LAUSSANE, Switzerland—A heel quantitative ultrasound coupled with an assessment of specific osteoporosis-related risk factors (age, recent fall, failed chair-test, and fracture history) can help doctors predict fracture risk in their patients and decide who would need further screening with dual-energy X-ray absorptiometry (DXA), according to a new study in the July 2008 issue of Radiology.¹

"Our prediction rule is a simple tool that can be applied systematically in the evaluation of elderly patients," conclude researchers led by Idris Guessous, MD, a senior research fellow in the department of internal medicine at Lausanne University Hospital in Switzerland.

New prediction rule IDs at-risk population

In the 3-year multicenter study, 6174 women ages 70 to 85 with no previous diagnosis of osteoporosis were screened with heel-bone quantitative ultrasound to calculate stiffness index. Researchers accounted for risk factors such as age, history of fractures, or a recent fall to the results of the heel-bone ultrasound to develop a predictive rule to estimate fracture risk. Overall, 1464 women (23.7%) were considered lower risk and 4710 (76.3%) higher risk.

Study participants were mailed questionnaires every 6 months for up to 32 months to record any health changes. If a fracture occurred, the patients were asked to provide details and a medical report from their treating physician. Among higher risk women, 290 (6.1%) sustained fractures whereas only 27 (1.8%) of the women in the low risk group sustained fractures. Among the 66 women who sustained a hip fracture, 60 (90%) were in the higher risk group.

"Heel [ultrasound] in conjunction with clinical risk factors can be used to identify a population at a very low fracture probability in which no further diagnostic evaluation may be necessary," Dr. Guessous said in a press release.

The DXA conundrum

Currently, the Washington, DC-based National Osteoporosis Foundation recommends DXA testing for all women aged ≥65 and all men aged ≥70, regardless of their risk factors for bone loss. Testing is also recommended for younger men and women with identified risk factors, but those who should have the test are not getting it due in part to access issues.

"[The] integration of heel quantitative ultrasound parameters may be an effective alternative to DXA in response to the expected growth in demand for osteoporosis management in the next decades," the study authors write.

Translating research into practice

"[I]f we…want to prevent problems before they occur, as opposed to after they manifest (ie, fractures), we need to move to a method to screen large populations to see who is at risk for these fractures, identify them earlier, send them for more definitive diagnostic tests, then treat them more definitively" said Levon Nazarian, MD, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia. "Generally speaking, ultrasound is less costly than other types of imaging technology and every physician could have it in their office. …we can take someone before they ever had a DXA and better assess their risk," he told MSKreport.com.

Reference

1. Guessous I, Cornuz J, Ruffieux C, et al. Osteoporotic fracture risk in elderly women: estimation with quantitiative heel US and clinical risk factors. Radiology. 2008;248:179-184.