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Ultrasound-based estimates of cortical bone thickness and porosity are associated with non-traumatic fractures in postmenopausal woman: A pilot study
Minonzio, Jean Gabriel
Recent ultrasound axial transmission techniques exploit the multimode waveguide response of long bones to yield estimates of cortical bone structure characteristics. This pilot cross‐sectional study aimed to evaluate the performance at the one‐third distal radius of a bidirectional axial transmission (BDAT) device to discriminate between fractured and non‐fractured postmenopausal women. Cortical thickness (Ct.Th) and porosity (Ct.Po) estimates were obtained for 201 postmenopausal women, among whom 109 were non‐fractured (62.6±7.8 years), 92 with one or more non‐traumatic fractures (68.8±9.2 years), 17 with hip fractures (66.1±10.3 years), 32 with vertebral fractures (72.4±7.9 years), and 17 with wrist fractures (67.8±9.6 years). The areal bone mineral density (aBMD) was obtained using dual‐energy X‐ray absorptiometry (DXA) at the femur and spine. Femoral aBMD correlated weakly but significantly with Ct.Th (R=0.23, p < 0.001) and Ct.Po (R=‐0.15, p < 0.05). Femoral aBMD and both ultrasound parameters were significantly different between the subgroup of all non‐traumatic fractures combined and the control group (p < 0.05). The main findings were (i) that Ct.Po was discriminant for all non‐traumatic fractures combined (odds ratio OR=1.39; area under the receiver operating characteristic curve AUC=0.71), for vertebral (OR=1.96; AUC=0.84) and wrist fractures (OR=1.80; AUC=0.71), while Ct.Th was discriminant for hip fractures only (OR=2.01; AUC=0.72); (ii) the demonstration of a significant association between increased Ct.Po and vertebral and wrist fractures when these fractures were not associated with any measured aBMD variables; (iii) the association between increased Ct.Po and all non‐traumatic fractures combined independently of aBMD neck; and (iv) the association between decreased Ct.Th and hip fractures independently of aBMD femur. BDAT variables showed comparable performance to that of aBMD neck with all types of fractures (OR=1.48; AUC=0.72) and that of aBMD femur with hip fractures (OR=2.21; AUC=0.70). If these results are confirmed in prospective studies, cortical BDAT measurements may be considered useful for assessing fracture risk in postmenopausal women. This article is protected by copyright. All rights reserved.