An innovative ultrasound-based method for the identification of patients at high fracture risk

The clinical significance of osteoporosis lies in the relevant occurrence of fractures. Osteoporosis affects about 200 million people in the world and is responsible for 8.9 million fractures each year worldwide. Hip fractures are a major public health burden, from both social and economic point of view, since they represent one of the most important causes of morbidity, disability, decreased quality of life and mortality for the elderly population. It has been demonstrated that bone mineral density (BMD) measurements on lumbar spine or proximal femur, standardly evaluated by dual-energy X-ray absorptiometry (DXA) examinations, are the most reliable available tool to predict the general risk of osteoporotic fractures. However, DXA, bearing X-ray related issues, is inadequate for population screening purposes and early diagnosis. In the present work, we present a new ultrasound (US)-based method and evaluate its performance for the prediction of osteoporotic fractures. We enrolled 40 women with recent non-vertebral osteoporotic fractures (frail subjects) and 44 controls without fracture history (non-frail subjects): this sample was used to compare the discriminatory power of the novel US methodology applied on spine with lumbar DXA by building the corresponding Receiver Operating Characteristic (ROC) curves. Obtained results showed that the new proposed US parameter (named Fragility Score, F.S.) is suitable for population screening purposes, since its Area Under the Curve (AUC) was the same of DXAmeasured BMD (0.77) but it was coupled with a better sensitivity (83% vs 68%) in identifying patients at high risk of osteoporotic fracture.