Authors: C Durosier D Hans M A Krieg C Ruffieux J Cornuz P J Meunier A M Schott
Publish Date: 2007/07/11
Volume: 18, Issue: 12, Pages: 1651-1659
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 424 versus 338 using CRF alone and 384 using the SI alone This combined CRFSI score could be used wherever and whenever DXA is not readily accessibleSeveral strategies have been proposed to identify women at high risk for osteoporosisrelated 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 aloneWe pooled two Caucasian cohorts EPIDOS and SEMOF into a large database named “EPISEM” in which 12064 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 QUSderived heel stiffness index SI and the following seven CRF patient age body mass index BMI fracture history fall history diabetes history chairtest results and past estrogen treatmentUsing the composite SICRF 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 5400 including 112 hip fractures and 5032 including 111 hip fractures to 4549 including 100 including fractures for the CRF and QUS alone versus the combination scoreWe want to thank the EPIDOS and SEMOF study groups for making their databases available to us The EPIDOS study was supported by a contract INSERMMSDChibret This analysis was partly funded by a research grant provided by Geneva University HospitalMembers of the EPIDOS study group Coordinators G Bréart P DargentMolina PJ Meunier AM Schott D Hans PD Delmas Principal investigators center C Baudoin JL Sebert Amiens MC Chapuy AM Schott Lyon F Favier C Marcelli Montpellier E Hausherr CJ Menkes C Cormier Paris H Grandjean C Ribot ToulouseMembers of the SEMOF study group MA Krieg J Cornuz C Ruffieux G Van Melle D Büche M A Dambacher F Hartl H J Häuselmann M Kraenzlin K Lippuner M Neff P Pancaldi R Rizzoli F Tanzi R Theiler A Tyndall C Wimpfheimer P Burckhardt
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