Comparison of calcaneal quantitative ultrasound and bone densitometry parameters as fracture risk predictors in type 2 diabetes mellitus

Abstract

Aim To investigate the utility of calcaneal quantitative ultrasound compared with bone densitometry (DXA) in predicting incident low-trauma fracture in type 2 diabetes. Methods This retrospective cohort study included a subset of participants in the Dubbo Osteoporosis Epidemiology Study who had concurrent calcaneal quantitative ultrasound and DXA measurement, comprising 809 people without type 2 diabetes and 96 with type 2 diabetes. Fracture data had been collected prospectively. Cox proportional hazard models and receiver operating curves (ROC) were used to compare calcaneal quantitative ultrasound and DXA parameters as predictors for any low-trauma fracture. Results The median age of participants was 71 years (IQR 68-76, 50% men) for those without type 2 diabetes and 70 years (IQR 68-76, 55% men) for those with type 2 diabetes. There was no difference in low-trauma fracture incidence between groups when stratified by sex. In those without type 2 diabetes, the hazard ratio for fracture per 1 SD decrease in broadband ultrasound attenuation and femoral neck bone mineral density (BMD) was 1.47 [95% confidence interval (CI) 1.26-1.71] and 1.39 (95% CI 1.17-1.64), respectively. The corresponding figures in type 2 diabetes were 1.81 (95% CI 1.03-3.19) for broadband ultrasound attenuation and 2.55 (95% CI 1.28-5.08) for femoral neck BMD. Conclusion Broadband ultrasound attenuation is comparable with femoral neck BMD as a predictor for low trauma incident fracture in type 2 diabetes. Calcaneal quantitative ultrasound offers several advantages over DXA and should be considered in further studies of bone health screening or in clinical practice where DXA is unavailable.

Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus

“…We have previously proposed that QUS may have utility in bone health screening [ 13 ]; however, this data now suggests one would need to simultaneously screen for peripheral neuropathy. Peripheral measures of bone health are less likely to be representative of general bone health when peripheral neuropathy is present.…”

“…In this case, central DXA may be more relevant. While we have previously shown that QUS is predictive of any low trauma fracture in T2DM [ 13 ], specific relevance to foot fracture and Charcot foot prediction would require further evaluation. Of interest, if QUS could be used to identify those at greatest risk of Charcot foot prior to its onset, there may be opportunity for preventative action.…”

“…In contrast, calcaneal quantitative ultrasound (QUS) is specifically designed to measure bone health at the heel and is portable, affordable and easy to use [ 12 ]. Utility for fracture risk prediction in T2DM is comparable to bone densitometry, and therefore this tool has potential application in screening [ 13 ]. Vibration perception threshold (VPT) is widely recommended in screening for clinically relevant diabetes-related peripheral neuropathy [ 14 , 15 ].…”

Portable Bone Imaging Devices for Screening and Diagnosing Osteoporosis

“…The 3 NRS used prospective cohort designs over a long-term duration of follow-up; that is, 20 years 18 5 years, 19 and over 20 years, 20 respectively. All 3 studies used both a portable bone imaging device and DXA to measure bone properties in each study participant and compare clinical utility across follow-up.…”

Imaging techniques to study diabetic bone disease

“…Other more complex QUS parameters include stiffness index, amplitude-dependent speed of sound, and bone transmission time. Although QUS parameters have shown correlations with aBMD [44,45] and bone microstructure [46], associations with risk of fracture [47], and even comparable predictive capabilities as femoral neck aBMD for low trauma incident fracture in T2D [48], the clinical utility of QUS is still limited as a prescreening tool mainly due to standardization issues between different manufacturers.…”