Does Combining the Results from Multiple Bone Sites Measured by a New Quantitative Ultrasound Device Improve Discrimination of Hip Fracture?

Abstract

There is a growing interest in the use of quantitative ultrasound (QUS) measurements as an alternative to current radiation-based bone densitometry techniques for the noninvasive assessment of fracture risk. While most of the commercialized ultrasound devices measure only single predefined peripheral skeletal sites, the Omnisense prototype (Sunlight Ltd., Israel) can be used on multiple bones, including the spinous processes. In this study, we examined the ability of speed of sound measured at the calcaneus, distal third and ultradistal radius, proximal third phalanx, metacarpal, capitate, patella, and the posterior process of the thoracic spine to differentiate subjects with hip fractures from normal controls. Seventy-nine postmenopausal Caucasian Israeli women who had sustained an atraumatic fracture of the proximal femur within the last 6 months were recruited from the local population (mean age 80 ± 8.9 years). As controls, 295 postmenopausal Caucasian Israeli women without osteoporotic fractures were also included (mean age 70 ± 8.7 years). Discrimination of hip fractures with QUS at all ultrasound sites was highly statistically significant (p < 0.01) (odds ratios [ORs] = 1.4-3.0; area under the ROC curve [AUC] 77-92%), except for the hand metacarpal. Distal radius and calcaneus measurements (ORs = 2.4 and 3.0) were the best discriminators of hip fracture patients from controls. Using a forward selective linear regression model, the discriminator values of combined assessment at two sites were investigated. There was moderate improvement in diagnostic value, but the best combination was the calcaneus with the distal radius, which improved the AUC by 3% and raised both the sensitivity and specificity to 94%. These data demonstrate the encouraging potential of improving discrimination of hip fracture by using multiple-site ultrasonic measurements. (J Bone Miner Res 1999;14:644-651)

Speed of sound in bone at the tibia: is it related to lower limb bone mineral density in spinal-cord-injured individuals?

“…6 Another study measured a broader range of sites and all were able to discriminate subjects with hip fracture from controls, although the tibia was not included among the sites measured. 16 Radius SOS was able to discriminate Colles' fracture cases from controls, however, the odds ratio was lower than for spine or hip BMD. 17 SOS at the radius has also been demonstrated to be able to discriminate between elderly women with hip fracture and age-matched controls.…”

“…6,15,16 However, the four measurement sites available with the multisite device (radius, phalanx, metatarsal and tibia) may not have the same ability to predict fracture. Unlike the other three sites, tibia SOS was not able to distinguish women with vertebral fracture from women without vertebral fracture.…”

The effects of bone therapy on tibial bone loss in young women with anorexia nervosa

“…How ever, most DXA machines are located near aca demic centers or major metropolitan areas. Furthermore, many recent studies using the Sun light omnisense bone sonometer (Sunlight Medi cal, Rehovot, Israel), which measures the tibial speed of sound (SOS), has been proven to be equally efficacious as DXA for assessing osteoporosis (Hans & Dargent-Molina, 1996;Hans, Srivastav, & Singal, 1999;Schott et al, 1995). SOS measurement has been found to be a more convenient and lower cost technology for mass screening of anorexic women in a primary care setting.…”

“…The mean coefficients of variation (CVs) in vivo were less than 1.4% for broadband ultrasound attenuation. It was not considered to significantly affect the reported date (Hans & Dargent-Molina, 1996;Hans et al, 1999;Schott et al, 1995). All SOS measurements were made by the same operator.…”

Ultrasound Wave Propagation in a Stochastic Cortical Bone Plate

“…This emitter and receiver configuration is typical one in ultrasonic axial transmission devices for characterizing the cortical layer of bone. When using the axial transmission technique, the earliest event or wavelet (also called by First Arriving Signal, FAS) of the multicomponent signal recorded at the receivers has been the most often investigated because it is considered as a relevant index of bone status [18,1,8]. In this work, the quantity of interest to be studied will be the FAS velocity.…”