nach oben

Archives of Osteoporosis

Erschienen in:

01.12.2020 | Original Article

The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study

verfasst von: Peter van den Berg, Dave H. Schweitzer, Paul M.M. van Haard, Piet P. Geusens, Joop P. van den Bergh

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Summary

A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF).

Introduction

Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds.

Patients and methods

In this cross-sectional study, 209 consecutive women of 50–70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm²)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA).

Results

Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer’s recommended P-EU threshold (DI 0.844 g/cm²) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm² resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)).

Conclusion

The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.

Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C, (IOF Fracture Working Group) (2013) Capture the Fracture®: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24(8):2135–2152. https://doi.org/10.1007/s00198-013-2348-zCrossRefPubMedPubMedCentral

Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, McLellan A, Stenmark J, Pierroz DD, Schneider MC, Kanis JA, Akesson K, Cooper C, IOF Fracture Working Group, EXCO (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int 26:2573–2578. https://doi.org/10.1007/s00198-015-3192-0CrossRefPubMed

Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27(10):2039–2046. https://doi.org/10.1002/jbmr.1698CrossRefPubMed

Hauger AV, Bergland A, Holvik K, Ståhle A, Emaus N, Strand BH (2018) Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study. Osteoporos Int 29(11):2447–2456. https://doi.org/10.1007/s00198-018-4653-zCrossRefPubMed

Bliuc D, Alarkawi D, Nguyen TV, Eisman JA, Center JR (2015) Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 30:637–646. https://doi.org/10.1002/jbmr.2393CrossRefPubMed

McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003 Dec) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14(12):1028–1034CrossRef

Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, Blauth M, Czerwinski E, da Silva J, Herrera A, Hoffmeyer P, Kvien T, Maalouf G, Marsh D, Puget J, Puhl W, Poor G, Rasch L, Roux C, Schüler S, Seriolo B, Tarantino U, van Geel T, Woolf A, Wyers C, Geusens P (2017 May) EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis 76(5):802–810. https://doi.org/10.1136/annrheumdis-2016-210289CrossRefPubMed

van den Berg P, Schweitzer DH, van Haard PMM, van den Bergh JP, Geusens PP (2015 Sep) Meeting international standards of secondary fracture prevention: a survey on Fracture Liaison Services in the Netherlands. Osteoporos Int 26(9):2257–2263. https://doi.org/10.1007/s00198-015-3117-yCrossRefPubMed

Eekman DA, van Helden SH, Huisman AM, Verhaar HJ, Bultink IE, Geusens PP, Lips P, Lems WF (2014 Feb) Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int 25(2):701–709. https://doi.org/10.1007/s00198-013-2481-8CrossRefPubMed

10.

Luc M, Corriveau H, Boire G, Filiatrault J, Beaulieu MC, Gaboury I (2018) Patient-related factors associated with adherence to recommendations made by a Fracture Liaison Service: a mixed-method prospective study. Int J Environ Res Public Health 15(5). https://doi.org/10.3390/ijerph15050944

11.

Giangregorio L, Thabane L, Cranney A, Adili A, deBeer J, Dolovich L, Adachi JD, Papaioannou A (2010) Osteoporosis knowledge among individuals with recent fragility fracture. Orthop Nurs 29(2):99–107. https://doi.org/10.1097/NOR.0b013e3181d2436cCrossRefPubMedPubMedCentral

12.

Grover ML, Edwards FD, Chang YH, Cook CB, Behrens MC, Dueck AC (2014) Fracture risk perception study: patient self-perceptions of bone health often disagree with calculated fracture risk. Womens Health Issues 24(1):e69–e75. https://doi.org/10.1016/j.whi.2013.11.007CrossRefPubMed

13.

Drew S, Judge A, Cooper C, Javaid MK, Farmer A, Gooberman-Hill R (2016) Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery. Osteoporos Int 27:1719–1727. https://doi.org/10.1007/s00198-015-3452-zCrossRefPubMedPubMedCentral

14.

Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA (2017 Mar) Imminent risk of fracture after fracture. Osteoporos Int 28(3):775–780. https://doi.org/10.1007/s00198-016-3868-0CrossRefPubMed

15.

van der Velde RY, Wyers CE, Geusens PPMM, van den Bergh JPW, de Vries F, Cooper C, van de Staa TP, Harvey NC (2018 Nov) Incidence of subsequent fractures in the UK between 1990 and 2012 among individuals 50 years or older. Osteoporos Int 29(11):2469–2475. https://doi.org/10.1007/s00198-018-4636-0CrossRefPubMedPubMedCentral

16.

Pisani P, Renna MD, Conversano Casciaro E, Muratore M, Quarta E, Paola MD, Casciaro S (2013) Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol 5(11):398–410. https://doi.org/10.4329/wjr.v5.i11.398CrossRefPubMedPubMedCentral

17.

Holmberg T, Bech M, Gram J, Hermann AP, Rubin KH, Brixen K (2016 Mar) Point-of-care phalangeal bone mineral density measurement can reduce the need of dual-energy X-ray absorptiometry scanning in Danish women at risk of fracture. Calcif Tissue Int 98(3):244–252. https://doi.org/10.1007/s00223-015-0084-4CrossRefPubMed

18.

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-yCrossRefPubMed

19.

Hans D, Baim S (2017) Quantitative ultrasound (QUS) in the management of osteoporosis and assessment of fracture risk. J Clin Densitom 20(3):322–333. https://doi.org/10.1016/j.jocd.2017.06.018CrossRefPubMed

20.

Karjalainen JP, Riekkinen O, Töyräs J, Hakulinen M, Kröger H, Rikkonen T, Salovaara K, Jurvelin JS (2012) Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 23:1287–1295. https://doi.org/10.1007/s00198-011-1682-2CrossRefPubMed

21.

Karjalainen JP, Riekkinen O, Töyräs J, Jurvelin JS, Kröger H (2016 Mar) New method for point-of-care osteoporosis screening and diagnostics. Osteoporos Int 27(3):971–977. https://doi.org/10.1007/s00198-015-3387-4CrossRefPubMed

22.

Schousboe JT, Riekkinen O, Karjalainen J (2017) Prediction of hip osteoporosis by DXA using a novel pulse-echo ultrasound device. Osteoporos Int 28:85–93. https://doi.org/10.1007/s00198-016-3722-4CrossRefPubMed

23.

Schneider J, Ramiandrisoa D, Armbrecht G, Ritter Z, Felsenberg D, Raum K, Minonzio JG (2019 May) In vivo measurements of cortical thickness and porosity at the proximal third of the tibia using guided waves: comparison with site-matched peripheral quantitative computed tomography and distal high-resolution peripheral quantitative computed tomography. Ultrasound Med Biol 45(5):1234–1242. https://doi.org/10.1016/j.ultrasmedbio.2019.01.008CrossRefPubMed

24.

van der Velde RY, Bours SPG, Wyers CE, Lems WF, Geusens PPMM, van den Bergh JPW (2017 Oct) Effect of implementation of guidelines on assessment and diagnosis of vertebral fractures in patients older than 50 years with a recent non-vertebral fracture. Osteoporos Int 28(10):3017–3022. https://doi.org/10.1007/s00198-017-4147-4CrossRefPubMedPubMedCentral

25.

Lötters FJ, van den Bergh JP, de Vries F, Rutten-van Mölken MP (2016) Current and future incidence and costs of osteoporosis-related fractures in the Netherlands: combining claims data with BMD measurements. Calcif Tissue Int 98(3):235–243. https://doi.org/10.1007/s00223-015-0089-zCrossRefPubMedPubMedCentral

26.

https://www.sheffield.ac.uk/FRAX/ Assessed 10-11-2019

27.

https://www.nice.org.uk/advice/mib106/resources/bindex-for-investigating-suspected-osteoporosis-pdf-2285963217659077 Assessed 10-11-2019

28.

Dutch Institute for Healthcare Improvement CBO (2011) Richtlijn Osteoporose en Fractuurpreventie. www.diliguide.nl/document/1015/file/pdf/. (Dutch) Assessed 14-02-2019

29.

Warriner A et al (2011) Minor, major, low-trauma, and high-trauma fractures: what are the subsequent fracture risks and how do they vary? Curr Osteoporos Rep 9(3):122–128. https://doi.org/10.1007/s11914-011-0064-1CrossRefPubMed

30.

Genant HK, Jergas M, Palermo L et al (2009) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996. https://doi.org/10.1002/jbmr.5650110716CrossRef

31.

Eneh CT, Malo MK, Karjalainen JP, Liukkonen J, Töyräs J, Jurvelin JS (2016) Effect of porosity, tissue density, and mechanical properties on radial sound speed in human cortical bone. Med Phys 43(5):2030. https://doi.org/10.1118/1.4942808CrossRefPubMed

32.

Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8(1):23–34CrossRef

33.

R Development Core Team (version 3.5.2; 2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.R-project.org/. Accessesd 2 Nov 2019

34.

DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRef

35.

Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35. https://doi.org/10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3

36.

van den Berg P, van Haard PMM, Geusens PP, van den Bergh JP, Schweitzer DH (2019) Challenges and opportunities to improve fracture liaison service attendance: fracture registration and patient characteristics and motivations. Osteoporos Int 30:1597–1606. https://doi.org/10.1007/s00198-019-05016-4CrossRefPubMed

Titel: The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study
verfasst von: Peter van den Berg
Dave H. Schweitzer
Paul M.M. van Haard
Piet P. Geusens
Joop P. van den Bergh
Publikationsdatum: 01.12.2020
Verlag: Springer London
Erschienen in: Archives of Osteoporosis / Ausgabe 1/2020
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-020-00730-7

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Springer Medizin

The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study

Abstract

Summary

Introduction

Patients and methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Summary

Introduction

Patients and methods

Results

Conclusion

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

Weitere Artikel der Ausgabe 1/2020

Association of bone mineral density with the development of knee osteoarthritis in men and women: a cross-sectional study using the fourth and fifth Korea National Health and Nutrition Examination Surveys

Did changes to recommended testing criteria affect the rate of vitamin D testing among Australian women

Distal radius bone microarchitecture: what are the differences between age 25 and old age?

Comparison of hip subregion bone mineral density to the type of proximal femur fracture

Estimated epidemiology of osteoporosis diagnoses and osteoporosis-related high fracture risk in Germany: a German claims data analysis

Outcome of osteoporosis evaluation, treatment, and follow-up in patients referred to a specialized outpatient clinic compared to patients in care of general practitioners

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Update Orthopädie und Unfallchirurgie