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Quantitative Heel Ultrasound Exam May Predict Osteoporotic Fracture Risk in Elderly Women

An ultrasound exam of the heel may be able to predict if a woman is at heightened risk for fracture due to osteoporosis, reveals a 3-year prospective multicenter study published in the July 2008 issue of the journal Radiology.

Along with four clinical risk factors for the incidence of osteoporotic fracture, radiation-free ultrasound of the heel may be used to better select women who need further bone density testing, such as a dual-energy x-ray absorptiometry (DXA) exam.

“Osteoporosis is a major public health issue expected to increase in association with worldwide ageing of the population,” writes lead author Idris Guessous, M.D., senior research fellow in the Department of Internal Medicine at the Lausanne University Hospital in Switzerland.

“The incidence of osteoporosis will outpace economic resources, and the development of strategies to better identify women who need to be tested is crucial.”

Osteoporosis is a disease that is characterized by low bone mass and the deterioration of bone tissue.

“Patients with osteoporosis are not optimally treated because of a lack of general awareness,” Dr. Guessous writes.

“A simple prediction rule might be a useful clinical tool for healthcare providers to optimize osteoporosis screening.”

In this study, 6174 women aged 70 to 85 with no previous formal diagnosis of osteoporosis are screened with heel-bone quantitative ultrasound (QUS). QUS is used to calculate the stiffness index at the heel, an indicator of bone strength.

The researchers used five risk factors - older age, low heel QUS stiffness index, history of fracture, recent fall and a failed chair test - to develop a predictive rule for identifying elderly women at risk for osteoporotic fractures. A chair test is a test in which participants were asked to rise from a chair three times in quick succession without using their arms for balance.

Osteoporotic Fracture Risk in Elderly Women The results revealed that 1,464 women (23.7%) were at lower risk and 4,710 (76.3%) were at higher risk for osteoporotic fracture. The women were then followed for three years. “Among the higher-risk women, 6.1% had an osteoporotic fracture, versus 1.8% of women at lower risk,” report Dr. Guessous and colleagues.

“Among the women who had a hip fracture, 90% were in the higher-risk group.”

“Facture risk is not just related to the strength of your bones,” writes Dr. Guessous.

“It is also determined by risk of falling, but this risk is often overlooked by clinicians.”

The results showed that heel QUS is not only effective in identifying high-risk patients who should receive further testing, but it may also be helpful in identifying patients for whom further testing can be avoided.

“Heel QUS in conjunction with clinical risk factors can be used to identify a population at a very low fracture probability in which no further diagnostic evaluation may be necessary,” writes Dr. Guessous.

Source: Guessous I, et al. Osteoporotic fracture risk in elderly women: Estimation with quantitative heel US and clinical risk factors. Radiology 2008; 248: 179-184; Boyles S. New Test for Osteoporosis Fracture Risk. Heel Ultrasound Could Be Alternative to X-Ray Bone Density Testing for Some Patients. WebMD Health News 2008, June 24.