Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls

• Published in: Osteoporosis international 2009-10, Vol.20 (10), p.1695-1703
• Main Authors: Nanchen, D, Cornuz, J, Ruffieux, C, Riesen, W, Burckhardt, P, Krieg, M. A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amino Acids - urine; Biological and medical sciences; Biomarkers; Biomarkers - urine; Bone markers; Bone Resorption - diagnosis; Bone Resorption - diagnostic imaging; Bone ultrasound; Bones; Calcaneus - diagnostic imaging; Chromatography, High Pressure Liquid - methods; Diseases of the osteoarticular system; Endocrinology; Epidemiologic Methods; Female; Fracture risk; Fractures; Fundamental and applied biological sciences. Psychology; Humans; Injuries of the limb. Injuries of the spine; Medical sciences; Medicine; Medicine & Public Health; Nested case-control study; Older people; Original Article; Orthopedics; osteoporosis; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - diagnosis; Osteoporotic Fractures - diagnostic imaging; Rheumatology; Risk factors; Skeleton and joints; Traumas. Diseases due to physical agents; Ultrasonic imaging; Ultrasonography; Vertebrates: osteoarticular system, musculoskeletal system; Womens health
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-009-0843-z

Summary This nested case-control analysis of a Swiss ambulatory cohort of elderly women assessed the discriminatory power of urinary markers of bone resorption and heel quantitative ultrasound for non-vertebral fractures. The tests all discriminated between cases and controls, but combining the two strategies yielded no additional relevant information. Introduction Data are limited regarding the combination of bone resorption markers and heel quantitative bone ultrasound (QUS) in the detection of women at risk for fracture. Methods In a nested case-control analysis, we studied 368 women (mean age 76.2 ± 3.2 years), 195 with low-trauma non-vertebral fractures and 173 without, matched for age, BMI, medical center, and follow-up duration, from a prospective study designed to predict fractures. Urinary total pyridinolines (PYD) and deoxypyridinolines (DPD) were measured by high performance liquid chromatography. All women underwent bone evaluations using Achilles+ and Sahara heel QUS. Results Areas under the receiver operating-characteristic curve (AUC) for discriminative models of the fracture group, with 95% confidence intervals, were 0.62 (0.56-0.68) and 0.59 (0.53-0.65) for PYD and DPD, and 0.64 (0.58-0.69) and 0.65 (0.59-0.71) for Achilles+ and Sahara QUS, respectively. The combination of resorption markers and QUS added no significant discriminatory information to either measurement alone with an AUC of 0.66 (0.60-0.71) for Achilles+ with PYD and 0.68 (0.62-0.73) for Sahara with PYD. Conclusions Urinary bone resorption markers and QUS are equally discriminatory between non-vertebral fracture patients and controls. However, the combination of bone resorption markers and QUS is not better than either test used alone.