Is Calcaneal Quantitative Ultrasound Useful As a Prescreen Stratification Tool for Osteoporosis?

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2015 Jan 31

PMID 25634771

Citations 28

Authors

K Thomsen

D B Jepsen

L Matzen

A P Hermann

T Masud

J Ryg

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Association between physical performance and bone mass in community-dwelling postmenopausal Japanese women: The Unzen study.

Suiko M, Mizukami S, Arima K, Nakashima H, Nishimura T, Tomita Y PLoS One. 2024; 19(1):e0296457.

PMID: 38165878 PMC: 10760765. DOI: 10.1371/journal.pone.0296457.

Fracture risk prediction in old Chinese people-a narrative review.

Su Y, Zhou B, Kwok T Arch Osteoporos. 2023; 19(1):3.

PMID: 38110842 DOI: 10.1007/s11657-023-01360-5.

Comparison between calcaneus quantitative ultrasound and the gold standard DXA in the ability to detect osteoporosis in chronic obstructive pulmonary disease patients.

Chanprasertpinyo W, Punsawad C, Khwanchuea R, Sukkriang N, Yincharoen P, Rerkswattavorn C J Orthop Surg Res. 2023; 18(1):778.

PMID: 37845656 PMC: 10577968. DOI: 10.1186/s13018-023-04211-8.

MicroRNAs as potential biopredictors for premenopausal osteoporosis: a biochemical and molecular study.

Al-Rawaf H, Gabr S, Iqbal A, Alghadir A BMC Womens Health. 2023; 23(1):481.

PMID: 37689658 PMC: 10493018. DOI: 10.1186/s12905-023-02626-3.

Quantitative Ultrasound and Bone Health in Elderly People, a Systematic Review.

Escobio-Prieto I, Blanco-Diaz M, Pinero-Pinto E, Rodriguez-Rodriguez A, Ruiz-Dorantes F, Albornoz-Cabello M Biomedicines. 2023; 11(4).

PMID: 37189793 PMC: 10135977. DOI: 10.3390/biomedicines11041175.

References

Pfister A, Starcher V, Welch C . The use of calcaneal quantitative ultrasound for determining bone mass of the hip. W V Med J. 2003; 99(2):71-3. View

Lippuner K, Fuchs G, Ruetsche A, Perrelet R, Casez J, Neto I . How well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine or hip? A cost-effectiveness analysis. J Clin Densitom. 2000; 3(3):241-9. DOI: 10.1385/jcd:3:3:241. View

SIM M, Stone M, Johansen A, Evans W . Cost effectiveness analysis of BMD referral for DXA using ultrasound as a selective pre-screen in a group of women with low trauma Colles' fractures. Technol Health Care. 2001; 8(5):277-84. View

Boonen S, Nijs J, Borghs H, Peeters H, Vanderschueren D, Luyten F . Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study. Osteoporos Int. 2004; 16(1):93-100. DOI: 10.1007/s00198-004-1660-z. View

Diez-Perez A, Marin F, Vila J, Abizanda M, Cervera A, Carbonell C . Evaluation of calcaneal quantitative ultrasound in a primary care setting as a screening tool for osteoporosis in postmenopausal women. J Clin Densitom. 2003; 6(3):237-45. DOI: 10.1385/jcd:6:3:237. View

Rud B, Hilden J, Hyldstrup L, Hrobjartsson A . The Osteoporosis Self-Assessment Tool versus alternative tests for selecting postmenopausal women for bone mineral density assessment: a comparative systematic review of accuracy. Osteoporos Int. 2008; 20(4):599-607. DOI: 10.1007/s00198-008-0713-0. View

Roux C, Dougados M . Quantitative ultrasound in postmenopausal osteoporosis. Curr Opin Rheumatol. 2000; 12(4):336-45. DOI: 10.1097/00002281-200007000-00018. View

Pang W, Inderjeeth C . FRAX without bone mineral density versus osteoporosis self-assessment screening tool as predictors of osteoporosis in primary screening of individuals aged 70 and older. J Am Geriatr Soc. 2014; 62(3):442-6. DOI: 10.1111/jgs.12696. View

Larijani B, Dabbaghmanesh M, Aghakhani S, Sedaghat M, Hamidi Z, Rahimi E . Correlation of quantitative heel ultrasonography with central dual-energy X-ray absorptiometric bone mineral density in postmenopausal women. J Ultrasound Med. 2005; 24(7):941-6. DOI: 10.7863/jum.2005.24.7.941. View

10.

Edelmann-Schafer B, Berthold L, Stracke H, Luhrmann P, Neuhauser-Berthold M . Identifying elderly women with osteoporosis by spinal dual X-ray absorptiometry, calcaneal quantitative ultrasound and spinal quantitative computed tomography: a comparative study. Ultrasound Med Biol. 2010; 37(1):29-36. DOI: 10.1016/j.ultrasmedbio.2010.10.003. View

11.

Bachman D, Crewson P, Lewis R . Comparison of heel ultrasound and finger DXA to central DXA in the detection of osteoporosis. Implications for patient management. J Clin Densitom. 2002; 5(2):131-41. DOI: 10.1385/jcd:5:2:131. View

12.

Ayers M, Prince M, Ahmadi S, Baran D . Reconciling quantitative ultrasound of the calcaneus with X-ray-based measurements of the central skeleton. J Bone Miner Res. 2000; 15(9):1850-5. DOI: 10.1359/jbmr.2000.15.9.1850. View

13.

Martini G, Valenti R, Gennari L, Salvadori S, Galli B, Nuti R . Dual X-ray and laser absorptiometry of the calcaneus: comparison with quantitative ultrasound and dual-energy X-ray absorptiometry. J Clin Densitom. 2004; 7(3):349-54. DOI: 10.1385/jcd:7:3:349. View

14.

Whiting P, Rutjes A, Westwood M, Mallett S, Deeks J, Reitsma J . QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155(8):529-36. DOI: 10.7326/0003-4819-155-8-201110180-00009. View

15.

Stone K, Seeley D, Lui L, Cauley J, Ensrud K, Browner W . BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003; 18(11):1947-54. DOI: 10.1359/jbmr.2003.18.11.1947. View

16.

Gudmundsdottir S, Indridason O, Franzson L, Sigurdsson G . Age-related decline in bone mass measured by dual-energy X-ray absorptiometry and quantitative ultrasound in a population-based sample of both sexes: identification of useful ultrasound thresholds for osteoporosis screening. J Clin Densitom. 2005; 8(1):80-6. DOI: 10.1385/jcd:8:1:080. View

17.

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J . Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations.... Arch Osteoporos. 2013; 8:136. PMC: 3880487. DOI: 10.1007/s11657-013-0136-1. View

18.

Sim M, Stone M, Phillips C, Cheung W, Johansen A, Vasishta S . Cost effectiveness analysis of using quantitative ultrasound as a selective pre-screen for bone densitometry. Technol Health Care. 2005; 13(2):75-85. View

19.

Langton C, Langton D, Beardsworth S . Comparison of accuracy and cost effectiveness of clinical criteria and BUA for referral for BMD assessment by DXA in osteoporotic and osteopenic perimenopausal subjects. Technol Health Care. 1999; 7(5):319-30. View

20.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View