To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women ≥70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not.Introduction: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. Materials and Methods:The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women Ն70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. Results: From the 7609 women who were included in the study, 7062 women 75.2 ± 3.1 (SD) years of age were prospectively followed for 2.9 ± 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). Conclusions: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Bone ultrasound measures (QUSs) can assess fracture risk in the elderly. We compared three QUSs and their association with nonvertebral fracture history in 7562 Swiss women 70 -80 years of age. The association between nonvertebral fracture was higher for heel than phalangeal QUS.Introduction: Because of the high morbidity and mortality associated with osteoporotic fractures, it is essential to detect subjects at risk for such fractures with screening methods. Because quantitative bone ultrasound (QUS) discriminated subjects with osteoporotic fractures from controls in several cross-sectional studies and predicted fractures in prospective studies, QUS could be more practical than DXA for screening. Material and Methods:This cross-sectional and retrospective multicenter (10 centers) study was performed to compare three QUSs (two heel ultrasounds: Achillesϩ [GE-Lunar] and Sahara [Hologic]; the phalanges: ultrasound DBM sonic 1200 [IGEA]) for determining by logistic regression nonvertebral fracture odds ratio (OR) in a sample of 7562 Swiss women, 75.3 Ϯ 3.1 years of age. The two heel QUSs measured the broadband ultrasound attenuation (BUA) and the speed of sound (SOS). In addition, Achillesϩ calculated the stiffness index (SI) and the Sahara calculated the quantitative ultrasound index (QUI) from BUA and SOS. The DBM sonic 1200 measured the amplitude-dependent SOS (AD-SOS). Results: Eighty-six women had a history of atraumatic hip fracture after the age of 50, 1594 had a history of forearm fracture, and 2016 had other nonvertebral fractures. No fracture history was reported by 3866 women. Discrimination for hip fracture was higher than for the other nonvertebral fractures. The two heel QUSs had a significantly higher discrimination power than the QUSs of the phalanges, with standardized ORs, adjusted for age and body mass index, ranging from 2.1 to 2.7 (95% CI ϭ 1.6, 3.5) compared with 1.4 (95% CI ϭ 1.1, 1.7) for the AD-SOS of DBM sonic 1200. Conclusion: This study showed a high association between heel QUS and hip fracture history in elderly Swiss women. This could justify integration of QUS among screening strategies for identifying elderly women at risk for osteoporotic fractures.

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Our data suggest that wide interindividual variation and the failure to provide a separate measure of trabecular bone density account for the conflicting evidence in earlier reports. Serum osteocalcin concentration during the first trimester distinguishes between fast and slow losers of trabecular bone and should be evaluated in future studies as predictor for later bone loss (osteoporosis).

Objective To study the annual change of bone mass in women aged 30-45 years being treated with depot medroxyprogesterone acetate (DMPA) in order to evaluate whether the bone mass depends on the duration of DMPA use or the oestradiol level.Design Prospective longitudinal study over an interval of 12 months.Setting A family planning centre of a university hospital.Patients Thirty-six current users of DMPA.Interventions Injection of 150 mg DMPA every 12 weeks.Measurements Bone mass was measured at the distal radius by peripheral quantitative computed tomography (reproducibility 0.3%).Results Mean annual changes (SD) in trabecular and cortical bone mass were 0.06 (1.6%) [P = 0.81 and -0.26% (0-6) [ P < 0.041. The decrease in cortical bone mass was not significant because the changes were within the precision error of the method used for the measurements. Duration of DMPA use and oestradiol levels were not associated to the bone parameters.Conclusion We did not find a negative impact of DMPA on the bone mass of premenopausal women aged 30-45 years.

Abstract. The aim of this study was to evaluate whether fast trabecular bone loss in osteoporotic and osteopenic patients can effectively be treated with active vitamin D metabolites. Thirty-one osteoporotic and osteopenic patients were monitored between 4 and 22 months before and between 8 and 18 months during the treatment. Fast bone losers were designated as osteoporotic or osteopenic patients with a loss of trabecular bone density in the radius of 3% or more calculated for 1 year. For this differentiation, the high precise peripheral quantitative computed tomography system (DENSISCAN 1000) was used (reproducability 0.3% in mixed collectives). The pretreatment loss and the "gain" under treatment with active vitamin D metabolites was calculated for 1 year. The treatment consisted of either 0.5 flg calcitriol daily or 1 flg of alfacalcidol daily. Before treatment, the trabecular bone loss in the radius/year was -6.6 ± 0.5% (mean ± SEM). After treatment with vitamin D metabolites, the trabecular bone gain in the radius/year was 0.01 ± 0.6% (mean ± SEM). The difference was highly significant (P < 0.001). In contrast to this, the loss of cortical bone density before treatment was -1.8 ± 0.3% (mean ± SEM) and the reduced loss after treatment -0.2 ± 0.4% (mean ± SEM), both values calculated for I year. This difference was less significant (P < 0.05). This study shows that the treatment with active vitamin D metabolites is very effective in slowing fast trabecular bone loss in osteoporotic and osteopenic patients.Key words: Fast bone loss -Osteoporosis -Quantitative computed tomography -Calcitriol -Alfacalcidol.In postmenopausal and senile osteoporosis, reduced calcium absorption is often reported. Pathophysiologically, a disorder in the vitamin D metabolism as cause can be postulated, although it is of a different character. For both groups a lower concentration of 1,25(OHhD 3 in the serum, a decrease of the amount of 1,25(OHhD3 receptors, and a disorder of the active calcium absorption in the intestine is known. For the postmenopausal osteoporosis there is a low parathyroid hormone (PTH) level and an additional deficit in the activation of the PTH-induced 1,25(OHhD3 synthesis. For the senile osteoporosis, in addition to the above, there is a lack of vitamin D uptake and an increase in the Vitamin D metabolites have proved to be effective in preventing osteoporosis by increasing low mineral density [2] and decreasing fracture rates [3][4][5] while showing a low toxicity; the incidence of hypercalcemia is <1 % [6]. The prevention of bone loss has been shown to be due to restoration to a positive calcium balance due to a correction of calcium malabsorption [7]. Furthermore, it has been reported that treatment with alfacalcidol improves the myopathy associated with the bone loss of aging [8] and should reduce the tendency to fall and the risk of osteoporotic fractures.Until now anabolic substances like fluorides were used for the tailored treatment of osteoporosis in slow bone losers (loss of trabecular bone density in...

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