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Prospective evaluation of risk of vertebral fractures using quantitative ultrasound measurements and bone mineral density in a population-based sample of postmenopausal women: results of the Basel Osteoporosis Study
  1. R Hollaender1,
  2. F Hartl1,
  3. M-A Krieg2,
  4. A Tyndall1,
  5. C Geuckel3,
  6. C Buitrago-Tellez4,
  7. M Manghani1,
  8. M Kraenzlin5,
  9. R Theiler6,
  10. D Hans7
  1. 1
    Department of Rheumatology, Felix Platter-Hospital, University of Basel, Basel, Switzerland
  2. 2
    Department of Internal Medicine, University of Lausanne, Switzerland
  3. 3
    Imamed Radiologie Nordwest, Basel, Switzerland
  4. 4
    Hightech Research Center, Institute of Radiology, Zofingen Hospital, Switzerland
  5. 5
    Department of Endocrinology, University of Basel, Basel, Switzerland
  6. 6
    Department of Rheumatology, City Hospital Triemli, Zurich, Switzerland
  7. 7
    Nuclear Medicine Division, Geneva University Hospital, Geneva, Switzerland
  1. Rebecca Hollaender, Departmant of Rheumatology, Basel University, Felix Platter Spital, Bugfelderstrasse 101, CH-4012 Basel, Switzerland; Rebecca.Hollaender{at}


Objective: Prospective studies have shown that quantitative ultrasound (QUS) techniques predict the risk of fracture of the proximal femur with similar standardised risk ratios to dual-energy x-ray absorptiometry (DXA). Few studies have investigated these devices for the prediction of vertebral fractures. The Basel Osteoporosis Study (BOS) is a population-based prospective study to assess the performance of QUS devices and DXA in predicting incident vertebral fractures.

Methods: 432 women aged 60–80 years were followed-up for 3 years. Incident vertebral fractures were assessed radiologically. Bone measurements using DXA (spine and hip) and QUS measurements (calcaneus and proximal phalanges) were performed. Measurements were assessed for their value in predicting incident vertebral fractures using logistic regression.

Results: QUS measurements at the calcaneus and DXA measurements discriminated between women with and without incident vertebral fracture, (20% height reduction). The relative risks (RRs) for vertebral fracture, adjusted for age, were 2.3 for the Stiffness Index (SI) and 2.8 for the Quantitative Ultrasound Index (QUI) at the calcaneus and 2.0 for bone mineral density at the lumbar spine. The predictive value (AUC (95% CI)) of QUS measurements at the calcaneus remained highly significant (0.70 for SI, 0.72 for the QUI, and 0.67 for DXA at the lumbar spine) even after adjustment for other confounding variables.

Conclusions: QUS of the calcaneus and bone mineral density measurements were shown to be significant predictors of incident vertebral fracture. The RRs for QUS measurements at the calcaneus are of similar magnitude as for DXA measurements.

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  • Competing interests: None.

  • Funding: This study was funded in part by the Swiss Federal Research Commission for Rheumatology (Eidgenössische Rheuma-Forshungskommission) and Merck, Sharp & Dohme provided a research grant.