A population-based study examining calcaneus quantitative ultrasound and its optimal cut-points to discriminate osteoporotic fractures among 9352 Chinese women and men

J Clin Endocrinol Metab. 2012 Mar;97(3):800-9. doi: 10.1210/jc.2011-1654. Epub 2011 Dec 14.


Context: No generally accepted thresholds for quantitative ultrasound (QUS) parameters to screen individuals at high risk of osteoporotic fractures have been defined.

Objective: We sought to define appropriate cutoff points for osteoporotic fractures of calcaneus ultrasound according to participants' prevalent osteoporotic fractures.

Design and setting: This was a cross-sectional, population-based study conducted in Shanghai, China.

Participants: A total of 9352 Chinese women and men aged 40 and older were studied.

Main outcome measures: We measured calcaneus QUS (Achilles Express, GE Lunar) values and their relationships with osteoporotic fractures.

Results: A prevalence of 14.9 and 12.2% of osteoporotic fractures was found in the women and men (P<0.001), respectively. Subjects with osteoporotic fractures had significantly lower QUS values than those without (P<0.001). One sd decline in the stiffness index (SI)-derived T-score was associated with a high risk of nonvertebral fracture [odds ratio (OR)=1.50; 95% confidence interval (CI), 1.39-1.62; P<0.001], clinical vertebral fracture (OR=1.49; 95% CI, 1.18-1.90; P<0.01), and multi-fractures (OR=1.98; 95% CI, 1.63-2.40; P<0.001). The receiver operating characteristic analysis showed that QUS could differentiate osteoporotic fractures in postmenopausal women and men, but not in premenopausal women. The optimal cutoff points for the SI-derived T-score to detect a high risk of nonvertebral fractures, clinical vertebral fractures, and multi-fractures were -1.25, -1.55, and -1.80 in postmenopausal women, respectively, and -1.30, -1.90, and -2.00 in males, respectively.

Conclusions: As a screening tool, the SI-derived T-score obtained from the Achilles QUS device for a postmenopausal woman or man that is less than -1.25 and -1.30, respectively, may indicate an increased risk of osteoporotic fractures and should be further evaluated by central DXA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Calcaneus / diagnostic imaging*
  • China
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Osteoporotic Fractures / diagnostic imaging*
  • Predictive Value of Tests
  • Surveys and Questionnaires
  • Ultrasonography