Discordance between quantitative ultrasound and dual-energy X-ray absorptiometry in bone mineral density: The Vietnam Osteoporosis Study

Abstract

Objectives Calcaneal quantitative ultrasound measurement (QUS) has been considered an alternative to dual-energy X-ray absorptiometry (DXA) based bone mineral density (BMD) for assessing bone health. This study sought to examine the utility of QUS as an osteoporosis screening tool by evaluating the correlation between QUS and DXA. Methods The study was a part of the Vietnam Osteoporosis Study that involved 1270 women and 773 men aged 18 years and older. BMD at the femoral neck, total hip and lumbar spine was measured using DXA. Osteoporosis was diagnosed based on the femoral neck T-score using World Health Organization criteria. Broadband ultrasound attenuation (BUA) at the calcaneus was measured by QUS. The concordance between BUA and BMD was analyzed by the linear regression model. Results In all individuals, BUA modestly correlated with femoral neck BMD (r = 0.35; P < 0.0001) and lumbar spine BMD (r = 0.34; P < 0.0001) in both men and women. In individuals aged 50 years and older, approximately 16% (n = 92/575) of women and 3.2% (n = 10/314) of men were diagnosed to have osteoporosis. Only 0.9% (n = 5/575) women and 1.0% (n = 3/314) men were classified as “Low BUA”. The kappa coefficient of concordance between BMD and BUA classification was 0.09 (95% CI, 0.04 to 0.15) for women and 0.12 (95% CI, 0.03 to 0.22) for men. Conclusions In this population-based study, QUS BUA modestly correlated with DXA BMD, suggesting that BUA is not a reliable method for screening of osteoporosis.

Evaluation of community-based screening tools for the early screening of osteoporosis in postmenopausal Vietnamese women

“…GDP per capita was 2,715 USD in 2019 [ 12 ]. The prevalence of osteoporosis in Vietnam varies from 14% to 16% between studies [ 13 – 15 ] and is increasing [ 14 ]. In line with global population aging, the proportion of over-50s in Vietnam has risen over the past decade and this is expected to increase further the prevalence of osteoporosis.…”

Portable Bone Imaging Devices for Screening and Diagnosing Osteoporosis

“…[2][3][4] Fragility fractures can be devastating, with downstream outcomes including significant morbidity and even mortality. 5,6 Hip fracture, for instance, carries a high risk of mortality, with estimates comparing the risk of death to that of breast cancer. 5 Other estimates indicate that as many as 40% of people who suffer a hip fracture die within 1 year.…”

“…5,6 Hip fracture, for instance, carries a high risk of mortality, with estimates comparing the risk of death to that of breast cancer. 5 Other estimates indicate that as many as 40% of people who suffer a hip fracture die within 1 year. 2,7 These deleterious effects of osteoporosis have a significant impact on older populations, communities and the health systems that serve them, with major costs presenting a significant burden to health systems.…”

“…3 Osteoporosis is defined as a bone mineral density (BMD) T-score of equal-to or less-than 2.5 standard deviations below that of a healthy, young reference population. 5,8 Dual-energy X-ray absorptiometry (DXA) is the most commonly used measure of BMD and is considered to be the gold standard diagnostic approach. 1 Nonetheless, DXA is often neither available nor accessible in many resource-constrained areas throughout the world, making access to screening and diagnostic services for osteoporosis a challenge for the aging population across the globe.…”

What is normal bone health? A bioarchaeological perspective on meaningful measures and interpretations of bone strength, loss, and aging

“…This has recently started to change with the ability to use state‐of‐the‐art 3D imaging such as volumetric QCT (vQCT), high‐resolution CT (hrCT), high‐resolution MR (hrMR) (Abel et al, 2013; Brandi, 2009), and high‐resolution peripheral quantitative computed tomography (HR‐pQCT) (Boutroy et al, 2005; Whittier et al, 2020) in the clinical setting. Tools such as quantitative ultrasonography (qUS) also offer a portable alternative to absorptiometry that allows the assessment of bone quality along with bone density in remote settings such as rural populations (Knapp, 2009; Lee et al, 2021; Madimenos et al, 2011; Stieglitz et al, 2016), although there has been some question of the correlation of qUS measures with absorptiometric measures of BMD (Faulkner et al, 1994; Nguyen et al, 2021). While these newer noninvasive clinical methods do not account for all aspects of bone tissue material changes with age, they do promise more accurate assessments of fracture risk for individual patients and assessment of “whole bone strength” (Currey, 2001; Sievänen et al, 2007).…”