Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2008 Sep 30;39(12):655–659. [Article in Spanish] doi: 10.1157/13113959

Valor predictivo de la densitometría por ultrasonidos como método de cribado selectivo de la osteoporosis en atención primaria☆

Predictive value of ultrasound densitometry as a method of selective screening for osteoporosis in primary care

Eunate Arana-Arri a,⁎, Iñaki Gutiérrez Ibarluzea b, Amaia Ecenarro Mugaguren c, José Asua Batarrita b
PMCID: PMC7664762  PMID: 18093504

Abstract

Objective

To determine the cut-off point of calcaneous quantitative ultrasound densitometry (QUS) as a selection method in primary care for referral of postmenopausal women for dual energy x-ray absorptiometry (DXA).

Design

Diagnostic techniques trial.

Setting

Four general practices in the Basque Country Autonomous Region, Spain.

Participants

Randomly selected Caucasian women older than 45, chosen at random. A sample size of 146 women was used.

Interventions

Calcaneous ultra sound bone mineral density (BMD) measurement, using Achilles Express® and DXA.

Principal measurements

T-score BMD measurement on both devices. The sensitivity, specificity and positive predictive values of QUS and finally the ideal cut-off value were calculated.

Results

The mean age of the sample was 58.2 (17.7) (range, 48-83 years old). The prevalence of women with osteoporosis, osteopaenia and normal DXA was 14.1%, 50.4% and 35.5%, respectively. The estimated sensitivity of QUS was 78.9% (56.7-91.5) and the specificity was 64.7% (55.6-72.8). The negative predictive value (NPV) was 94.9% (87.7-98.0) and the positive predictive value (PPV) was 26.8% (17.0-39.6). After the COR curve analysis, the ideal cut-off for QUS was determined as a T-score ≤ −2.0.

Conclusions

Given its high NPV, QUS can be considered a useful device for screening before DXA. Its low PPV means it has to be combined with other complementary or substitutive selective screening methods, such as predictive rules, which should be evaluated in each specific use.

Key words: Postmenopausal osteoporosis, Screening, Ultrasounds, Bone densitometry, Primary care

Footnotes

☆

Resultados parciales se presentaron en forma de comunicación oral en el XXIV Congreso Nacional de Medicina Familiar y Comunitaria, celebrado en Sevilla del 8 al 11 de diciembre de 2004.

Bibliografía

  • 1.Walter-Bone K., Dennison E., Cooper C. Epidemiology of osteoporosis. Rheum Dis Clin North Am. 2001;27:1–18. doi: 10.1016/s0889-857x(05)70185-x. [DOI] [PubMed] [Google Scholar]
  • 2.Díaz-Curiel M., García J.J., Carrasco J.L., Honorato J., Pérez R., Rapado A. Prevalencia de osteoporosis determinada por densitometría en la población femenina española. Med Clin (Barc) 2001;116:86–88. doi: 10.1016/s0025-7753(01)71732-0. [DOI] [PubMed] [Google Scholar]
  • 3.Millar P.D., Zapalowski C., Julak C.A.M., Bilezikian J.P. Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol. 1999;84:1867–1871. doi: 10.1210/jcem.84.6.5710. [DOI] [PubMed] [Google Scholar]
  • 4.Grupo de trabajo de menopausia y postmenopausia. Guía de práctica clínica sobre la menopausia y postmenopausia. Barcelona: Sociedad Española de Ginecología y Obstetricia, Asociación Española para el Estudio de la Menopausia, Sociedad Española de Medicina de Familia y Comunitaria y Centro Cochrane Iberoamericano; 2004.
  • 5.Guglielmi G., Gluer C.C., Majumdar S., Blunt B.A., Genant H.K. Current methods and advances in bone densitometry. Eur Radiol. 1995;5:129–139. [PubMed] [Google Scholar]
  • 6.Blake G.M., Fogelman I. Bone densiometry and the diagnosis of osteoporosis. Semin Nucl Med. 2001;31:69–81. doi: 10.1053/snuc.2001.18749. [DOI] [PubMed] [Google Scholar]
  • 7.Report of the WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: WHO Technical Report Series 843.World Health Organization; 1994. [PubMed]
  • 8.Glüer C.C., Eastell R., Reid D.M., Felsenberg D., Roux C., Barkman R. Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS Study. J Bone Miner Res. 2004;19:782–793. doi: 10.1359/JBMR.040304. [DOI] [PubMed] [Google Scholar]
  • 9.Sim M.F., Stone M.D., Phillips C.J., Cheung W.Y., Johansen A., Vasishta S. Cost effectiveness analysis of using quantitative ultrasound as a selective pre-screen for bone densitometry. Technol Health Care. 2005;13:75–85. [PubMed] [Google Scholar]
  • 10.Frost M.L., Blake G.M., Fogelman I. Can the WHO criteria for diagnosing osteoporosis be applied to calcaneal quantitative ultrasound? Osteoporos Int. 2000;11:321–330. doi: 10.1007/s001980070121. [DOI] [PubMed] [Google Scholar]
  • 11.Damilakis J., Perisinakis K., Gourtsoyiannis N. Imaging ultrasonometry of the calcaneus: optimum T-score thresholds for the identification of osteoporotic subjects. Calcif Tissue Int. 2001;68:219–224. doi: 10.1007/s002230020014. [DOI] [PubMed] [Google Scholar]
  • 12.Homik J., Hailey D. Alberta Heritage Foundation for Medical Research; Edmonton: 1998. Quantitative ultrasound for bone density measurement. October. [Google Scholar]
  • 13.Cynthia D.M., Dale F.K., Susan M., Nancy C., Peggy M.N., Mark H. Osteoporosis in postmenopausal women: diagnosis and monitoring. AHRQ. 2001;(N. ° 28) [Google Scholar]
  • 14.CCOHTA . Canadian Coordinating Office for Health Technology Assessment; 2003. Bone mineral density screening. N.° 8. [Google Scholar]
  • 15.Estrada MD, Ferrer A, Borrás A, Benítez D, Espallargues M. Guía para la indicación de la densitometría ósea en la valoración del riesgo de fractura y en el control evolutivo de la osteoporosis. Actualización diciembre 2004. Barcelona: Agència d’Avaluació de Tecnologia Mèdica. CatSalut. Departament de Salut. Generalitat de Catalunya; 2006.
  • 16.Weiss M., Ben-Shlomo A., Hagag P., Rapoport M. Referent database for bone speed of sound measurements by a novel quantitative multi-site ultrasound device. Osteopros Int. 2000;11:688–696. doi: 10.1007/s001980070067. [DOI] [PubMed] [Google Scholar]
  • 17.Sosa Henríquez M., Saavedra Santana P., Alegre López J., Gómez Alonso C., González Macias J., Guanabens Gay N. Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO. Rev Clin Esp. 2003;203:329–333. doi: 10.1157/13047946. [DOI] [PubMed] [Google Scholar]
  • 18.Bauer D.C., Gluer C.C., Cauley J.A., Vogt T.M., Ensrud K.E., Genant H.K. Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older woman. A prospective study. Study of Osteoporotic Fractures Research Group. Arch Int Med. 1997;157:629–634. [PubMed] [Google Scholar]
  • 19.Hans D., Dargent-Molina P., Schott A.M., Sebert J.L., Cormier C., Kotzki P.O. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet. 1996;348:511–514. doi: 10.1016/s0140-6736(95)11456-4. [DOI] [PubMed] [Google Scholar]
  • 20.Hodson J., Marsh J. Quantitative ultrasound and risk factor enquiry as predictors of postmenopausal osteoporosis: comparative study in primary care. BMJ. 2003;326:1250–1251. doi: 10.1136/bmj.326.7401.1250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Kung A.W., Luk K.D., Chu L.W., Tang G.W. Quantitative ultrasound and symptomatic vertebral fracture risk in Chinese women. Osteoporos Int. 1999;10:456–461. doi: 10.1007/s001980050254. [DOI] [PubMed] [Google Scholar]
  • 22.Reyes B.J., Moreno O.J. Prevalencia de osteopenia y osteoporosis en mujeres posmenopáusicas. Aten Primaria. 2005;35:342–345. doi: 10.1157/13074306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Cadarette S.M., Jaglal S.B., Kreiger N., McIsaac W.J., Darlington G.A., Tu J.V. Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162:1289–1294. [PMC free article] [PubMed] [Google Scholar]
  • 24.Kung A.W., Ho A.Y., Sedrine W.B., Reginster J.Y., Ross P.D. Comparison of a simple clinical risk index and quantitative bone ultrasound for identifying women at increased risk of osteoporosis. Osteoporos Int. 2003;14:716–721. doi: 10.1007/s00198-003-1428-x. [DOI] [PubMed] [Google Scholar]
  • 25.Van Geel A.C.M., Geusens P.P., Nagtzaam I.F., Schreurs C.M.J.R., Van der Voort D.J.M., Rinkens P.E.L.M. Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study. BMC Med. 2006;4:24. doi: 10.1186/1741-7015-4-24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Roig V.D., Valero C. Proporción de individuos con criterios de indicación de densitometría ósea y frecuencia de los factores de riesgo de baja masa ósea en consultas de atención primaria. Aten Primaria. 2006;38:435–442. doi: 10.1157/13094800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Arana-Arri E., Gutiérrez-Ibarluzea I., Grupo de Investigación de osteoporosis de la Comarca Uribe . 1.a ed. Osakidetza-Servicio Vasco de Salud; Vitoria-Gasteiz: 2005. Osteoporosis: Guía de Práctica Clínica de manejo en Atención Primaria. [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES