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Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis

Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis
Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis
Summary: The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time.

Introduction: The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture.

Methods: In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored.

Results:Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20–100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40–1.51) and SOS (1.42, 95 % CI 1.36–1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56–1.82) and 1.60 (95 % CI, 1.48–1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p?<?0.001). The predictive value of QUS was the same for men and women and for all ages (p?>?0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p?=?0.018 and p?=?0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42–1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27–1.46).

Conclusions: Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.
bone densitometry, bone ultrasound, fractures, meta-analysis, osteoporosis
0937-941X
1979-1987
McCloskey, E.V.
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Kanis, J.A.
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Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Bauer, D.
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Gonzalez-Macias, J.
1c441f12-35fd-412c-bd7d-60795954864c
Hans, D.
1986bda6-590a-40af-8f44-825462b7305e
Kaptoge, S.
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Krieg, M.A.
eb130083-1a1b-4e00-9ed3-e91f43830bb6
Kwok, T.
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Marin, F.
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Moayyeri, A.
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Orwoll, E.
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Gluer, C.
f426808d-c8c0-4b65-9e8d-d029ee021128
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
McCloskey, E.V.
38518227-db8f-4a53-88a6-462f469151de
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Bauer, D.
8c8b3580-430a-43d1-84cf-02e1c9e5c0bb
Gonzalez-Macias, J.
1c441f12-35fd-412c-bd7d-60795954864c
Hans, D.
1986bda6-590a-40af-8f44-825462b7305e
Kaptoge, S.
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Krieg, M.A.
eb130083-1a1b-4e00-9ed3-e91f43830bb6
Kwok, T.
01b9b35f-9d20-4af8-8298-0b5af0d197f3
Marin, F.
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Moayyeri, A.
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Orwoll, E.
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Gluer, C.
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Johansson, H.
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McCloskey, E.V., Kanis, J.A., Oden, A., Harvey, N.C., Bauer, D., Gonzalez-Macias, J., Hans, D., Kaptoge, S., Krieg, M.A., Kwok, T., Marin, F., Moayyeri, A., Orwoll, E., Gluer, C. and Johansson, H. (2015) Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis. Osteoporosis International, 26 (7), 1979-1987. (doi:10.1007/s00198-015-3072-7). (PMID:25690339)

Record type: Article

Abstract

Summary: The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time.

Introduction: The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture.

Methods: In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored.

Results:Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20–100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40–1.51) and SOS (1.42, 95 % CI 1.36–1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56–1.82) and 1.60 (95 % CI, 1.48–1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p?<?0.001). The predictive value of QUS was the same for men and women and for all ages (p?>?0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p?=?0.018 and p?=?0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42–1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27–1.46).

Conclusions: Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.

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More information

Accepted/In Press date: 6 February 2015
e-pub ahead of print date: 18 February 2015
Published date: July 2015
Keywords: bone densitometry, bone ultrasound, fractures, meta-analysis, osteoporosis
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 386956
URI: http://eprints.soton.ac.uk/id/eprint/386956
ISSN: 0937-941X
PURE UUID: 5ff29c73-d1fa-492b-a06a-972067f1aee3
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 05 Feb 2016 15:23
Last modified: 10 Dec 2019 01:45

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Contributors

Author: E.V. McCloskey
Author: J.A. Kanis
Author: A. Oden
Author: N.C. Harvey ORCID iD
Author: D. Bauer
Author: J. Gonzalez-Macias
Author: D. Hans
Author: S. Kaptoge
Author: M.A. Krieg
Author: T. Kwok
Author: F. Marin
Author: A. Moayyeri
Author: E. Orwoll
Author: C. Gluer
Author: H. Johansson

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