ULTRASOUND AND DUAL X-RAY ABSORPTIOMETRY DENSITOMETRY IN WOMEN WITH HIP FRACTURE

To assess the usefulness of the measurement of the os calcis by ultras ound, a method that probably reflects bone quality as well as density, we have studied 54 women with hip fracture of the proximal femur and a control group. Ultrasound evaluation of the os calcis [broadband ult rasound attenuation (BUA), speed of the sound (SOS), and a combined in dex (''stiffness'')], and bone mineral density (BMD) determination ove r the proximal femur by dual X-ray absorptiometry (DXA) were performed , Weight, BMD, and ultrasound values in the hip fracture patients were significantly lower than controls (P < 0.001), The Z-scores for BUA a nd stiffness were not different than that for femoral neck, Ward's tri angle or trochanteric BMD (between -1.7 and -1.5). The odds ratios det ermined by receiver-operating characteristics (ROC) analysis were grea ter at the femoral neck (25.1) and BUA (24.4). Intermediate values wer e found at stiffness (16.9), Ward's triangle (12.8), and trochanter (1 1.1), and lower values were obtained at SOS (4.2). In turn, patients w ith trochanteric hip fractures had a significantly lower femoral neck and Ward's triangle BMD, stiffness, and BUA than patients with cervica l hip fractures. Comparing a subgroup of 30 women with hip fractures w ithout vertebral fractures with an age-matched group of 87 women with osteoporotic vertebral fractures, both groups were of similar weight a nd BMD but all ultrasound values were significantly lower in the hip f ractures compared with vertebral fracture patients (P < 0.05 - P < 0.0 1). Our findings suggest that in women with hip fractures, ultrasound evaluation of the os calcis has diagnostic sensitivity comparable to D XA of the femur and could be useful to predict hip fracture risk. Ultr asound values are lower in hip fractures compared with vertebral fract ure, age-matched women and in older compared with younger hip fracture patients.