nach oben

Clinical Rheumatology

Erschienen in:

17.01.2020 | Original Article

Calcaneal quantitative ultrasound has a role in out ruling low bone mineral density in axial spondyloarthropathy

verfasst von: Gillian E. Fitzgerald, Tochukwu Anachebe, Kevin G. McCarroll, Finbar O’Shea

Erschienen in: Clinical Rheumatology | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Abstract

Objective

The aim of this study was to investigate the role of quantitative ultrasound (QUS) of the calcaneus in screening for osteoporosis in adults with axial spondyloarthropathy (axSpA).

Method

Postmenopausal women and men over 50 years with axSpA were recruited for this observational cross-sectional study. Dual-energy x-ray absorptiometry (DXA) assessed bone mineral density (BMD) of the spine and hip. QUS of the calcaneus produced broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and T-scores. Receiver-operating characteristics (ROC) curve analysis determined the ability of QUS to discriminate between low and normal BMD. Thresholds were identified to (1) out rule low BMD, (2) identify osteoporosis, and (3) identify low BMD. The number of DXAs which could be avoided using this approach was calculated.

Results

56 participants were analyzed. BUA, SI, and T-score QUS parameters correlated with BMD by DXA; SOS did not. All QUS parameters had the ability to discriminate between low and normal BMD (area under the curve varied from 0.695 to 0.779). QUS identified individuals without low BMD with 90% confidence, with BUA performing best (sensitivity 93%, negative predictive value 86%). Using QUS as a triage tool, up to 27% of DXA assessments could have been avoided. QUS could not confidently identify individuals with osteoporosis.

Conclusions

QUS of the calcaneus confidently out ruled low BMD in individuals with axSpA, reducing the need for onward DXA referral by up to 27%. QUS is promising as a non-invasive triage tool in the assessment of osteoporosis in adults with axSpA.

Key Points

• Osteoporosis is common in axial spondyloarthropathy (SpA), but evaluation of bone health is suboptimal in this population.

• Quantitative ultrasound (QUS) of the calcaneus can out rule low bone mineral density in individuals with axial SpA, reducing the need for DXA assessment.

• QUS is a promising non-invasive triage tool in the assessment of bone health in axial SpA.

Nur mit Berechtigung zugänglich

Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, Burgos-Vargas R, Cheung PP, Collantes-Estevez E, Deodhar A, El-Zorkany B, Erdes S, Gu J, Hajjaj-Hassouni N, Kiltz U, Kim TH, Kishimoto M, Luo SF, Machado PM, Maksymowych WP, Maldonado-Cocco J, Marzo-Ortega H, Montecucco CM, Ozgocmen S, van Gaalen F, Dougados M (2016) Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis 75(6):1016–1023. https://doi.org/10.1136/annrheumdis-2015-208174 CrossRefPubMed

Pray C, Feroz NI, Nigil Haroon N (2017) Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis. Calcif Tissue Int 101(2):182–192. https://doi.org/10.1007/s00223-017-0274-3 CrossRefPubMed

Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156. https://doi.org/10.1007/s00586-008-0764-0 CrossRefPubMed

Bessant R, Harris C, Keat A (2003) Audit of the diagnosis, assessment, and treatment of osteoporosis in patients with ankylosing spondylitis. J Rheumatol 30(4):779–782PubMed

Fitzgerald G, Gallagher P, O'Shea F (2019) Multimorbidity is common in axial spondyloarthropathy and is associated with worse disease outcomes: results from the ASRI cohort. J Rheumatol. https://doi.org/10.3899/jrheum.181415 CrossRefPubMed

Shepherd JA, Schousboe JT, Broy SB, Engelke K, Leslie WD (2015) Executive summary of the 2015 ISCD position development conference on advanced measures from DXA and QCT: fracture prediction beyond BMD. J Clin Densitom 18(3):274–286. https://doi.org/10.1016/j.jocd.2015.06.013 CrossRefPubMed

European Commission (2018) The 2018 ageing report: economic and budgetary projections for the 28 EU member states (2016-2070). Brussels. https://doi.org/10.2765/615631

Chin KY, Ima-Nirwana S (2013) Calcaneal quantitative ultrasound as a determinant of bone health status: what properties of bone does it reflect? Int J Med Sci 10(12):1778–1783. https://doi.org/10.7150/ijms.6765 CrossRefPubMedPubMedCentral

Guglielmi G, de Terlizzi F (2009) Quantitative ultrasound in the assessment of osteoporosis. Eur J Radiol 71(3):425–431. https://doi.org/10.1016/j.ejrad.2008.04.060 CrossRefPubMed

10.

Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 international society for clinical densitometry position development conference on bone densitometry. J Clin Densitom 16(4):455–466. https://doi.org/10.1016/j.jocd.2013.08.004 CrossRefPubMed

11.

Thomsen K, Jepsen DB, Matzen L, Hermann AP, Masud T, Ryg J (2015) Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis? Osteoporos Int 26(5):1459–1475. https://doi.org/10.1007/s00198-014-3012-y CrossRefPubMed

12.

Meszaros S, Toth E, Ferencz V, Csupor E, Hosszu E, Horvath C (2007) Calcaneous quantitative ultrasound measurements predicts vertebral fractures in idiopathic male osteoporosis. Joint Bone Spine 74(1):79–84. https://doi.org/10.1016/j.jbspin.2006.04.008 CrossRefPubMed

13.

Gonnelli S, Cepollaro C, Gennari L, Montagnani A, Caffarelli C, Merlotti D, Rossi S, Cadirni A, Nuti R (2005) Quantitative ultrasound and dual-energy X-ray absorptiometry in the prediction of fragility fracture in men. Osteoporos Int 16(8):963–968. https://doi.org/10.1007/s00198-004-1771-6 CrossRefPubMed

14.

Speden DJ, Calin AI, Ring FJ, Bhalla AK (2002) Bone mineral density, calcaneal ultrasound, and bone turnover markers in women with ankylosing spondylitis. J Rheumatol 29(3):516–521PubMed

15.

Jansen TL, Aarts MH, Zanen S, Bruyn GA (2003) Risk assessment for osteoporosis by quantitative ultrasound of the heel in ankylosing spondylitis. Clin Exp Rheumatol 21(5):599–604PubMed

16.

Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B, Dougados M, Emery P, van der Horst-Bruinsma IE, Inman R, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Sturrock R, de Vlam K, Sieper J (2009) The development of assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 68(6):770–776. https://doi.org/10.1136/ard.2009.108217 CrossRefPubMed

17.

(1993) Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94(6):646–650

18.

Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS metrology index. J Rheumatol 21(9):1694–1698PubMed

19.

GE Healthcare (2011) Achilles InSight product data sheet. http://www3.gehealthcare.com.au/~/media/documents/us-global/products/bone-health/abstracts/quantitative%20ultrasound/achilles/gehealthcare-achilles-insight-productspec.pdf. Accessed 23 Nov 2017

20.

Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 21(12):2286–2291PubMed

21.

Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21(12):2281–2285PubMed

22.

Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, McKenna SP, Tennant A, van der Heijde D, Chamberlain MA (2003) Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 62(1):20–26CrossRefPubMedPubMedCentral

23.

Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford health assessment questionnaire. Arthritis Rheum 26(11):1346–1353CrossRefPubMed

24.

Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL (2005) Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 64(1):127–129. https://doi.org/10.1136/ard.2004.020503 CrossRefPubMed

25.

van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. a proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368CrossRefPubMed

26.

Miller PD, Njeh CF, Jankowski LG, Lenchik L (2002) What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis? J Clin Densitom 5(Suppl):S39–S45CrossRefPubMed

27.

Cryer JR, Otter SJ, Bowen CJ (2007) Use of quantitative ultrasound scans of the calcaneus to diagnose osteoporosis in patients with rheumatoid arthritis. J Am Podiatr Med Assoc 97(2):108–114CrossRefPubMed

28.

Clowes JA, Peel NF, Eastell R (2006) Device-specific thresholds to diagnose osteoporosis at the proximal femur: an approach to interpreting peripheral bone measurements in clinical practice. Osteoporos Int 17(9):1293–1302. https://doi.org/10.1007/s00198-006-0122-1 CrossRefPubMed

29.

Zha XY, Hu Y, Pang XN, Chang GL, Li L (2015) Diagnostic value of osteoporosis self-assessment tool for Asians (OSTA) and quantitative bone ultrasound (QUS) in detecting high-risk populations for osteoporosis among elderly Chinese men. J Bone Miner Metab 33(2):230–238. https://doi.org/10.1007/s00774-014-0587-5 CrossRefPubMed

30.

Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393(10169):364–376. https://doi.org/10.1016/s0140-6736(18)32112-3 CrossRefPubMed

31.

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381. https://doi.org/10.1007/s00198-014-2794-2 CrossRefPubMedPubMedCentral

Titel: Calcaneal quantitative ultrasound has a role in out ruling low bone mineral density in axial spondyloarthropathy
verfasst von: Gillian E. Fitzgerald
Tochukwu Anachebe
Kevin G. McCarroll
Finbar O’Shea
Publikationsdatum: 17.01.2020
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 6/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04876-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Objective

Method

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2020

Noninvasive positive pressure ventilator deteriorates the outcome of pneumomediastinum in anti-MDA5 antibody-positive clinically amyopathic dermatomyositis

Serum/plasma homocysteine levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Prevalence of Sjögren’s syndrome associated with rheumatoid arthritis in the USA: an observational study from the Corrona registry

New onset of axial spondyloarthropathy in patients treated with isotretinoin for acne vulgaris: incidence, follow-up, and MRI findings

Differences in musculoskeletal ultrasound findings between RS3PE syndrome and elderly-onset rheumatoid arthritis

No evidence of abnormal metabolic or inflammatory activity in the brains of patients with rheumatoid arthritis: results from a preliminary study using whole-brain magnetic resonance spectroscopic imaging (MRSI)