Long-term fracture prediction by DXA and QUS: A 10-year prospective study

Alison Stewart, A. Kumar, David M Reid

Research output: Contribution to journalArticlepeer-review

80 Citations (Scopus)


This study investigated the ability of DXA and QUS to predict fractures long term when measured around the time of the menopause. We found both DXA and QUS are able to predict both any fracture and "osteoporotic" fractures and that QUS can predict independently of BMD.

Introduction: There are now many treatments available for prevention of osteoporotic fracture. To be cost-effective, we need to target those most at risk. This study examines the ability of DXA and QUS to predict fractures in an early postmenopausal population of women.

Materials and Methods: We prospectively measured 3883 women who had been randomly selected from a community-based register. At baseline, they were measured using DXA of spine and hip (Norland XR-26) and QUS of the heel (Walker Sonix UBA 575). Follow-up had a mean of 9.7 +/- 1.1 (SD) years. All incident fractures were identified and validated by examination of X-ray reports, and these were compared with those without fracture in a Cox-regression model to calculate hazard ratios (HRs).

Results: We found adjusted HRs for any fracture per 1 SD reduction in spine BMD to be 1.61. (1.42-1.83), whereas neck of femur BMD was 1.54 (1.34-1.75). Areas under the curve (AUC) for a receiver operator characteristic (ROC) analysis were 0.62 for spine BMD and 0.59 for neck BMD. In a subgroup where OUS was also measured, the HR for a 1 SD reduction in BMD was 1.69 (1.29-2.22) for spine BMD and 1.55 (1.17-2.06) for neck BMD. The HR for a 1 SD reduction in broadband ultrasound attenuation (BUA) was 1.53 (1.19-1.96), and 1.44 (1.12-1.86) when further adjusted for neck BMD. The AUCs were 0.63 for spine BMD, 0.59 for neck BMD, and 0.62 for BUA. When only osteoporotic fractures were examined, the HRs increased in all situations. BUA showed the highest HR of 2.25 (1.51-3.34), and when further adjusted for neck BMD was 2.12 (1.38-3.28).

Conclusions: In conclusion, it may be possible to scan women around the time of the menopause to predict future fractures. It seems that, for "osteoporotic" fractures, BUA may be an improved predictor of fractures in comparison with DXA, because the relative risk is highest for BUA, and independent of BMD.

Original languageEnglish
Pages (from-to)413-418
Number of pages5
JournalJournal of Bone and Mineral Research
Issue number3
Early online date19 Dec 2005
Publication statusPublished - Mar 2006


  • fractures
  • prospective study
  • DXA
  • QUS
  • menopause
  • bone-mineral density
  • elderly-women
  • hip fracture
  • quantitative ultrasound
  • risk-factors
  • perimenopausal fractures
  • osteoporotic fractures
  • older women
  • T-scores
  • absorptiometry


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