Fracture risk prediction in postmenopausal women from GO Study: the comparison between FRAX, Garvan, and POL-RISK algorithms.

In the longitudinal, retrospective study, the ability of the FRAX, Garvan, and POL-RISK algorithms to predict osteoporotic fractures was compared in a group of 457 women. Using the rigid threshold of 10% showed a significant discrepancy in sensitivity and specificity of all tools. New thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds allow for improving the diagnostic accuracy of all three calculators. INTRODUCTION: The aim of the longitudinal, retrospective study was to compare three tools designed to assess fracture risk: FRAX, Garvan, and POL-RISK in their prediction of fracture incidence. MATERIAL: The study group consisted of 457 postmenopausal women with a mean age of 64.21 ± 5.94 years from the Gliwice Osteoporosis (GO) Study. Comprehensive data on clinical factors related to fractures were collected for all participants. Bone densitometry was performed at the proximal femur using the Prodigy device (GE, USA). Fracture risk was established using the FRAX, Garvan, and POL-RISK algorithms. Data on the incidence of osteoporotic fractures were collected over the last 10 years. RESULTS: During the period of observation 72, osteoporotic fractures occurred in 63 subjects. For a preliminary comparison of the predictive value of analyzed diagnostic tools, the fracture risk threshold of 10% was used. For FRAX, the fracture probability exceeding 10% was observed only in 11 subjects who experienced fractures; thus, the fracture was properly predicted only in 22.9% of women. For Garvan, the respective value was 90.5%, and for POL-RISK, it was 98.4%. That gave a very low true positive value for FRAX and a very high false positive value for Garvan and POL-RISK. Based on ROC curves, new thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds improve the diagnostic accuracy of all compared fracture prediction tools. CONCLUSION: The current study showed that different fracture risk assessment tools, although having similar clinical purposes, require different cut-off thresholds for making therapeutic decisions. Better identification of patients requiring therapy based on such an approach may help reduce the number of new fractures.

Optimal fracture prediction thresholds for therapy onset, established from FRAX and Garvan algorithms: a longitudinal observation of the population representative female cohort from the RAC-OST-POL Study.

The study shows that the use of unified cutoff thresholds to identify high fracture risks by two popular calculators-FRAX and Garvan-leads to a significant discrepancy between the prediction of fractures and their actual prevalence over the period of 10 years. On the basis of the ROC analyses, a proposal of differentiated thresholds is presented. They were established at 6% for FRAX major fracture risk, 1.4% for FRAX hip fracture risk, 14.4% for Garvan any fracture risk, and 8.8% for Garvan hip fracture risk. PURPOSE/INTRODUCTION: The aim of the study was to verify how much were the tools, designed to predict fracture risks, precise vs. the actual fracture incidence values over a prospective observation. METHODS: The study group consisted of a population-based postmenopausal sample from the RAC-OST-POL Study. At baseline, there were 978 subjects at the mean age of 66.4 ± 7.8 years and, after a 10-year follow-up, 640 women remained at the mean age of 75.0 ± 6.95 years. At baseline, the fracture risk was established by the FRAX and Garvan tools. RESULTS: During the observation period, 190 osteoporotic fractures were identified in 129 subjects. When high-risk fracture cutoff thresholds (of 10% for major/any and 3% for hip fractures) were employed, only 19.59% of major fractures and 50% of hip fractures were identified in the high-risk group. For the Garvan tool, the percentage of correctly predicted fractures for any and hip fractures was 86.05% and 71.43%, respectively. Nevertheless, the fracture prediction by the Garvan tool was associated with the qualification of numerous subjects to the high-risk group, who subsequently did not experience a fracture in the 10-year follow-up period (false-positive prediction). Based on the ROC analyses, new high-risk thresholds were proposed individually for each calculator, improving the sensitivity, specificity, and diagnostic accuracy of these tools. They were established at 6% for FRAX major fracture risk, 1.4% for FRAX hip fracture risk, 14.4% for Garvan any fracture risk, and 8.8% for Garvan hip fracture risk. CONCLUSIONS: The current prospective study enabled to establish new, optimal thresholds for therapy initiation. Such a modified approach may enable a more accurate identification of treatment requiring patients and, in consequence, reduce the number of new fractures.

Height loss in postmenopausal women-do we need more for fracture risk assessment? Results from the GO Study.

Human body height loss of 3-4 cm or more may be considered a simple indicator of increasing fracture risk, where the information is very similar to the results from fracture risk assessments by available online calculators, all of them based on a multiple variable approaches. INTRODUCTION: The aim of the study was to assess the relationship between body height loss (HL) and fracture risk in postmenopausal women from the Gliwice Osteoporosis (GO) Study. METHODS: The study sample included 1735 postmenopausal women, aged over 55 years and recruited at the Osteoporotic Outpatient Clinic. The mean age of the study participants was 68.15 ± 8.16 years. Fracture risk was established, using the fracture risk assessment tool (FRAX) (10-year probability of major and hip fractures), the Garvan calculator (any and hip fractures, 5 and 10 years) and the Polish (POL-RISK) algorithm, available at www. fracture - risk .pl (any fractures, 5 years). Bone densitometry at the femoral neck was performed, using a Prodigy device (Lunar, GE, USA). Body heights were measured before bone densitometry, using a wall stadiometer and compared with the maximum body heights, measured in early adulthood and reported by the study participants themselves. RESULTS: In 199 women, the body heights, measured during the study, did not change in comparison to their corresponding values in early adulthood, while being decreased in the other 1536 women. The mean height loss (HL) in the whole study group was 3.95 ± 3.24 cm. That HL correlated significantly with the calculated fracture risk (the r range from 0.13 to 0.39, p < 0.0001). In general, regarding the patients with fracture risk close to the recommended therapeutic thresholds, HL was around 3-4 cm, except of the values from the FRAX calculator for major fractures, where the commonly used therapeutic threshold (20%) was related to HL of approximately 6.5 cm. In subjects with HL between 3.5 and 4 cm (n = 208), the FRAX value for major fractures was 6.83 ± 3.74. CONCLUSIONS: Body height measurements, carried out to establish HL, provide an important information for clinical practice, where HL of 3-4 cm or more may be considered a simple indicator of increasing fracture risk.

Scientific output quality of 40 globally top-ranked medical researchers in the field of osteoporosis.

The study presents the research output of 40 globally top-ranked authors, publishing in the field of osteoporosis. Their h-index is compared with the Scientific Quality Index (SQI), a novel indicator. Using SQI, 92.5% of the authors changed their initial positions in the general ranking. SQI partially depends on bibliometric measures different from those influencing h-index and may be considered as an assessment tool, reflecting more objective, qualitative, rather than quantitative, features of individual scientific output. PURPOSE: The study approaches the research output of 40 globally top-ranked authors in the field of osteoporosis. METHODS: The assessed authors were identified in the Scopus database, using the key word "osteoporosis" and the h-index data, collected during the last decade (2008-2017). The data, concerning the scientific output, expressed by the h-index, were compared with a novel indicator of scientific quality-called the Scientific Quality Index (SQI). SQI is calculated according to the following formula: Parameter No. 1 + Parameter No. 2, where: Parameter No. 1 (the percent of papers cited ≥ 10 times) the number of papers cited ≥ 10 times (excluding self-citations and citations of all co-authors) is divided by the number of all the published papers (including the papers with no citation) × 100%, Parameter No. 2 (the mean number of citations per paper) the total number of citations (excluding self-citations and citations of all co-authors) divided by the number of all published papers (including papers with no citation). RESULTS: The following research output values were obtained: the citation index, 2483.6 ± 1348.7; the total number of papers, 75.1 ± 23.2; the total number of cited papers, 69.3 ± 22.0; the number of papers cited, at least, 10 times, 45.4 ± 17.2; the percent of papers cited, at least, 10 times, 59.9 ± 10.0; and the mean citations per paper, 32.8 ± 15.0. The mean value of Hirsch index was 24.2 ± 6.2 and SQI 92.7 ± 22.3. Using SQI, only three authors did not change their initial ranking position, established according to the h-index; 18 authors noted a decrease, while other 19 improved their initial ranking position. The h-index correlated with SQI; r = 0.72; p < 0.0001. CONCLUSION: Qualitative features of scientific output, reflected by SQI, have changed the classification of 92.5% of authors. SQI may be considered as an assessment tool which is more strongly determined by qualitative than quantitative features of individual scientific output.

Risk Factors for Fractures Identified in the Algorithm Developed in 5-Year Follow-Up of Postmenopausal Women From RAC-OST-POL Study.

The aim of the study was to establish factors with an impact on fracture risk and to develop an algorithm to predict osteoporotic fracture. A total of 978 postmenopausal women from the epidemiological, population-based RAC-OST-POL study with a mean age of 65.7 ± 7.3 years were enrolled. At baseline, bone mineral density at hip and clinical risk factors for fracture were collected. Afterward, each person was asked annually on fracture incidence in the 5-year follow-up. Finally, data for complete 5-year observation were gathered for the group of 802 patients. During the follow-up, 92 osteoporotic fractures occurred in 78 women. The most common fracture site was the forearm (n = 45). The following baseline factors were found as significant for fracture incidence: femoral neck bone mineral density, prior fractures, steroid use, falls within previous 12 months, and height. Fracture risk was predicted by the following formula: Riskoffractureincidence=11+e-(-9.899+1.077∗STEROIDS+0.681∗PRIORFALLS+0.611∗PRIORFRACTURES-0.483∗FNTscore+0.042∗HEIGHT). In our current longitudinal study, an algorithm predicting fracture occurrence over a period of 5 years was developed. It may find application in daily medical practice.

Alpine skiing is associated with higher femoral neck bone mineral density.

OBJECTIVE: To evaluate the influence of elite-level alpine skiing on athletes' skeleton. METHODS: Thirteen professional alpine skiers (9 males and 4 females with mean age of 22.6 years) and their age- and height matched control subjects were measured with dual energy X-ray absorptiometry (total body, lumbar spine, proximal femur, forearm) and quantitative ultrasound (hand). RESULTS: After adjusting for sex, age, weight and height, between-group differences were 15% (p=0.012) for the lumbar spine, 14% (p=0.022) for the femoral neck, 10% (p=0.051) for the total hip, and 11% (p=0.001) for the total body favoring the alpine skiers. However, after controlling for total body lean mass (~muscle mass), the group-differences lost their statistical significance, the borderline 10% difference (p=0.051) in femoral neck BMD excluded. CONCLUSION: Factors contributing to the alpine skiers' higher BMD may not only include the greater muscle mass (~stronger muscles) of these athletes but also a large number of impacts and possibly other high-frequency features in external loading generated by the high-speed skiing performance.

High fracture probability predicts fractures in a 4-year follow-up in women from the RAC-OST-POL study.

UNLABELLED: In 770 postmenopausal women, the fracture incidence during a 4-year follow-up was analyzed in relation to the fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator) predicted at baseline. Incident fractures occurred in 62 subjects with a higher prevalence in high-risk subgroups. Prior fracture, rheumatoid arthritis, femoral neck T-score and falls increased independent of fracture incidence. INTRODUCTION: The aim of the study was to analyze the incidence of fractures during a 4-year follow-up in relation to the baseline fracture probability and risk. METHODS: Enrolled in the study were 770 postmenopausal women with a mean age of 65.7 ± 7.3 years. Bone mineral density (BMD) at the proximal femur, clinical data, and fracture probability using the FRAX tool and risk using the Garvan calculator were determined. Each subject was asked yearly by phone call about the incidence of fracture during the follow-up period. RESULTS: Of the 770 women, 62 had a fracture during follow-up, and 46 had a major fracture. At baseline, BMD was significantly lower, and fracture probability and fracture risk were significantly higher in women who had a fracture. Among women with a major fracture, the percentage with a high baseline fracture probability (>10 %) was significantly higher than among those without a fracture (p < 0.01). Fracture incidence during follow-up was significantly higher among women with a high baseline fracture probability (12.7 % vs. 5.2 %) and a high fracture risk (9.2 vs. 5.3 %) so that the "fracture-free survival" curves were significantly different (p < 0.05). The number of clinical risk factors noted at baseline was significantly associated with fracture incidence (chi-squared = 20.82, p < 0.01). Prior fracture, rheumatoid arthritis, and femoral neck T-score were identified as significant risk factors for major fractures (for any fractures, the influence of falls was also significant). CONCLUSIONS: During follow-up, fracture incidence was predicted by baseline fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator). A number of clinical risk factors and a prior fracture, rheumatoid arthritis, femoral neck T-score, and falls were independently associated with an increased incidence of fractures. [Corrected]

Functional status and prevalence of falls and fractures in population-based sample of postmenopausal women from the RAC-OST-POL Study.

BACKGROUND: Prevalence of osteoporotic fractures and falls, and functional status may be related with each other. OBJECTIVE: The aim of the study was to assess functional status and prevalence of falls and fractures in Polish postmenopausal women in a representative, randomly selected population sample from RAC-OST-POL Study. DESIGN: Population-based epidemiological study. SETTING: Raciborz city and district, Poland. PARTICIPANTS: The study included 618 postmenopausal women aged ≥ 55 years (mean age 66.3 ± 7.8 years). MEASUREMENTS: Data concerning falls, fractures etc. were collected using on a questionnaire. Functional assessment was carried out using Instrumental Activity of Daily Living (IADL) Lawton's test and 'Stand up & go' (SUG) test. Skeletal status was assessed using DXA at the hip and with phalangeal quantitative ultrasound (QUS). RESULTS: Fifty-six per cent of studied women have got a reduced mobility estimated using SUG test (time > 10 s). Functional independence level estimated using IADL test is reduced among 14% of women (≤ 23 points). Twenty-eight per cent of women sustained osteoporotic fracture and 34% of women have got a positive fall history in the last year. The number of falls or fractures correlates significantly with results of IADL and SUG tests. Functional status of women who fell or sustained fracture was significantly decreased in comparison with women without falls or fractures. The significant factors increasing the risk of fall are: presence of depression, presence of chronic disease and a reduced functional independence. The significant factors increasing the risk of fractures are: history of fall, age, T-score value for trochanter bone mineral density. CONCLUSION: Results of the study indicate that functional status plays an important role as a factor increasing the risk of falls and fractures in postmenopausal women.

Ten-year fracture risk in the assessment of osteoporosis management efficacy in postmenopausal women: a pilot study.

BACKGROUND: The aim of the reported longitudinal, retrospective pilot study was to establish changes in 10-year fracture risk in postmenopausal women with respect to applied fracture management. METHODS: A group of 191 postmenopausal women with a mean age of 68.76± 6.72 years was divided into subgroups. The subgroups were made up of untreated patients (n = 41), patients treated with vitamin D plus calcium (n = 46), and patients treated with bisphosphonates, vitamin D and calcium (n = 104). Repeated densitometric measurements and clinical data were taken into consideration (both baseline and follow-up). Ten-year fracture risk was established, using FRAX(TM) and Garvan nomograms. The mean follow-up period was 2.01±1.87 years. RESULTS: Generally, the mean fracture probability increased in the studied women over the observation period. Patients on bisphosphonate therapy demonstrated the smallest increase in fracture probability. The probability rate for either any fractures or hip fractures decreased when the T-score increased. A diminished number of falls non-significantly decreased the probability for hip fractures and any fractures. CONCLUSION: Ten-year fracture risk increased irrespective of applied management, while a decreased risk was observed only in women with improved bone status.

Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.-Conformity between methods and their clinical utility.

PURPOSE: The aim of the cross-sectional study was to establish the degree of conformity between 10-year probability of osteoporotic fracture, assessed by FRAX, and using the nomograms, as proposed by Nguyen at al. METHODS: Postmenopausal Polish women (2012) were examined in their mean age of 68.5+/-7.9 years (age range 55-90 years). Fracture probability by FRAX was based on age, BMI, prior fracture, hip fracture in parents, steroid use, rheumatoid arthritis, alcohol use, secondary osteoporosis and T-score for femoral neck BMD. Fracture probability by Nguyen's nomograms was based on age, the number of prior fractures, the number of falls and T-score for femoral neck BMD. RESULTS: The mean conformity rate was 79.1% for any fracture risk (for threshold 20%) and 79.5% for hip fracture (threshold 3%). Any and hip fracture risks were significantly higher for both methods in women with fracture history in comparison to those without fracture and increased with ageing. The influence of prior fracture and ageing was more evident in Nguyen's nomograms. ROC analyses of any fracture risk in FRAX and Nguyen's methods demonstrated the area under curve (AUC) at 0.833 and 0.879, respectively. Similar analyses for hip fracture demonstrated AUCs for FRAX and Nguyen's technique at 0.726 and 0.850, respectively. The AUCs for Nguyen's nomograms were significantly larger than the AUCs for FRAX (p<0.0001). CONCLUSION: The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment, especially for hip fractures, due to a higher accuracy of the method. The information on the number of falls during the last year and multiple fractures ought to be incorporated into the method of fracture risk prediction. MINI-ABSTRACT: The degree of conformity was assessed in a group of 2012 women between 10-year FRAX prognosis of fracture and Nguyen et al.'s nomograms. The mean conformity for any fracture risk is 79.1% and 79.5% for hip fracture. Nguyen's nomograms seem to be more efficient in fracture risk assessment due to higher accuracy.

Quantitative ultrasound at the hand phalanges in 2850 females aged 7 to 77 yr: a cross-sectional study.

In the study, skeletal status was evaluated in 2850 females aged 7 to 77 yr using quantitative ultrasound (QUS amplitude-dependent speed of sound [Ad-SoS]). Ad-SoS ranged from 1923 +/- 30 to 1876 +/- 81 m/s, and the peak value (2121 m/s) was achieved in 19-yr-old females. Ad-SoS increased significantly between subgroups aged 11 and 12 yr, 12 and 13 yr, 13 and 14 yr, 14 and 15 yr, and 15 and 16 yr. After the age of 19 yr the only significant drop was noted between age groups 47 and 48 yr. Ad-SoS was regressed on age, weight, and height for age ranges 7 to 11 yr.(before an increase in Ad-SoS), 12 to 19 yr (from the onset of the increase to the peak value), and older than 19 yr to menopause. In females after menopause, years since menopause (YSM) were taken into consideration. In the two youngest groups Ad-SoS was affected positively by age, and in the two next groups, age had a negative influence on Ad-SoS, whereas weight had a negative and height a positive influence in all groups. YSM did not influence the Ad-SoS value. It was concluded that QUS measurements at the hand phalanges are a useful tool in assessment of skeletal status in the female population.

Skeletal status in survivors of acute lymphoblastic leukemia assessed by quantitative ultrasound at the hand phalanges: a longitudinal study.

The skeletal growth in a course of acute lymphoblastic leukemia (ALL) may be affected, and the aim of the longitudinal study was to assess the skeletal status in survivors of (ALL). The studied population consisted of 38 subjects (17 female and 21 male) measured at the age of 13.9 +/- 3.8 years (5.7 +/- 2.9 years after completion of the therapy, 11.0 +/- 14.4 years after diagnosis) and 2 years earlier; compared with 1402 controls (628 female and 774 male). Patients and controls did not differ significantly in regard to age, height or weight. Skeletal status was assessed by quantitative ultrasound (US) measurements at the hand phalanges using the DBM Sonic 1200, which measures amplitude-dependent speed-of-sound, Ad-SoS (m/s). rms CV% was 0.43%. Mean baseline Ad-SoS value in patients was 1990 +/- 76 m/s and, at second measurement, 2045 +/- 86 m/s (p < 0.000001). In 31 patients, Ad-SoS increased and, in one patient, decreased more than the value of the least significant change. In controls, mean Ad-SoS values were 1973 +/- 64 m/s (baseline) and 2016 +/- 86 m/s (follow-up) and did not differ significantly vs. baseline values in patients. At second measurement, Ad-SoS in controls was significantly lower than in patients (p < 0.05). In five patients with low baseline Ad-SoS values, bone mineral density (BMD) at the spine using DPX-L was estimated; baseline mean BMD was 0.95 +/- 0.11 g/cm2, Z-score was 1.25 +/- 0.97 and, at second measurement, 1.16 +/- 0.07 g/cm2, Z-score was 0.23 +/- 0.43. A significant increase in BMD (p < 0.01) and Z-score (p < 0.05) was noted. In patients, Ad-SoS correlated significantly with age, period after completion of the therapy, body size and Tanner stages (r ranged from 0.43 to 0.83, p ranged from 0.0001 to 0.05). It can be concluded that skeletal status assessed by quantitative US at the hand phalanges in survivors of ALL improved significantly over the period of observation.

Quantitative ultrasound at hand phalanges in adults with end-stage renal failure.

The aim of this study was to assess bone status in 220 subjects with end-stage renal failure (ESRF) (146 men, mean age 53.0 +/- 13.9 years and 74 women, mean age 48.1 +/- 14.3 years). The duration of hemodialysis (durHD) and duration of renal insufficiency (durRI) were, in men, 2.6 +/- 3.8 years and 7.7 +/- 8.0 years, and, in women, 2.8 +/- 3.4 years and 9.1 +/- 7.6 years, respectively. ESRF was caused by the following reasons: chronic glomerulonephritis in 92 patients, diabetes in 52, chronic pyelonephritis in 37, polycystic kidney disease in 19, amyloidosis in 5, hypertension in 4 and unknown cause in 11. The control group consisted of 1615 normal healthy subjects (1216 women, mean age 48.1 +/- 12.1 years and 399 men, mean age 52.9 +/- 14.8 years). Mean age did not differ between patients and controls. Skeletal status was evaluated by quantitative ultrasound (US) measurements at the hand phalanges using DBM 1200 (IGEA, Italy) which measures amplitude-dependent speed of sound (Ad-SoS, m/s). The mean value of Ad-SoS in male patients was 1981 +/- 88 m/s, T-score -l2.03 +/- 1.26, Z-score -0.53 +/- 1.7 and, in female patients, 1967 +/- 96 m/s, -2.23 +/- 1.37, -1.41 +/- 1.56, respectively. Respective values in male controls were 2008 +/- 81 m/s, -1.66 +/- 1.16, -0.01 +/- 0.98 and, in female controls, 2026 +/- 81 m/s, -1.4 +/- 1.15, -0.74 +/- 0.86, and were significantly higher than in male (p < 0.001) and female (p < 0.0000001) patients. A correlation analysis of Ad-SoS with durHD and durRI showed that only in males did both factors significantly influence parameters measured (r = -0.26, p < 0.01). Multiple stepwise regression analysis of Ad-SoS on age, durHD, durRI, weight and height was possible to perform only in males and the following equation was established: Ad-SoS = 2545 m/s - 3.09 x age (years) - 5.68 x durHD (years) - 2.15 x height (cm) - 0.99 x durRI (years), p < 0.000001, r = 0.55, SEE = 69.6. Concluding, in subjects with ESRF treated with hemodialysis, skeletal status assessed with the use of quantitative US was affected.

Knowledge about osteoporosis in a cohort of Polish females: the influence of age, level of education and personal experiences.

In this study, a group of 1065 women aged 16-72 years recruited from patients attending general practitioners was studied to investigate knowledge of osteoporosis and attitude towards methods of preventing the disease. The interviews were carried out by students of the Silesian School of Medicine, using a structured questionnaire. The average number of correct answers in the whole population was 7.05, and in women with established osteoporosis 6.89. In the whole population, the majority of answers were correct and ranged from 60% to 95% in seven out of ten questions. The answers for three questions were incorrect in about half or more of the cohort: 53% of subjects considered that osteoporosis could be cured; for 50% of women osteoporosis is a minor health problem (except for the youngest women and women with university education--74% and 69% of correct answers, respectively); and 58% of women considered that those with osteoporosis should not engage in physical activity due to the risk of falling and causing a fracture. A simple chi-squared test was used to show the role of age, level of education and personal experiences with osteoporosis on answers given by the subjects studied. Age (six out of ten answers), level of education (seven out of ten answers) and personal experience (four out of ten answers) significantly affected answers given. The number of correct answers decreased with age and increased with level of education, and there was no systematic influence of personal experience. In summary, data collected provide important information about knowledge of osteoporosis. Generally, the level of knowledge about osteoporosis was high. Higher level of education and younger age improve the knowledge of osteoporosis with no systematic influence of personal experience with the disease.

Quantitative ultrasound at the hand phalanges in women on hormone replacement therapy.

The aim of the observational study was to evaluate the influence of hormone replacement therapy (HRT) on the results of quantitative ultrasound (US) at the hand phalanges in 732 women (mean age about 53 years). Among them were 228 postmenopausal women treated within 6 months after the last menstrual bleeding (group 1), 90 postmenopausal women taking HRT after a break between menopause and the onset of the therapy of about 2 years (group 2) and 414 controls. Mean age and body size did not differ significantly between groups studied. Years since menopause (YSM) did not differ significantly between group 2 and controls. Skeletal status was assessed using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS) in m/s. Ad-SoS was significantly higher in both groups on HRT than in controls (p < 0.000001), and in group 1 compared with group 2 (p < 0.05). The duration of HRT did not affect Ad-SoS values. The influence of age on Ad-SoS values was significantly weaker in women on HRT than in controls and YSM did not influence Ad-SoS value in postmenopausal women taking HRT. In controls, YSM negatively and significantly affected Ad-SoS value. In conclusion, HRT administered in perimenopause or early postmenopause had a significant influence on quantitative US measurements at the hand phalanges, and the difference between both treated groups suggests that HRT ought to be indicated directly after the last menstrual bleeding.

Quantitative ultrasound of the hand phalanges in patients with genetic disorders: a pilot case-control study.

Skeletal status in subjects with genetic disorders rarely has been a matter of interest, and the risk for osteoporotic fracture in this population is not known. The aim of this study was to estimate ultrasound values in subjects with genetic disorders. In the study 50 patients (36 boys and 14 girls, mean age 11.8 +/- 2.9 years) and 528 healthy controls matched for age and body size (380 boys and 148 girls, mean age 11.9 +/- 2.5 years) were evaluated. Patients with the following disorders were included: Down syndrome, Martin-Bell syndrome, Marfan-Mass phenotype and others. Bone status was assessed by quantitative ultrasound (QUS) of hand phalanges using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS, m/s). Ad-SoS was significantly lower in patients than in controls (in the whole group 1,915 +/- 69 m/s vs. 1,970 +/- 62.0 m/s, P<0.0000001; in males 1,917 +/- 73 m/s vs. 1,972 +/- 63 m/s, P<0.000001; in females 1,910 +/- 58 m/s vs. 1,963 +/- 58 m/s, P<0.01). Ad-SoS correlated significantly with age and body size (except for Ad-SoS with age in female patients). In all subgroups of patients (except for the subjects with Marfan-Mass syndrome) Ad-SoS values were significantly lower than in controls. In a multiple, stepwise regression analysis of Ad-SoS on age and body size, in the whole group of patients age and height had significant influence on Ad-SoS, and in controls age, height and weight. In conclusion, the study shows significantly lower phalangeal ultrasound values in subjects with different genetic disorders compared to normal healthy persons.