Quantitative ultrasonography as good as Dual X ray Absorptiometry in predicting BMD: JAPI

Osteoporosis is a silent disease until it is complicated by fractures. Fractures in aging individuals place an enormous medical and personal burden, therefore primary prevention by screening before fracture occur or even after the first fracture has occurred decrease future fracture risk. As there is no universally availability of Dual energy X ray Absorptiometry (DXA) and affordability issues has lead to search for lower cost alternatives like quantitative ultrasonography (QUS).

Researchers undertook the current study to determine risk of low Bone mineral density (BMD) in elderly ambulant population (>60 yrs) by osteoporosis self- assessment tool (OST). Identify presence of low BMD by QUS in all patients and confirm by DXA scan and test ability of QUS and OST individually and in combination in predicting low bone density and fracture risk.

The study was designed as an observational study with sample size of 217 with elderly population as subjects. Details of presenting symptoms and past history co-morbidities and fracture were taken. Osteoporosis risk is calculated by OST.Subjects were screened for presence of low BMD by calcaneal QUS machine and classified into Osteopenia and osteoporosis based on T score by QUS and DXA. X rays of pelvis with both hips and spine obtained for documentation of fractures.

Results revealed some interesting facts.

• The prevalence of Osteoporosis 15% (33) and Osteopenia 39% (84).Osteoporosis was more among female (37%).
• Low BMD had significant association (p<0.05) with Low BMI, Smoking, alcohol consumption, Previous fractures, anemia, Vitamin D3 levels and low serum calcium. OST cutoff of <-1 had sensitivity of 96%, specificity of 40% for predicting low BMD.
• QUS had sensitivity of 75.8 % and specificity of 90% in predicting osteoporosis.
• The combined (QUS+OST) had sensitivity of 81.8% and specificity of 95.1%. Fracture risk by QUS had RR 3.3 and OR 5.8 when combined with OST had RR 3.8 and OR 4.6 as compared to DXA (RR 4.0/OR 4.2).

"Reduction in bone mineral density is a gradual and silent process; risk factors such as increasing age, female gender, postmenopausal state, poor nutrition, habits of smoking and alcohol consumption accentuate this process. Effective screening would help identify the issue and plan interventions. Simple osteoporosis screening tool like Osteoporosis Self assessment which have incorporated risk factors helps in identifying candidates for further BMD testing and interventions. Quantitative bone scan in this study has shown to be a promising tool and cost effective tool for identifying individuals with osteoporosis and risk of fragile fractures. Two step approach of screening for low bone mineral density by self assessment tools and confirming by QUS has shown to be as effective as gold standard DXA for selecting patients for pharmacotherapy. As this was ambulatory outpatient based study only apparently healthy population who could attend, the exact disease burden could not be assessed in morbid patients, which would have much higher incidence."the team concluded.

For full article follow the link: https://www.japi.org/x284b464/study-of-low-bone-mineral-density-in-ambulant-elderly-population-by-quantitative-ultrasonography-and-its-implications-on-fragile-fracture-risk

Source: Journal Of The Association Of Physicians In India