Identification of osteoporosis risk in postmenopausal women by the combined use of ultrasounds and clinical factors

Abstract

Objective: Dual Energy X-ray Absorptiometry (DEXA) is considered the gold standard for osteoporosis diagnosis and identification of postmenopausal women at high risk for osteoporotic fractures. However DEXA supposes the use of expensive and not easily available instruments. The aim of this study was to verify the possibility of identifying osteoporotic patients by the association of clinical-anamnestic algorithms with ultrasonographical bone evaluation, using portable, noninvasive, and less expensive instrument.Design: Two hundred twenty-four postmenopausal women (57.9±6.2 years old) were recruited at the Menopause Clinic in Brescia and Pisa. All subjects were evaluated by ultrasonography at the phalanxes (DBM Sonic BP) and by DEXA at the femur and lumbar spine (Hologic QDR 4500 W S/N 49681); for each patient we also gathered information about weight, height, Body Mass Index (BMI) and age at menopause.Materials and Methods: We considered as osteoporosis risk factors the presence of low values of ultrasonographical parameters (Amplitude Dependent Speed of Sound [AD-SoS] T-score ≤ −2 SD and/or Ultrasound Bone Profiler Index [UBPI] T-score ≤ −2 SD) and/or low values of BMI (BMI ≤ 22 kg/m2). The number (and the percentage) of subjects at risk for the presence of at least one of the above-mentioned factors was evaluated. Fifty-eight patients were diagnosed as osteoporotics by DEXA evaluation, assumed as gold standard. We calculated the number of osteoporotic subjects correctly identified by ultrasound evaluation (QUS) and BMI (sensitivity of the method).Results: As shown in the table, the sensitivity of ultrasound evaluation was higher than the use of BMI risk factor analysis. The sensitivity of the algorithm including ultrasound evaluation and BMI analysis for the identification of osteoporotic subjects (diagnosed by DEXA of at least one site) was up to 90%.Using this algorithm only the 58.9% of the involved subjects would be submitted to a further densitometric evaluation by DEXA, while for the remaining 41.1% the evaluation deriving from the association among ultrasound evaluation and a single clinical risk factor is sufficient to correctly identify subjects who are not osteoporotic. Tabled 1Conclusion: Ultrasound evaluation in combination with clinical risk factors, in particular with BMI evaluation, seems to represent a first level screening method able to identify subjects at high osteoporotic risk, to be addressed to a further evaluation with DEXA. The proposed diagnostic workup, because of its simplicity, seems to be sufficiently effective for an extensive clinical use. Objective: Dual Energy X-ray Absorptiometry (DEXA) is considered the gold standard for osteoporosis diagnosis and identification of postmenopausal women at high risk for osteoporotic fractures. However DEXA supposes the use of expensive and not easily available instruments. The aim of this study was to verify the possibility of identifying osteoporotic patients by the association of clinical-anamnestic algorithms with ultrasonographical bone evaluation, using portable, noninvasive, and less expensive instrument. Design: Two hundred twenty-four postmenopausal women (57.9±6.2 years old) were recruited at the Menopause Clinic in Brescia and Pisa. All subjects were evaluated by ultrasonography at the phalanxes (DBM Sonic BP) and by DEXA at the femur and lumbar spine (Hologic QDR 4500 W S/N 49681); for each patient we also gathered information about weight, height, Body Mass Index (BMI) and age at menopause. Materials and Methods: We considered as osteoporosis risk factors the presence of low values of ultrasonographical parameters (Amplitude Dependent Speed of Sound [AD-SoS] T-score ≤ −2 SD and/or Ultrasound Bone Profiler Index [UBPI] T-score ≤ −2 SD) and/or low values of BMI (BMI ≤ 22 kg/m2). The number (and the percentage) of subjects at risk for the presence of at least one of the above-mentioned factors was evaluated. Fifty-eight patients were diagnosed as osteoporotics by DEXA evaluation, assumed as gold standard. We calculated the number of osteoporotic subjects correctly identified by ultrasound evaluation (QUS) and BMI (sensitivity of the method). Results: As shown in the table, the sensitivity of ultrasound evaluation was higher than the use of BMI risk factor analysis. The sensitivity of the algorithm including ultrasound evaluation and BMI analysis for the identification of osteoporotic subjects (diagnosed by DEXA of at least one site) was up to 90%. Using this algorithm only the 58.9% of the involved subjects would be submitted to a further densitometric evaluation by DEXA, while for the remaining 41.1% the evaluation deriving from the association among ultrasound evaluation and a single clinical risk factor is sufficient to correctly identify subjects who are not osteoporotic. Tabled 1 Conclusion: Ultrasound evaluation in combination with clinical risk factors, in particular with BMI evaluation, seems to represent a first level screening method able to identify subjects at high osteoporotic risk, to be addressed to a further evaluation with DEXA. The proposed diagnostic workup, because of its simplicity, seems to be sufficiently effective for an extensive clinical use.