Ultrasound-based estimates of cortical bone thickness and porosity are associated with non-traumatic fractures in postmenopausal women: A pilot study

• Published in: Journal of bone and mineral research
• Main Authors: Minonzio, J-G, Bochud, N, Vallet, Q, Ramiandrisoa, D, Etcheto, A, Briot, K, Kolta, S, Roux, C, Laugier, P
• Format: Journal Article
• Language: English
• Published: American Society for Bone and Mineral Research 2019
• Subjects: Bioengineering; Gynecology and obstetrics; Human health and pathology; Imaging; Life Sciences; Rhumatology and musculoskeletal system; quantitative ultrasound; fracture discrimination; guided waves; osteoporosis; Cortical bone
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1002/jbmr.3733

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.