Fri., 10/17/08 Pelvis/Injury Prevention, Paper #33, 12:24 pm OTA-2008
A Comparison of Quantitative Ultrasound the Calcaneus to Dual-Energy X-Ray Absorptiometry of Hospitalized Orthopaedic Trauma Patients
Cory A. Collinge, MD1 (a-Foundation for Orthopedic Trauma; c-Biomet; c,e-Smith + Nephew);
George Lebus, BA2 (n); Michael Gardner, MD3 (n); Laura Gehrig, MD4 (n);
1Harris Methodist Fort Worth Hospital/John Peter Smith Orthopedic Surgery Residency
Program, Fort Worth, Texas, USA;
2UT Southwestern Medical School, Dallas, Texas, USA;
3Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA;
4Doctors’ Hospital, Shreveport, Louisiana, USA
Purpose: Many of the risk factors for trauma (alcohol and tobacco abuse, central nervous system– altering medications, poor self-care, etc) are also risk factors for osteoporosis. Identifying orthopaedic trauma patients with osteoporosis provides the potential to intervene and prevent future fractures. While dual-energy x-ray Absorptiometry (DXA) is recognized as the gold standard for diagnosing osteoporosis, quantitative ultrasound (QUS) of the heel has recently been shown to be as predictive of future fracture risk as DXA. Furthermore, the QUS machine is portable and inexpensive, requires no specially-trained personnel, and uses no ionizing radiation. Our purpose was to evaluate QUS of the heel in comparison with DXA to identify patients at risk for osteoporosis in a hospitalized orthopaedic trauma setting.
Methods: We attempted to cross-sectionally evaluate 250 consecutive hospitalized orthopaedic trauma patients with QUS and DXA. Devices used were Achilles InSight (GE Medical Systems) for calcaneal QUS and GELunar (GE Medical Systems) for DXA measurements. QUS T-score and bone mineral density (BMD) T-score (hip or radius) were obtained from U.S. normative data.
Results: BMD testing was accomplished in 240 patients with heel QUS and in 101 with DXA. Calcaneal QUS parameters were positively correlated with femoral BMD (P <0.001). Receiver operating characteristic area under the curve is 0.84 (95% confidence interval = 0.75-0.90; P = 0.0001). In receiver operator characteristic analysis, a QUS T-score ≤–1.3 standard deviation had 77% sensitivity and 78% specificity for osteoporosis diagnosis by DXA criteria.
Conclusion and Significance: Significant problems were found in obtaining DXA in hospitalized orthopaedic trauma patients, while QUS was predictably obtained in this patient population. For those patients that did undergo DXA, good correlation was seen between femoral BMD and QUS results. We recommend QUS as a useful tool in evaluating for osteoporosis in orthopaedic trauma patients.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.