International Studies Show That
Ultrasound Bone Density Testing is a Reliable Technique to Assess Fracture Risk
Due to Osteoporosis
Bone Ultrasonometry has been
extensively evaluated in Australia, USA and Europe and is found to be a
reliable technique to assess fracture risk due to osteoprosis. The American FDA
(Federal Drug Authority) the strictest authority in the USA has approved 5
different ultrasound instruments for the routine diagnosis of osteoporosis,
determination of fracture risk and monitoring bone changes.
Large prospective studies published in premier scientific journals by eminent
international researchers concerned with osteoporosis confirm strong fracture
prediction capacity. Doctors can with confidence initiate treatment regimes for
their patients. Doctors can use the results, along with information about
family history, diet, age, stage of menopause and other risk factors to
determine the need for further investigation and management.
Modern science now enables us to determine risk before we break a bone.
Ultrasound to measure bone density is radiation free, inexpensive and easily
accessible therefore provides the opportunity to bring prevention of
osteoporosis by early detection of risk to the forefront of the community.
For more than 10 years Results of large scale studies published in premier international medical journals show that QUS ultrasound is a reliable and effective method to assist in assessing risk of bone fracture.
Journal of Bone and Mineral Research, July 2006:21:1126-1135 (doi: 10.1359/jmbr.060417)
RELATIONSHIP BETWEEN BONE QUATITATIVE ULTRASOUND AND FRACTURES: A META-ANALYSIS
Fernado Marin, Jesus Gonzalez-Marcias, Adlolfo Diez-Perez et al Spain
The relationship between bone QUS and fracture risk was estimated in a systematic review of data from 14 prospective studies of 47,300 individuals and 2350 incident fractures. In older women, low QUS values were associated with overall fracture risk, low trauma fractures, and with hip, forearm and humerus fractures separately.
Conclusions: Measurements of bone QUS are significantly associated with nonspinal fracture risk in older women in a similar degree to DXA. QUS may be a valid alternative to evaluate fracture risk.
Journal of Bone and Mineral Research, March 2006:21:413-418 (doi: 10.1359/JBMR.051205)
Long-Term Fracture Prediction by DXA & QUS: 10-Year Prospective Study
Alison Stewart, Vinod Kumar, David M Reid Osteoporosis Research Unit, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom.
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 QUS can predict independently of BMD.
Introduction: There are now many treatments available for prevention of osteoporotic fracture. To be cost-effective, we need to target those most at risk. This study examines the ability of DXA and QUS to predict fractures in an early postmenopausal population of women.
Materials and Methods: We prospectively measured 3883 women who had been randomly selected from a community-based register. At baseline, they were measured using DXA of spine and hip (Norland XR-26) and QUS of the heel (Walker Sonix UBA 575). Follow-up had a mean of 9.7 ± 1.1 (SD) years. All incident
fractures were identified and validated by examination of X-ray reports, and these were compared with those without fracture in a Cox-regression model to calculate hazard ratios (HRs).
Results: We found adjusted HRs for any fracture per 1 SD reduction in spine BMD to be 1.61 (1.42-1.83), whereas neck of femur BMD was 1.54 (1.34-1.75). Areas under the curve (AUC) for a receiver operator characteristic (ROC) analysis were 0.62 for spine BMD and 0.59 for neck BMD. In a subgroup where QUS was also measured, the HR for a 1 SD reduction in BMD was 1.69 (1.29-2.22) for spine BMD and 1.55 (1.17-2.06) for neck BMD. The HR for a 1 SD reduction in broadband ultrasound attenuation (BUA) was 1.53 (1.19-1.96), and 1.44 (1.12-1.86) when further adjusted for neck BMD. The AUCs were 0.63 for spine BMD, 0.59 for neck BMD, and 0.62 for BUA. When only osteoporotic fractures were examined, the HRs increased in all situations. BUA showed the highest HR of 2.25 (1.51-3.34), and when further adjusted for neck BMD was 2.12 (1.38-3.28).
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.
US National Library of Medicine National Institute
of Health (PubMed.com)
Cost effectiveness of ultrasound and bone
densitometry for osteoporosis screening in post-menopausal women.
Mueller D, Gandjour A.
Source Institute of Health Economics and Clinical
Epidemiology, University of Cologne, Cologne, Germany. firstname.lastname@example.org
BACKGROUND: According to a new German guideline, decisions about bisphosphonate treatment for post-menopausal women should be based on 10-year fracture risk, and bone density should be measured by dual x-ray absorptiometry (DXA). Recently, there has been growing interest in quantitative ultrasound (QUS) as a less expensive screening alternative.
OBJECTIVE: To determine the cost effectiveness of osteoporosis screening with QUS as a pre-test for DXA and treatment with alendronate compared with (i) immediate access to DXA and (ii) no screening in women of the general population aged 50-90 years in Germany.
METHODS: A cost-utility analysis and a budget impact analysis were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length was used to simulate costs and benefits (QALYs), discounted at 3% per annum, over a lifetime. The number of women correctly diagnosed by QUS and DXA as being above a 10-year risk of > or =30% was estimated for different age groups (50-60, 60-70, 70-80 and 80-90 years, respectively). The robustness of the results was tested by a probabilistic Monte Carlo simulation.
RESULTS: Compared with no screening, the cost effectiveness of QUS plus DXA was found to be Euro 3529, Euro 9983, Euro 4382 and Euro 1987 per QALY for 50-, 60-, 70- and 80-year-old women, respectively (year 2006 values). This screening strategy results in annual costs of Euro 96 million or 0.07% of the SHI's annual budget. The cost effectiveness of DXA alone compared with DXA plus QUS is Euro 5331, Euro 60, 804, Euro 14, 943 and Euro 3654 per QALY for 50-, 60-, 70- and 80-year-old women, respectively. DXA alone results in a higher number of QALYs in all age groups. The results were robust in the sensitivity analysis.
CONCLUSION: Compared with no screening, the cost effectiveness of QUS and DXA in sequence is very favourable in all age groups. However, direct access to DXA is also a cost-effective option, as it increases the number of QALYs at an acceptable cost compared with pre-testing by QUS (except for women aged 60-70 years). Therefore, QUS as a pre-test for DXA can be clearly recommended only in women aged 60-70 years. For the other age groups, the cost effectiveness of QUS as a pre-test depends on the global budget constraint and the accessibility of DXA.
[PubMed - indexed for MEDLINE]