. Methods: From June 1999 to November 2001, 596 women who have not been diagnosed osteoporosis and without previous history of pathologic fractures were enrolled in this study. They had a mean age of 58.7 98.5 years, a mean height of 166 9 3.5 cm and a mean weight of 66 9 4.1 kg. According to the age, women were divided into three groups: group A included women between 45 and 55 years; group B women between 56 and 66 years and group C women between 67 and 77 years. Each patient underwent to both methods to determine the presence of osteoporosis. Results: QUS resulted in a greater number of women of group A at risk of osteoporosis, whereas DEXA indicated that more women of group C were at increased osteoporotic risk. QUS and DEXA gave concordant results only in women of group B. Conclusion: These results suggested that QUS screening for osteoporosis may be more suitable for 'younger' postmenopausal women.
Osteoporosis and Sarcopenia, 2021
Objectives: Calcaneal quantitative ultrasound measurement (QUS) has been considered an alternative to dual-energy X-ray absorptiometry (DXA) based bone mineral density (BMD) for assessing bone health. This study sought to examine the utility of QUS as an osteoporosis screening tool by evaluating the correlation between QUS and DXA. Methods: The study was a part of the Vietnam Osteoporosis Study that involved 1270 women and 773 men aged 18 years and older. BMD at the femoral neck, total hip and lumbar spine was measured using DXA. Osteoporosis was diagnosed based on the femoral neck T-score using World Health Organization criteria. Broadband ultrasound attenuation (BUA) at the calcaneus was measured by QUS. The concordance between BUA and BMD was analyzed by the linear regression model. Results: In all individuals, BUA modestly correlated with femoral neck BMD (r ¼ 0.35; P < 0.0001) and lumbar spine BMD (r ¼ 0.34; P < 0.0001) in both men and women. In individuals aged 50 years and older, approximately 16% (n ¼ 92/575) of women and 3.2% (n ¼ 10/314) of men were diagnosed to have osteoporosis. Only 0.9% (n ¼ 5/575) women and 1.0% (n ¼ 3/314) men were classified as "Low BUA". The kappa coefficient of concordance between BMD and BUA classification was 0.09 (95% CI, 0.04 to 0.15) for women and 0.12 (95% CI, 0.03 to 0.22) for men. Conclusions: In this population-based study, QUS BUA modestly correlated with DXA BMD, suggesting that BUA is not a reliable method for screening of osteoporosis.
The role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry
Rheumatology International, 2001
The aim of this study was to establish whether quantitative ultrasound (QUS) parameters could identify patients classi®ed as osteoporotic and osteopenic on the basis of dual energy X-ray absorptiometry (DEXA). One hundred and twenty-three patients (39 male, 84 female) with osteoporosis and suspected of having osteoporosis were included in this study. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured and bone mineral densities (BMD) of the lumbar spine and left hip was measured by DEXA. Subjects were classi®ed into three groups (normal, osteopenic and osteoporotic) on the basis of BMD T-scores measured by DEXA. QUS parameters of the osteoporotic group were signi®cantly lower than those of osteopenic and normal groups; there was no dierence in QUS parameters between the normal and osteopenic groups. Correlations of both right and left SOS and BUA with the spine and femoral neck BMD were moderate (r 0.343±0.539, P < 0.001). There was also reasonable correlation between DEXA and QUS T-scores (r 0.364±0.510, P < 0.001). QUS had a sensitivity of 21% and a speci®city of 95% for diagnosing osteoporosis. We concluded that, although DEXA and QUS parameters were signi®cantly correlated, QUS parameters can not predict osteopenia as de®ned by DEXA, and sensitivities and speci®cities of QUS parameters were not suciently high for QUS to be used as an alternative to DEXA.
Journal of Chitwan Medical College, 2019
Background: The aim of the study was to establish the correlation quantitative ultrasound (QUS) between and dual-energy X-ray absorptiometry (DEXA) and to assess the ability of QUS as a screening tool for osteoporosis. Methods: The study was conducted on 115 patients. All the patients underwent QUS of radius using Sunlight MiniOmni bone sonometer and DEXA screening for measurement of bone mineral density (BMD) at lumbar spine, total left & femoral neck and radius. Results: Significant correlations were observed between QUS and DEXA T score. Conclusions: QUS is a sensitive screening tool to detect changes in the bone mass and risk of osteoporosis.
Journal of Clinical Densitometry, 2003
Screening of osteoporosis by quantitative ultrasound (QUS) has become widely available in Europe, but no clear strategies for its clinical use have been established. The aim of this study was to validate the use of QUS in a cross-sectional study carried out in three primary care centers. Measurements of calcaneal QUS and bone mineral density (BMD) at proximal femur were obtained by dual-energy X-ray absorptiometry (DXA). Osteoporosis was diagnosed by DXA T-score ≤ -2.5 at the femoral neck. Sensitivity, specificity, kappa index, and receives operator characteristics (ROC) curve QUS values were calculated with respect to the standard reference. Both positive and negative likelihood ratios (LR) were used to calculate the optimum cut-off levels. Two hundred and sixty-seven women aged 65 or older were included. Fifty-five percent had osteoporotic femoral neck BMD values (T-score ≤ -2.5). The same threshold for QUS yielded a lower prevalence of osteoporosis (10%). Women with BMD diagnosis of osteoporosis were older and showed lower age-adjusted values for all QUS parameters (p < 0.001). Area under the curve (AUC) ranged from 0.662-0.678 for the different QUS parameters; correlation and concordance of all parameters with femoral neck BMD were statistically significant (p < 0.001). Cut-off values calculated from the AUC yielded 61.1% sensitivity and 65.3% specificity for the best QUS parameter (i.e., Estimated Heel T-score ≤ -1.55). Estimated Heel T-score values of +0.05 or above ruled out osteoporosis (LR 0.18), whereas those -2.50 or below supported the diagnosis (LR 5.98). The application of these cutoff points allowed classification of 22.1% of cases. In conclusion, in postmenopausal women, QUS screening conclusively confirms or rules out osteoporosis in approximately one-fifth of cases, thereby avoiding the need for a DXA measurement.
Asia Pacific Journal of Multidisciplinary Research, 2015
The objective of this study was to assess the diagnostic value of quantitative ultrasound (QUS) and Osteoporosis self-assessment tool (OST) compared with Dual Energy x-ray absorptiometry (DXA), and to identify the best cutoff value for determining low bone mineral density (BMD) among postmenopausal women in Riyadh, Saudi Arabia. We conducted a community based cross-sectional study on 224 randomly selected post-menopausal women. Women visited primary heath care centers for answering self-administered questionnaireand screening for low BMD using QUS technique. OST was calculated based on age and weight. DXA scanwas performedforlumbar spine and femur neck at King Khalid University Hospital, Riyadh. Mean age of participants was 58.05(±8.97) years. The prevalence of low BMD at lumbar spine and femur neck was 56% and 28% respectively. The best cutoff value for QUS and OST was ≤-1 and ≤2 respectively. QUS yielded sensitivity and specificity of 73% vs 47% for lumbar spine (area under curve (AUC) 0.56) and 84% vs 43% for femur neck (AUC 0.61). OST yielded sensitivity and specificity of 38% vs 84% for lumbar spine (AUC 0.62) and 48% vs 78% for femur neck (AUC 0.68). On combining the results, sensitivity and specificity were81% vs 41% (AUC 0.61) for lumbar spine and 89% vs 35% for femur neck (AUC 0.68) respectively. QUS and OST separately have limited diagnostic value, however on combining both instruments there is improvement in sensitivity to detect low BMD for both lumbar spine and femur neck.
Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis
Open Medicine, 2010
Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2005
In this study, we sought the proper cutoff level for quantitative ultrasonography (QUS) of the heel in identifying bone mineral density (BMD) categories as determined by dual-energy x-ray absorptiometry (DXA) in postmenopausal women. With the use of DXA, BMD categories of the lumbar spine and different areas of the left femur of 420 healthy women according to World Health Organization definitions were determined. Quantitative ultrasonography of the heel was also performed in each subject. Receiver operating characteristic curves were plotted, and sensitivity and specificity of QUS to diagnose osteoporosis were examined at different points to identify the best cutoff level. The diagnostic agreement between the two techniques in identifying osteoporosis was assessed with kappa scores. The kappa scores were 0.31 for the lumbar region and 0.5 for the femoral neck region. On the receiver operating characteristic study, a score of -1 was found to be the appropriate cutoff point for QUS st...
Journal of the Medical Association of Thailand Chotmaihet thangphaet, 2007
Objective: To examine the diagnostic performance of clinical risk indices combined with quantitative ultrasound calcaneus measurement (QUS) for identifying osteoporosis in Thai postmenopausal women. Material and method: The present study was designed as a cross-sectional investigation in 300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS score was calculated for each woman using her age and weight Women with OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively. Results: Using DXA as the gold standard, the sensitivity of QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60 vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS. The sensitivity increased when using OSTA/KKOS combined with QUS to identify osteoporosis (approximately 87-89%) while the specificity, PPV and NPV were comparable with using clinical risk indices alone. The risk (odds ratio; OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35, 95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS). Furthermore, individuals were classified "high risk" from OSTA/KKOS with QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68, 95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and KKOS, respectively). Conclusion: Using the clinical risk indices combined with QUS could improve the accuracy of osteoporosis identification. This approach could be used in a primary care setting or community-based hospital where a DXA machine is not available.
Calcified Tissue International, 2003
The aim of our study was to assess, from the perspective of the National Health Services in Spain, the cost-effectiveness of quantitative ultrasound (QUS) as a prescreen referral method for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) in postmenopausal women of the general population. Using femoral neck DXA and heel QUS. We evaluated 267 consecutive postmenopausal women 65 years and older and attending primary care physician offices for any medical reason. Subjects were classified as osteoporotic or nonosteoporotic (normal or osteopenic) using the WHO definition for DXA. Effectiveness was assessed in terms of the sensitivity and specificity of the referral decisions based on the QUS measurement. Local costs were estimated from health services and actual resource used. Cost-effectiveness was evaluated in terms of the expected cost per true positive osteoporotic case detected. Baseline prevalence of osteoporosis evaluated by DXA was 55.8%. The sensitivity and specificity for the diagnosis of osteoporosis by QUS using the optimal cutoff thresholds for the estimated heel BMD T-score were 97% and 94%, respectively. The average cost per osteoporotic case detected based on DXA measurement alone was € 23.85. The average cost per osteoporotic case detected using QUS as a prescreen was €22.00. The incremental cost-effectiveness of DXA versus QUS was €114.00 per true positive case detected. Our results suggest that screening for osteoporosis with QUS while applying strict cufoff values in postmenopausal women of the general population is not substantially more cost-effective than DXA alone for the diagnosis of osteoporosis. However, the screening strategy with QUS may be an option in those circumstances where the diagnosis of osteoporosis is deficient because of the difficulty in accessing DXA equipment.