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Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis

Summary Meta-analysis of prospective studies shows that quantitative ultrasound of the heel using validated devices predicts risk of different types of fracture with similar performance across different devices and in elderly men and women. These predictions are independent of the risk estimates fro...

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Published in:Osteoporosis international 2012-01, Vol.23 (1), p.143-153
Main Authors: Moayyeri, A., Adams, J. E., Adler, R. A., Krieg, M.-A., Hans, D., Compston, J., Lewiecki, E. M.
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description Summary Meta-analysis of prospective studies shows that quantitative ultrasound of the heel using validated devices predicts risk of different types of fracture with similar performance across different devices and in elderly men and women. These predictions are independent of the risk estimates from hip DXA measures. Introduction Clinical utilisation of heel quantitative ultrasound (QUS) depends on its power to predict clinical fractures. This is particularly important in settings that have no access to DXA-derived bone density measurements. We aimed to assess the predictive power of heel QUS for fractures using a meta-analysis approach. Methods We conducted an inverse variance random effects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound [SOS], stiffness index [SI], and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic and major osteoporotic fractures) were reported based on study questions. Results Twenty-one studies including 55,164 women and 13,742 men were included in the meta-analysis with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fracture. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43–2.00), SOS was 1.96 (95% CI 1.64–2.34), SI was 2.26 (95%CI 1.71–2.99) and QUI was 1.99 (95% CI 1.49–2.67). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Validated devices from different manufacturers predicted fracture risks with similar performance (meta-regression p values > 0.05 for difference of devices). QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip BMD showed a significant and independent association with fracture risk (RR/SD for BUA = 1.34 [95%CI 1.22–1.49]). Conclusions This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women. Further research is needed for more widespread utilisation of the heel QUS in clinical settings across the world.
doi_str_mv 10.1007/s00198-011-1817-5
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E. ; Adler, R. A. ; Krieg, M.-A. ; Hans, D. ; Compston, J. ; Lewiecki, E. M.</creator><creatorcontrib>Moayyeri, A. ; Adams, J. E. ; Adler, R. A. ; Krieg, M.-A. ; Hans, D. ; Compston, J. ; Lewiecki, E. M.</creatorcontrib><description>Summary Meta-analysis of prospective studies shows that quantitative ultrasound of the heel using validated devices predicts risk of different types of fracture with similar performance across different devices and in elderly men and women. These predictions are independent of the risk estimates from hip DXA measures. Introduction Clinical utilisation of heel quantitative ultrasound (QUS) depends on its power to predict clinical fractures. This is particularly important in settings that have no access to DXA-derived bone density measurements. We aimed to assess the predictive power of heel QUS for fractures using a meta-analysis approach. Methods We conducted an inverse variance random effects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound [SOS], stiffness index [SI], and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic and major osteoporotic fractures) were reported based on study questions. Results Twenty-one studies including 55,164 women and 13,742 men were included in the meta-analysis with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fracture. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43–2.00), SOS was 1.96 (95% CI 1.64–2.34), SI was 2.26 (95%CI 1.71–2.99) and QUI was 1.99 (95% CI 1.49–2.67). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Validated devices from different manufacturers predicted fracture risks with similar performance (meta-regression p values &gt; 0.05 for difference of devices). QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip BMD showed a significant and independent association with fracture risk (RR/SD for BUA = 1.34 [95%CI 1.22–1.49]). Conclusions This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women. Further research is needed for more widespread utilisation of the heel QUS in clinical settings across the world.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-011-1817-5</identifier><identifier>PMID: 22037972</identifier><language>eng</language><publisher>London: Springer-Verlag</publisher><subject>Absorptiometry, Photon ; Aged ; bone density ; Bone Density - physiology ; Bone mineral density ; Calcaneus - diagnostic imaging ; Calcaneus - physiopathology ; Dual energy X-ray absorptiometry ; elderly ; Endocrinology ; Female ; Fractures ; Geriatrics ; Health risk assessment ; Hip ; hip fracture ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; Meta-analysis ; Middle Aged ; Original Article ; Orthopedics ; Osteoporosis ; Osteoporosis - diagnostic imaging ; Osteoporosis, Postmenopausal - complications ; Osteoporosis, Postmenopausal - diagnostic imaging ; Osteoporotic Fractures - diagnostic imaging ; Osteoporotic Fractures - etiology ; Prognosis ; Reviews ; Rheumatology ; Risk assessment ; Risk Assessment - methods ; Standard deviation ; Ultrasonic imaging ; Ultrasonography ; Ultrasound ; Vertebrae</subject><ispartof>Osteoporosis international, 2012-01, Vol.23 (1), p.143-153</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2011</rights><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-e70e78e28844343629c7b90948831cb49f0fd2af1a2a2eaa7b62c4714df0d8023</citedby><cites>FETCH-LOGICAL-c468t-e70e78e28844343629c7b90948831cb49f0fd2af1a2a2eaa7b62c4714df0d8023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22037972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moayyeri, A.</creatorcontrib><creatorcontrib>Adams, J. E.</creatorcontrib><creatorcontrib>Adler, R. A.</creatorcontrib><creatorcontrib>Krieg, M.-A.</creatorcontrib><creatorcontrib>Hans, D.</creatorcontrib><creatorcontrib>Compston, J.</creatorcontrib><creatorcontrib>Lewiecki, E. M.</creatorcontrib><title>Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>Summary Meta-analysis of prospective studies shows that quantitative ultrasound of the heel using validated devices predicts risk of different types of fracture with similar performance across different devices and in elderly men and women. These predictions are independent of the risk estimates from hip DXA measures. Introduction Clinical utilisation of heel quantitative ultrasound (QUS) depends on its power to predict clinical fractures. This is particularly important in settings that have no access to DXA-derived bone density measurements. We aimed to assess the predictive power of heel QUS for fractures using a meta-analysis approach. Methods We conducted an inverse variance random effects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound [SOS], stiffness index [SI], and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic and major osteoporotic fractures) were reported based on study questions. Results Twenty-one studies including 55,164 women and 13,742 men were included in the meta-analysis with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fracture. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43–2.00), SOS was 1.96 (95% CI 1.64–2.34), SI was 2.26 (95%CI 1.71–2.99) and QUI was 1.99 (95% CI 1.49–2.67). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Validated devices from different manufacturers predicted fracture risks with similar performance (meta-regression p values &gt; 0.05 for difference of devices). QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip BMD showed a significant and independent association with fracture risk (RR/SD for BUA = 1.34 [95%CI 1.22–1.49]). Conclusions This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women. 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E.</au><au>Adler, R. A.</au><au>Krieg, M.-A.</au><au>Hans, D.</au><au>Compston, J.</au><au>Lewiecki, E. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2012-01-01</date><risdate>2012</risdate><volume>23</volume><issue>1</issue><spage>143</spage><epage>153</epage><pages>143-153</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>Summary Meta-analysis of prospective studies shows that quantitative ultrasound of the heel using validated devices predicts risk of different types of fracture with similar performance across different devices and in elderly men and women. These predictions are independent of the risk estimates from hip DXA measures. Introduction Clinical utilisation of heel quantitative ultrasound (QUS) depends on its power to predict clinical fractures. This is particularly important in settings that have no access to DXA-derived bone density measurements. We aimed to assess the predictive power of heel QUS for fractures using a meta-analysis approach. Methods We conducted an inverse variance random effects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound [SOS], stiffness index [SI], and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic and major osteoporotic fractures) were reported based on study questions. Results Twenty-one studies including 55,164 women and 13,742 men were included in the meta-analysis with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fracture. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43–2.00), SOS was 1.96 (95% CI 1.64–2.34), SI was 2.26 (95%CI 1.71–2.99) and QUI was 1.99 (95% CI 1.49–2.67). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Validated devices from different manufacturers predicted fracture risks with similar performance (meta-regression p values &gt; 0.05 for difference of devices). QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip BMD showed a significant and independent association with fracture risk (RR/SD for BUA = 1.34 [95%CI 1.22–1.49]). Conclusions This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women. Further research is needed for more widespread utilisation of the heel QUS in clinical settings across the world.</abstract><cop>London</cop><pub>Springer-Verlag</pub><pmid>22037972</pmid><doi>10.1007/s00198-011-1817-5</doi><tpages>11</tpages></addata></record>
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subjects Absorptiometry, Photon
Aged
bone density
Bone Density - physiology
Bone mineral density
Calcaneus - diagnostic imaging
Calcaneus - physiopathology
Dual energy X-ray absorptiometry
elderly
Endocrinology
Female
Fractures
Geriatrics
Health risk assessment
Hip
hip fracture
Humans
Male
Medicine
Medicine & Public Health
Meta-analysis
Middle Aged
Original Article
Orthopedics
Osteoporosis
Osteoporosis - diagnostic imaging
Osteoporosis, Postmenopausal - complications
Osteoporosis, Postmenopausal - diagnostic imaging
Osteoporotic Fractures - diagnostic imaging
Osteoporotic Fractures - etiology
Prognosis
Reviews
Rheumatology
Risk assessment
Risk Assessment - methods
Standard deviation
Ultrasonic imaging
Ultrasonography
Ultrasound
Vertebrae
title Quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis
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