Osteoporosis: Schott AM

Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Del Rio Barquero L, Kaufman JJ, Lorenc R, Miller PD, Olszynski WP, Poiana C, Schott AM, Lewiecki EM, Hans D. · Lausanne University Hospital, Lausanne, Switzerland. <> · J Clin Densitom. · Pubmed #18442758 No free full text.

Abstract: Dual-energy X-ray absorptiometry (DXA) is commonly used in the care of patients for diagnostic classification of osteoporosis, low bone mass (osteopenia), or normal bone density; assessment of fracture risk; and monitoring changes in bone density over time. The development of other technologies for the evaluation of skeletal health has been associated with uncertainties regarding their applications in clinical practice. Quantitative ultrasound (QUS), a technology for measuring properties of bone at peripheral skeletal sites, is more portable and less expensive than DXA, without the use of ionizing radiation. The proliferation of QUS devices that are technologically diverse, measuring and reporting variable bone parameters in different ways, examining different skeletal sites, and having differing levels of validating data for association with DXA-measured bone density and fracture risk, has created many challenges in applying QUS for use in clinical practice. The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of QUS for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented here.

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N. · WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. · Osteoporos Int. · Pubmed #17323110 No free full text.

Abstract: SUMMARY: BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. INTRODUCTION AND HYPOTHESES: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. METHODS: Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). RESULTS: CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. CONCLUSIONS: The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.

Durosier C, Hans D, Krieg MA, Schott AM. · Nuclear Medicine Division, Geneva University Hospital, Geneva, Switzerland; Medical Information Department, Lyon University Hospital, Lyon, France. · J Clin Densitom. · Pubmed #17097535 No free full text.

Abstract: Osteoporotic hip fractures increase dramatically with age and are responsible for considerable morbidity and mortality. Several treatments to prevent the occurrence of hip fracture have been validated in large randomized trials and the current challenge is to improve the identification of individuals at high risk of fracture who would benefit from therapeutic or preventive intervention. We have performed an exhaustive literature review on hip fracture predictors, focusing primarily on clinical risk factors, dual X-ray absorptiometry (DXA), quantitative ultrasound, and bone markers. This review is based on original articles and meta-analyses. We have selected studies that aim both to predict the risk of hip fracture and to discriminate individuals with or without fracture. We have included only postmenopausal women in our review. For studies involving both men and women, only results concerning women have been considered. Regarding clinical factors, only prospective studies have been taken into account. Predictive factors have been used as stand-alone tools to predict hip fracture or sequentially through successive selection processes or by combination into risk scores. There is still much debate as to whether or not the combination of these various parameters, as risk scores or as sequential or concurrent combinations, could help to better predict hip fracture. There are conflicting results on whether or not such combinations provide improvement over each method alone. Sequential combination of bone mineral density and ultrasound parameters might be cost-effective compared with DXA alone, because of fewer bone mineral density measurements. However, use of multiple techniques may increase costs. One problem that precludes comparison of most published studies is that they use either relative risk, or absolute risk, or sensitivity and specificity. The absolute risk of individuals given their risk factors and bone assessment results would be a more appropriate model for decision-making than relative risk. Currently, a group appointed by the World Health Organization and lead by Professor John Kanis is working on such a model. It will therefore be possible to further assess the best choice of threshold to optimize the number of women needed to screen for each country and each treatment.

Amamra N, Berr C, Clavel-Chapelon F, Delcourt C, Delmas PD, Derriennic F, Ducimetière P, Goldberg M, Letenneur L, Rabilloud M, Meunier PJ, Schott AM. · Département d'Information Médicale des Hospices Civils de Lyon, 162 avenue Lacassagne, 69003 Lyon, France. · Joint Bone Spine. · Pubmed #15474393 No free full text.

Abstract: OBJECTIVES: To determine the number of women in France at least 50 years of age with risk factors for osteoporosis likely to lead to bone mineral density measurement, an investigation reimbursed by the French national health insurance system in patients at risk for osteoporosis. The study was commissioned by the French health authorities. MATERIALS AND METHODS: Risk factors for osteoporosis were defined as recommended by the French Agency for Accreditation and Evaluation in Health (ANAES) in 2001. The study data were from nine cohort studies done in France and from the National Health Insurance Agency for the Rhone-Alpes region of France. Risk factor prevalences in France were standardized by extrapolation according to the age distribution in France. RESULTS: Overall, data were collected in 123,986 women aged 50 years or older. From these data, risk factor estimates were as follows: menopause before 40 years of age, 1.5 million women; body mass index (BMI) lower than 19 kg/m(2), nearly 700,000; history of fracture, more than 2 million; history of femoral neck fracture in the mother, more than 1 million; history of health problems potentially responsible for osteoporosis, 400,000; and history of long-term glucocorticoid therapy, 612,000. In all, 3,186,318 (30%) women were estimated to have at least one risk factor and 785,512 (7.5%) at least two risk factors. CONCLUSIONS: Although our study sample was not representative of the population residing in France, the large sample size and diversity of data sources support the validity of our estimate of the prevalence of risk factors for osteoporosis in postmenopausal women living in France.

Hans D, Schott AM, Duboeuf F, Durosier C, Meunier PJ, Anonymous00206. · INSERM U 403, Hôpital Edouard Herriot, Lyon, France. · Bone. · Pubmed #15268884 No free full text.

Abstract: While the potential of quantitative ultrasound (QUS) in the management of osteoporosis has been accepted, its interaction with follow-up time has never been investigated. The aim of our study is to prospectively evaluate the influence of follow-up time on the prediction of hip fracture by ultrasound parameters in the elderly as compared to bone mineral density (BMD) and to establish a long-term fracture prediction model. In the multicenter prospective study EPIDOS, 5898 Caucasian healthy women, aged 75 and over, had femoral dual-energy X-ray absorptiometry (DXA) and heel ultrasound measurements at baseline. A survey of fracture occurrence was conducted every 4 months. Statistical analyses were performed for three different average lengths of follow-up, namely, 1.5, 2.5 and 3.5 years. Relative risks per standard deviation decrease (RR) and the area under the receiver operating characteristic (AUC) curves were given. Estimates of the long-term hip fracture prediction by DXA and QUS were extrapolated. During an average of 3.5 years follow-up, 227 women sustained their first non-traumatic hip fracture. For the three categories of follow-up, low values of both calcaneal ultrasound and hip BMD were associated with a significant increased risk of hip fracture [e.g. ultrasound Stiffness index RR = 2.8 (2.1-3.8), 2.1 (1.7-2.6) and 1.9 (1.7-2.3) for 1.5, 2.5 and 3.5 years of follow-up, respectively]. The combination of femoral neck BMD with the Stiffness showed an improvement of the hip fracture prediction model. Using extrapolation, the prediction of hip fracture by the Stiffness remained significant up to 7.5 years [RR = 1.2 (1.03-1.41)], whereas the limit of significance was reached at 10 years for the femoral neck BMD [RR = 1.25 (1.04-1.52)]. Our results indicate that the Stiffness tends to be the best short- and long-term predictor of hip fracture among ultrasound parameters. This paper provides additional information on the long-term prediction of hip fracture, which has always been an important issue in routine clinical practice as it influences the management of the disease. Our model should give a relatively good estimation of the fracture risk prediction at 5 years with the ultrasound and 10 years for the femoral neck BMD.

Hans D, Genton L, Drezner MK, Schott AM, Pacifici R, Avioli L, Slosman DO, Meunier PJ. · Nuclear Medicine Division, Geneva University Hospital, Geneva, Switzerland. · Calcif Tissue Int. · Pubmed #12200644 No free full text.

Abstract: Many studies have been done involving exercise, impact loading, and the effect on BMD. In some of these studies, particularly those involving outpatient activity, compliance and the specific parameters of an individual's impact loading have been difficult to monitor effectively. In this study, an individual, home-use platform was used to record daily, specific, and reproducible impact forces generated during a heel drop exercise. At three centers over 24 months, we conducted a randomized, prospective study of 157 osteoporotic and osteopenic women, aged 60-85 years. A total of 99 patients used the home Osteocare device (OrthoGenesis Incorporated, Northborough, Massachusetts USA) to generate a reproducible and specific daily impact program (active group). Controls (32) performed a similar motion on the unit but without trying to trigger an impact force (sham group), and 26 patients did no prescribed heel drop exercise (control group). All groups had the same calcium and vitamin D supplementation. Hip DXA was performed at baseline and every 6 months during the entire study duration. Compliance with the 3-5 min routine was high, and patients were able to consistently achieve the specific targeted impact range. Pooled BMD results showed no significant differences between groups in overall BMD measurements. However, a classification model that looked at individual site-specific BMD changes showed that more than 75% of the active group responded (versus 62% for both the sham and the control groups) by maintaining or increasing site-specific hip BMD over the 2-year trial. In fact, at the end of the study, 45% of the actives were gainers versus 12% and 22% in the sham and control groups, respectively. This study suggests that hip BMD may be maintained through a brief, safe, at-home, monitored impact loading program.

Durosier C, Hans D, Krieg MA, Schott AM. · Nuclear Medicine, University Hospital, Geneva, Switzerland. · J Clin Densitom. · Pubmed #18456531 No free full text.

Abstract: Using a large prospective cohort of over 12,000 women, we determined 2 thresholds (high risk and low risk of hip fracture) to use in a 10-yr hip fracture probability model that we had previously described, a model combining the heel stiffness index measured by quantitative ultrasound (QUS) and a set of easily determined clinical risk factors (CRFs). The model identified a higher percentage of women with fractures as high risk than a previously reported risk score that combined QUS and CRF. In addition, it categorized women in a way that was quite consistent with the categorization that occurred using dual X-ray absorptiometry (DXA) and the World Health Organization (WHO) classification system; the 2 methods identified similar percentages of women with and without fractures in each of their 3 categories, but the 2 identified only in part the same women. Nevertheless, combining our composite probability model with DXA in a case findings strategy will likely further improve the detection of women at high risk of fragility hip fracture. We conclude that the currently proposed model may be of some use as an alternative to the WHO classification criteria for osteoporosis, at least when access to DXA is limited.

Huot L, Couris CM, Tainturier V, Jaglal S, Colin C, Schott AM. · Hospices Civils de Lyon, Pole Information Médicale Evaluation Recherche, Unité d'Epidémiologie, Lyon F69003, France. · Osteoporos Int. · Pubmed #18373055 No free full text.

Abstract: SUMMARY: To assess the prescription patterns of anti-osteoporosis medications, three cross-sectional analyses were performed between 2004 and 2006. Women aged 50 and older were identified from the health insurance claims database of the Rhône-Alpes area. HRT prescriptions decreased while bisphosphonates and raloxifene prescriptions increased, respectively, in different age groups. INTRODUCTION: The objective of this study was to assess the prescription patterns of hormone replacement therapy (HRT) and anti-osteoporosis medications (AOM) in post-menopausal French women since the WHI and the revision of the French clinical practice guidelines in 2004. METHODS: Three cross-sectional analyses were performed between 2004 and 2006. Women aged 50 and older who had at least one claim for a prescription for HRT, bisphosphonates or raloxifene were identified from health insurance claims database of the Rhône-Alpes area. RESULTS: A 39% decrease in the number of women who had HRT was observed (67,241 to 41,024). Twenty-one percent and 18% increases were observed, respectively, for bisphosphonates (39,192 to 47,395) and raloxifene (10,263 to 12,060). HRT and raloxifene were mainly prescribed to women aged 55 to 64 (58% and 39%, respectively), bisphosphonates to women aged 65 to 84 (70%). Ninety-eight percent of women had HRT prescribed by a gynaecologist or a general practitioner (GP). Most AOM were prescribed by a GP; 13% of women had AOM prescribed by a rheumatologist. CONCLUSION: Prescriptions for HRT in post-menopausal French women have significantly decreased while bisphosphonates and raloxifene prescriptions have increased, respectively, in different age groups but to a lesser extent than the HRT decrease.

Couris CM, Duclos A, Rabilloud M, Couray-Targe S, Ecochard R, Delmas PD, Schott AM. · Hospices Civils de Lyon, Pole Information Medicale Evaluation recherche, Lyon, France. · Bone. · Pubmed #17715006 No free full text.

Abstract: BACKGROUND: Hip fractures are the most devastating result of osteoporosis and are common worldwide. Based on an exponential increase in incidence with age, many studies in the 1990s forecasted an epidemic of hip fracture in women in the next 15 years which is not currently being observed. Despite the ageing of the populations, accurate description of hip fracture incidence in women aged 85 or older are scarce. METHODS: All women aged 60 to 95, living in the Rhône-Alpes area of France, who were admitted to hospitals during 2001-2004 for treatment of hip fracture were selected from the French claims databases. An exponential model was tested to describe the increase in hip fracture incidence in women aged 60-84 and 60-95. The first model was used to predict annual hip fracture incidence in women aged 85-95 in the Rhône-Alpes area, in France and in Europe. RESULTS: An exponential model was adequate to describe the increase in incidence in women aged 60-84. Assuming an exponential increase in incidence in women aged 85-95, the predicted number of cases was overestimated by 70% in the Rhône-Alpes. In France and in Europe, the excess number of incident cases is believed to be respectively 16,000 and 85,965 a year. INTERPRETATION: The age-specific incidence estimates an average risk although the individual risks are heterogeneous throughout the population. The slower increase in incidence after age 85 might not be related to a decreasing individual risk with age but rather might indicate that women at higher risk have already experienced hip fracture or have died. After age 85, women who are still at risk may represent a population with a lower risk of hip fracture. Models adapted to the elderly population should be developed to improve the accuracy of predictions and optimise the health care system.

Durosier C, Hans D, Krieg MA, Ruffieux C, Cornuz J, Meunier PJ, Schott AM. · Division of Nuclear Medicine, Geneva University Hospital, 1211, Geneva 14, Switzerland. · Osteoporos Int. · Pubmed #17622478 No free full text.

Abstract: We hypothesized that combining clinical risk factors (CRF) with the heel stiffness index (SI) measured via quantitative ultrasound (QUS) would improve the detection of women both at low and high risk for hip fracture. Categorizing women by risk score improved the specificity of detection to 42.4%, versus 33.8% using CRF alone and 38.4% using the SI alone. This combined CRF-SI score could be used wherever and whenever DXA is not readily accessible. INTRODUCTION AND HYPOTHESIS: Several strategies have been proposed to identify women at high risk for osteoporosis-related fractures; we wanted to investigate whether combining clinical risk factors (CRF) and heel QUS parameters could provide a more accurate tool to identify women at both low and high risk for hip fracture than either CRF or QUS alone. METHODS: We pooled two Caucasian cohorts, EPIDOS and SEMOF, into a large database named "EPISEM", in which 12,064 women, 70 to 100 years old, were analyzed. Amongst all the CRF available in EPISEM, we used only the ones which were statistically significant in a Cox multivariate model. Then, we constructed a risk score, by combining the QUS-derived heel stiffness index (SI) and the following seven CRF: patient age, body mass index (BMI), fracture history, fall history, diabetes history, chair-test results, and past estrogen treatment. RESULTS: Using the composite SI-CRF score, 42% of the women who did not report a hip fracture were found to be at low risk at baseline, and 57% of those who subsequently sustained a fracture were at high risk. Using the SI alone, corresponding percentages were 38% and 52%; using CRF alone, 34% and 53%. The number of subjects in the intermediate group was reduced from 5,400 (including 112 hip fractures) and 5,032 (including 111 hip fractures) to 4,549 (including 100 including fractures) for the CRF and QUS alone versus the combination score. CONCLUSIONS: Combining clinical risk factors to heel bone ultrasound appears to correctly identify more women at low risk for hip fracture than either the stiffness index or the CRF alone; it improves the detection of women both at low and high risk.

Schott AM, Ganne C, Hans D, Monnier G, Gauchoux R, Krieg MA, Delmas PD, Meunier PJ, Colin C. · Epidemiology Unit, Département d'Information Médicale des Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon Cedex 03, France. · Osteoporos Int. · Pubmed #17039393 No free full text.

Abstract: INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

Robbins J, Schott AM, Azari R, Kronmal R. · Department of Medicine, University of California, Davis, Davis, CA, USA. · J Clin Densitom. · Pubmed #16931352 No free full text.

Abstract: Body mass index (BMI) is often used to predict bone mineral density (BMD). This may be flawed. Large epidemiologic studies with BMI and BMD data were analyzed. Weight alone is a better predictor of BMD than BMI. Thus, when selecting individuals for dual-energy X-ray absorptiometry, weight should be used instead of BMI. Low body mass index (BMI) is frequently suggested as one of the factors that indicates the need for bone mineral density (BMD) screening for osteoporosis. The inclusion of the height-squared term in the denominator of this predictive factor is taken on faith or from other data, but it may not be reasonable in this case. We used data from three large epidemiologic studies to test the BMI, height, and weight as predictors of BMD: (1) the Women's Health Initiative (WHI) with 11,390 women; (2) the Cardiovascular Health Study (CHS) with 1,578 men and women; (3) and EPIDOS with 7,598 women. Dual-energy X-ray absorptiometry data on one or more BMD sites, the total hip, the femoral neck, and the lumbar spine from the three studies, as well as height and weight were examined. Correlation coefficients for BMI and weight with BMD were compared. Log transformed models were evaluated to compare the strengths of the models. The result of weight alone was a much better predictor of BMD for all sites in the three studies than BMI. Taller participants had larger BMDs than would have been predicted by BMI. In conclusion, BMIs should not be used to select individuals for BMD screening. A regression model using weight alone or weight and height is a better predictor of BMD in all three populations.

Gayet-Ageron A, Amamra N, Ringa V, Tainturier V, Berr C, Clavel-Chapelon F, Delcourt C, Delmas PD, Ducimetière P, Schott AM. · Département d'Information Médicale des Hospices Civils de Lyon, 162 avenue Lacassagne, 69003 Lyon, France. · Maturitas. · Pubmed #15955641 links to  free full text

Abstract: OBJECTIVES: To estimate the number of women aged 50-69 years treated by hormone therapy (HT) in France before Women's Health Initiative's (WHI) results and to evaluate the potential decrease of HT prescriptions since the publication of WHI clinical trial. METHODS: We used data from eight computerized databases of French cohort studies providing information on HT and constituted by women aged over 50 years living in metropolitan France. From these, we used direct standardization on the French population to estimate the prevalence of HT users across 5 years age groups. Data from the National Health Insurance Agency on two time-periods November 2002-January 2003 and November 2003-January 2004 were used to evaluate the evolution of HT prescriptions since WHI's publication among women aged 50-69 years living in the Rhône-Alpes region. RESULTS: The crude prevalence of HT users among women aged 50-69 years was 52.3% (51.8-52.8) and corresponds to a standardized prevalence of 35.7% (35.1-36.4), that is about 2.56 (2.51-2.59) million women. Standardized prevalence was the highest in 50-54 years age group then it decreased significantly across the older age groups (p<10(-6)). HT reimbursements decreased significantly between the two studied time-periods in the Rhône-Alpes region (p<10(-6)) from -14 to -45%, depending on the considered age groups (65-69 or 50-54 years). CONCLUSIONS: Although WHI results have been criticized by French professional societies based on the fact that treatments used were different in France--mainly transdermal estrogens--and that French postmenopausal women were at lower vascular risk than those of the WHI, the release of this study had effect on the prescription before the French regulatory agency (AFSSAPS) edited limiting recommendations for HT prescription. Further efforts have to be made to collect systematically information on preventive treatments used at menopause followed by evaluation studies.

Robbins JA, Schott AM, Garnero P, Delmas PD, Hans D, Meunier PJ. · Department of Internal Medicine, University of California Davis, Sacramento, USA. · Osteoporos Int. · Pubmed #15185066 No free full text.

Abstract: Hip fractures are common among older women. At the present time, major efforts are being made to identify women with low bone mineral density (BMD). However, more than half of hip fractures occur in women who would not classically be considered osteoporotic by BMD. This study aimed to identify factors associated with hip fracture in women with high BMDs. A total of 7598 French women aged over 74 participated in the EPIDOS study and had BMD measured by dual energy X-ray absorptiometry. Analysis was carried out comparing women with and without hip fractures over more than 3 years of follow-up. The participants were divided into three groups based on femoral neck BMD, so as to have equal numbers in each group (cut-off points=0.601 g/cm(2), and 0.683 g/cm(2)). Multiple risk factors thought to be associated with hip fracture were tested in the high and low BMD groups to search for those whose effect was stronger in the high BMD group. Age adjusted Cox regression was used. Results for continuous variables are reported per standard deviation change. Positive interaction between higher BMD, hip fracture and the following factors were found: age (P<0.01), ultrasound attenuation (P<0.05), urinary deoxypyridinoline (DPD) (P<0.05), left quadriceps strength (P<0.05) and right and left foot coordination (P<0.05). The following factors had a larger hazards ratio in those in the upper third of BMD than the low and were statistically significant: femoral neck BMD, nulliparity, age, ultrasound attenuation and speed, prior fracture, urinary deoxypyridinoline, left grip strength and foot coordination. Multiple factors appear to be more strongly associated with hip fractures in women with high BMD than low. They appear to cluster as factors that may relate to bone turnover and architecture and others which are more subtle measures of left-sided coordination.

Dargent-Molina P, Schott AM, Hans D, Favier F, Grandjean H, Baudoin C, Meunier PJ, Bréart G. · INSERM Unit 149, Villejuif, France. · Osteoporos Int. · Pubmed #10367048 No free full text.

Abstract: Based on data from the EPIDOS prospective study, we have shown that femoral bone mineral density (BMD), calcaneal ultrasound measurements and fall-related factors are significant predictors of the risk of hip fracture. The goal of the present investigation, in the same cohort of elderly women, was (1) to assess and compare the value of femoral BMD, calcaneal broadband ultrasound attenuation (BUA), gait speed and age for identifying elderly women at high risk of hip fracture and (2) to determine whether combining two or more of these measurements would improve predictive ability over single measures. A total of 5895 elderly women had baseline measurements of femoral neck BMD by dual-energy X-ray absorptiometry, calcaneal BUA and gait speed. During an average of 33 months of follow-up, 170 women suffered a hip fracture. We compared the sensitivity and specificity of single and combined measures for three specific cutoff levels to define high risk, i.e., the median, the top quartile and the top decile of risk. We found that femoral BMD, calcaneal BUA, gait speed and age have approximatively the same discriminant value to identify women at high risk of hip fracture even though certain measures and combinations of measures have a significantly higher sensitivity for certain cutoff levels. The sensitivity of the available screening tools is low, even when they are combined: to obtain a sensitivity of about 80%, approximately 50% of the population must be considered to be at high risk.