DXA of the hip and heel ultrasound but not densitometry of the fingers candiscriminate female hip fracture patients from controls: A comparison between four different methods

Dual-energy X-ray absorptiometry (DXA) of the proximal femur and in more re cent years quantitative ultrasound (QUS) of the heel are the most establish ed methods for assessing hip fracture risk. Measurement of the fingers offe rs a new approach. We performed DXA of the proximal femur, QUS of the heel and fingers, and radiographic absorptiometry (RA) of the fingers in 87 non- institutionalized women, 65-85 years of age, with a first hip fracture and compared them with 195 randomly selected age-matched controls. Bone mineral density (BMD) of the femoral neck and heel Stiffness Index were significan tly lower among cases than among controls (by 15% and 17%, respectively; p <0.0001), whereas no significant differences were found for finger measurem ents. When applying the WHO criterion of osteoporosis, 62-98% of the patien ts were classified as osteoporotic, compared with 19-85% of the controls, d epending on method and site. The risks of hip fracture, estimated as odds r atios for every 1 SD reduction in femoral neck BMD, heel Stiffness Index, f inger QUS and finger RA, were: 3.6 (95% CI 2.4-5.5), 3.4 (95% CI 2.2-5.0), 1.0 (95% CI 0.7-1.3) and 1.2 (95% CI 0.81.6), respectively. Compared with w omen with normal BMD of the femoral neck, those classified as osteopenic ha d an odds ratio of hip fracture of 14 (95% CI 2-110), whereas those classif ied as osteoporotic had an odds ratio of 63 (95% CI 8-501). We conclude tha t hip DXA and heel QUS have similar capacities to discriminate the risk of a first hip fracture, whereas QUS and RA of the phalanges seem inferior tec hniques for differentiating female hip fracture patients from controls.