This study investigated the ability of DXA and QUS to predict fractures long term when measured around the time of the menopause. We found both DXA and QUS are able to predict both any fracture and "osteoporotic" fractures and that QUS can predict independently of BMD.
Conclusions: In conclusion, it may be possible to scan women around the time of the menopause to predict future fractures. It seems that, for "osteoporotic" fractures, BUA may be an improved predictor of fractures in comparison with DXA, because the relative risk is highest for BUA, and independent of BMD.
Quantitative Ultrasound: Use in Screening for Susceptibility to Stress Fractures in Female Army Recruits
J Lappe, K Davies, R Recker R Heaney
Quantitative Ultrasound (QUS) measurements were made on 4139 female army recruits (USA) at the beginning of basic training. QUS predicted stress fracture in female recruits as well as it predicted hip fracture in elderly women…The combination of QUS measurements with evaluation of individual risk factors can identify recruits who are at the very highest risk of stress fracture. The military may find these data helpful to determine the cost-effectiveness of alternate BT regimens
Conclusion: Calcaneal QUS, in combination with falls-risk assessments, can discriminate elderly women at risk of future osteoporotic fractures. Case finding for at-risk individuals may allow early intervention to be implemented, and consequently curb the spiralling cost of managing osteoporotic fractures.
In conclusion, all five QUS devices tested showed significant age-adjusted differences between subjects with and without vertebral fracture. When selecting the strongest variable, QUS of the calcaneus worked as well as central DXA for identification of women at high risk for prevalent osteoporotic vertebral fractures.
PREDICTION OF TOTAL HIP FRACTURE IN MEN AND WOMENBY QUANTITATIVE ULTRASOUND OF THE CALCANEUS: EPIC-NORFOLK PROSPECTIVE STUDY Kay-Tee Knaw, FRCP, Jonathan Reeve, FRCP, Robert Luben, BSc, Sheila Bingham, PhD, Ailsa Welch, BSc, Nicholas Wareham, FRCP, Suzy Oakes and Nicholas Day, FRCPath Interpretation: Quantitative calcaneum ultrasound predicts total and hip fracture risk in men and women in a continuous relation. The challenge now is to identify interventions to improve bone health in the whole population.
Conclusion: Quantitative ultrasound (QUS) is a reliable, reproducible instrument for measuring bone quality in the institutionalized elderly population, and has the advantage of portability and ease of use over the gold standard for bone density assessment, dual energy x-ray absorptiometry. Variance estimated with both methods was stable with increasing age suggesting that this is a useful method for estimation fracture risk even in the frail elderly.
In conclusion, it is well established that QUS measurements relate directly to bone density and possibly to some aspects of trabecular architecture. There is also evidence that QUS measurements are able to provide reliable estimates of fracture risk, and most importantly, for fracture risk at the hip. The portability and other features of QUS, allow for a wider assessment of osteoporosis and fracture risk across the general community, and this approach should be encouraged and promoted, especially in remote and rural areas.
Heel QUS can predict fracture risk in younger peri menopausal and post menopausal women between the ages of 45 and 75 years...This paper reports this compliance rates with the scanning programme, normal for ranges for the QUS parameters and the association of heel QUS at baseline with fracture history after the age of 45 years.
In conclusion, because ultrasound methods are less expensive, faster and radiation free, and because they predict the risk of hip fracture as efficiently as DPXA, their use should be encouraged in the assessment of the elderly population. Ultrasonography is a useful tool in any programme directed towards prevention of hip fractures.
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