Abstract
Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = −1.4 to 2.6). With a cut-off value of −1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.
Highlights
Despite the advances in diagnosis and management, osteoporosis remains a global health problem that causes more than 8.9 million fractures annually worldwide, and its prevalence is expected to further increase due to the ageing population [1, 2]
The observed poor agreement in the present study suggests that radial quantitative ultrasound (QUS) and dual energy X-ray absorptiometry (DXA) are not comparable and are not interchangeable in evaluating bone status of the children
Bland and Altman analysis revealed a significant bias and more importantly large limits of agreement between the Z-scores of measures, indicating that both techniques are not comparable. This is in concordance to the results of a recent study conducted by Williams et al [17], where the disagreement rate between radial QUS (Omnisense 7000P) and DXA techniques for “abnormal scans” (Z-scores ≤ −2) in healthy and diseased populations was relatively high (6– 14%)
Summary
Despite the advances in diagnosis and management, osteoporosis remains a global health problem that causes more than 8.9 million fractures annually worldwide, and its prevalence is expected to further increase due to the ageing population [1, 2]. Several noninvasive densitometric techniques are currently available for bone health monitoring, such as quantitative computed tomography, magnetic resonance imaging, and dual energy X-ray absorptiometry (DXA) [4]. They are known to differ in terms of technologies and acquisition methods, making it hard to reach a consensus of which of these techniques provides the best measurement of bone quality and how they are interchangeable. There is mounting evidence that DXA-derived bone parameters are related to fracture risks in these growing populations [6]. The expense of DXA is high and the equipment is neither universally available nor portable for the fieldwork situation [8]
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