The Optimal Cut-Points for Weight and Non-Weight
Quantitative Ultrasound of the Calcaneus to Screen
Osteoporosis in Postmenopausal Women
Sakda Arj-Ong Vallipakorn MD, PhD*, Orawin Vallipakorn MD*,
Areepan Sophonsritsuk MD, PhD**, Mayuree Jirapinyo MD**, Chanika Sritara MD***
Affiliation :
* Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi, Hospital,
Mahidol University, Bangkok, Thailand
** Menopause Division, Department of Obstetrics & Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
*** Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the optimal cut-off point of quantitative ultrasound (QUS) of the calcaneus, and optimized position
for QUS of the calcaneus, between non-weight (sitting) and weight (standing) position, to screen osteoporosis in
postmenopausal women.
Material and Method: A cross-sectional study of postmenopausal women aged 65 years or older who came for bone mineral
density (BMD) evaluation at the menopause unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital between
April 2013 and October 2015. Bone tissue was measured by using QUS of the calcaneus in the standard sitting (non-weight
position) and in standing (weight position) consecutively of non-dominant calcaneus to compared with BMD that measured
by dual energy X-ray absorptiometry (DXA) of lumbar spine and hip within the same visit of QUS measurement. The area
under Receiver Operating Characteristic (ROC) curve and optimal of diagnostic properties to diagnosed osteoporosis were
analyzed by sensitivity, specificity, positive and negative likelihood ratio (LR+/-).
Results : One hundred sixty one postmenopausal women were enrolled, median age was 70 (65, 94) years old, median time
since menopause was 22 (10, 55) years. Ten point five percent of subjects had history of osteoporotic fracture at wrist. The
prevalence of osteoporosis was 23% at lumbar spine and 30% at femoral neck respectively. Area under ROC curve for
diagnosed osteoporosis was 0.73 in the non-weight QUS of the calcaneus and correlated well with using DXA at neck of
femur (gold standard). However, the weight or standing position did not improve the diagnostic power of QUS of the
calcaneus. The optimal cut-point value of QUS of the calcaneus to screen osteoporosis at stiffness index was determined
by T-score of ≤ -2.6 with 81.42%, 45.83%, 1.5, and 0.41 for the sensitivity, specificity, LR+/- respectively.
Conclusion : QUS of the calcaneus was acceptable and promising to be alternative tool for screening osteoporosis in
postmenopausal woman age older than 65 years by the optimal cut-point of stiffness index T-score at ≤ -2.6 measured in
standard position or non-weight method.
Keywords : QUS, DXA, Calcaneus, Ultrasound, Osteoporosis, Screening, Weight, Non-weight
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