Comparison of Six Calcaneal Quantitative Ultrasound Devices: Precision and Hip Fracture Discrimination

Abstract

Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). The short-term and mid-term precisions of these devices were also determined. Thirty-five women (mean age 74.5+/-7.9 years) who had sustained a hip fracture within the past 3 years, and 35 age-matched controls (75.8+/-5.6 years) were recruited. Ultrasound measurements were acquired using six ultrasound devices: three gel-coupled and three water-coupled devices. Bone mineral density was measured at the hip using DXA. Discrimination of fracture patients versus controls was assessed using logistic regression analysis (expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA). The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson correlation coefficients between different devices was highly significant (SOS, r = 0.79-0.93; BUA, r = 0.71-0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r = 0.30-0.55; BUA, r = 0.35-0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r = 0.48-0.57 for BMD and r = 0.18-0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1-2.8) and BUA (2.4-3.4) were comparable to those for femoral BMD (2.6-3.5), as were the area under the curve (SOS, 0.65-0.71; BUA, 0.62-0.71; BMD, 0.65-0.74) from ROC analysis. Within the limitation of the sample size all devices show similar diagnostic sensitivity.

Cancellous bone fast and slow waves obtained with Bayesian probability theory correlate with porosity from computed tomography

“…This range of speeds of sound is similar to the range seen in clinical measurements of the speed of sound in the calcaneus based on analysis of the unseparated wave. 23,24 The difference between the fast and the slow wave speeds is smaller in this study than in other studies that have reported the speed of sound for both waves. 7,16,[25][26][27] This result is expected because the fast and slow wave speeds are most similar when propagating perpendicular to the predominant fiber direction.…”

Evaluation of a gel‐coupled quantitative ultrasound device for bone status assessment.

“…However, it is possible that positioning errors are not a major source of error in gelcoupled devices. One could speculate that because gel-coupled devices have consistently performed poorly compared with water-coupled devices, 9 issues of coupling (time of gel application and type of gel), the presence of edema, 22 and bonding of the transducers 23 may contribute significantly to the level of precision. Because gel-coupled devices are relatively portable, it is essential to identify the causes of poor precision.…”

Prevalência do risco para fraturas estimado pela ultra-sonometria óssea de calcâneo em uma população de mulheres brasileiras na pós-menopausa

“…Utilizamos as referências do aparelho fornecidas pelo fabricante baseado em estudo brasileiro que demonstrou a similaridade entre as duas curvas de referência 12 , conferindo para o mesmo um bom grau de confiabilidade. A existência de estudos equiparando múltiplas máquinas de ultra-sonometria óssea utilizando gel ou água 37,38,39,40 , e do estudo de Rodrigues et al 41 demonstrando a boa correlação entre Sonost 2000 e a resistência óssea em humanos, nos permitem ter uma relativa segurança com o seu uso.…”