2020 Volume 57 Issue 1 Pages 81-88
Aim: To investigate whether a combination of readily available osteoporosis screening systems, instead of dual energy X-ray absorptiometry (DXA), can aid in the identification of characteristic features of hip fracture in post-menopausal patients undergoing hemodialysis.
Methods: Forty patients (58-90 years old) who had undergone quantitative ultrasound (QUS) on more than one occasion were included. Heel QUS (conducted yearly for 3 years), digital image processing (DIP), and the fracture risk assessment tool (FRAXR) were used to evaluate bone fragility. The latter two assessments (DIP and FRAXR) were conducted on 25 and 26 of the 40 patients mentioned above respectively, for this study.
Results: Hip fractures were identified in five patients. The mean values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) in patients with hip fractures were 80±7 dB/MHz and 1,491±14 m/s, respectively, while the recorded values in patients without fractures were 88±9 dB/MHz and 1,506±22 m/s, respectively. The maximum value of BUA and SOS in patients with hip fractures were 91 dB/MHz and 1,510 m/s, respectively. These values were similar to the mean values in patients without fractures. The DIP (YAM) was 55-67% in four patients with fractures, compared to 44 - 91% in 25 examined patients without fractures. Moreover, in four patients with fractures, the FRAXR score was 12 - 55% for major osteoporotic fracture (MOF) and 3.3 - 9.3% for hip fracture (HF), compared to 4.4 - 33% for MOF and 0.3 -18% for HF in 26 examined patients without fractures. The results of these three methods were not statistically significant between patients with and without fractures.
Conclusions: The combination of the three screening systems was not superior diagnostic method for hip fractures in post-menopausal patients, compared to DXA. Heel QUS and FRAXR (MOF, HF), both of which do not include bone mineral content (BMC) and DIP (peripheral cortical bone), which accounts for BMC, were used to evaluate bone fragility. In patients undergoing hemodialysis, the clinical importance of measuring DXA is growing, but it is necessary to estimate not only bone mass, but also bone quality. New modalities for the evaluation of bone quality are required in the future.
