Performance of quantitative ultrasound and six osteoporosis risk indexes in menopausal women: validation and comparative evaluation study

Background: A number of questionnaire-based systems and the use of portable quantitative ultrasound scanners (QUS) have been devised in an attempt to produce a cost-effective method of screening for osteoporosis.Objective: to assess the sensitivity and specificity of different techniques and their ability to act as screening tools in relation to dual energy X-ray absorptiometry (DXA).Methods: 295 white postmenopausal women aged over 60 were enrolled. Each subject completed a standardized questionnaire which permits the measure of six osteoporosis indexes and had bone mineral density (BMD) measured using QUS and DXA. Sensitivity and specificity of the different techniques in relation to DXA were plotted as receiver-operating characteristic (ROC) curves at DXA T-score total hip ≤ -2.5 (osteoporosis).Results: BUA sensitivity and specificity values were respectively 76.8% and 51.2% at the total hip. The optimal cut-off T-score for QUS was -2 at the total hip. The osteoporosis self-assessment tool (OST) provided consistently the highest AUC (0.80) among the clinical tools and had the best sensitivity and specificity balance (90.2%-44.5%). OST negative likelihood ratio was 0.22.Conclusion: OST (based only on the weight and the age) performed slightly better than QUS and other risk questionnaires in predicting low BMD at the total hip

Relationship between Sex Hormone Levels; Bone Mineral Density and Bone Turnover Markers in Healthy Moroccan Men: a Cross-Sectional Study

Introduction: gonadal steroid hormones play a crucial role during skeletal growth and maturation in both men and women. The aim of this study is to evaluate the relationship of sex hormone levels; bone mineral density and biochemical markers of bone turnover in healthy Moroccan men. Methods: 142 Moroccan men who had no previous diagnosis of osteoporosis were enrolled prospectively in this cross-sectional study between December 2009 and August 2010. Also; subjects were excluded from the study if they had conditions affecting bone metabolism. Different biochemical parameters were assayed: Testosterone; Estradiol; sex hormone binding globulin; Osteocalcin; vitamin D; crosslaps; intact parathyroid hormone and alkaline phosphatase. Dual-energy X-ray absorptiometry was used to measure the Bone mineral density (BMD) (g/cm2). Results: in this study; among the 142 Moroccan men; 29 (20.1%) had densitometry osteoporosis and the prevalence of vitamin D insufficiency was 94%. No correlation was found between Estradiol; Testosterone and bone mineral density but we found significant differences in the levels of Estradiol between patients with osteoporosis; osteopenia and normal patients. Bone mineral density at the lumbar spine was negatively correlated to hormone-binding globulin and positively correlated to free androgen index; free estrogen index and the Body mass index. BMD at the total hip was positively correlated to free androgen index; Body mass index and negatively correlated to sex hormone binding globulin; alkaline phosphatase; intact parathyroid hormone; osteocalcin; Crosslaps and age. Conclusion: our study showed that increasing age; intact parathyroid hormone and alkaline phosphatase levels and decreasing body mass index were the most important independent factors associated to the presence of a low BMD at the total hip. Increasing body mass index and free androgen index level were the most important independent factors associated to the presence of a low BMD at the lumbar spine. The combination of variable that best predicted the male osteoporosis is age; body mass index; alkaline phosphatase and cigarette smoking