Association Between Radius Axial Low-Frequency Ultrasound Velocity and Bone Fragility in Primary Hyperparathyroidism

Abstract

Context: Radius quantitative ultrasound measurement utilizing portable low-frequency (VLF) axial transmission ultrasound for assessing properties of radius cortical bone revealed a possible role as a screening tool prior to dual-energy x-ray absorptiometry (DXA) to evaluate fragility fracture in some studies.

Objective: To evaluate this portable ultrasound device as a screening tool of skeletal fragility in patients with primary hyperparathyroidism (PHPT).

Methods: We enrolled 117 postmenopausal women with PHPT. Every subject had a DXA of femur, lumbar spine, nondominant distal one-third radius section, trabecular bone score (TBS) measurement, VLF with a portable device, and spine x-ray.

Results: The mean age of the patients was 68 ± 10 years. The measurement of agreement between radius DXA and VLF was: K = 0.43, P < .001. A lower radius ultrasound T-score, also adjusted for years since menopause and body mass index, was associated with DXA-identified osteoporosis at lumbar and/or femoral neck sites: odds ratio (OR) = 1.852 (CI 1.08, 3.18). All fractures were associated with femoral neck T-score: OR = 1.89 (95% CI 1.24, 2.89), as well as with total hip T-score: OR = 1.65 (95% CI 1.09, 2.50), and years since menopause: OR = 1.25 (95% CI 1.02, 1.54).Morphometric vertebral fractures were associated with years since menopause: OR = 1.28 (95% CI 1.02, 1.61), femoral neck T-score OR = 1.96 (95% CI 1.227, 3.135), total hip T-score OR = 1.64 (95% CI 1.04, 2.60), TBS OR = 0.779 (95% CI 0.60-0.99), both ultradistal radius T-score: OR = 1.50 (95% CI 1.05, 2.156), and radius ultrasound T-score: OR = 1.67 (95% CI 1.09, 2.56).

Conclusion: VLF could be used for screening purposes prior to DXA to evaluate PHPT fracture risk, only in conditions in which DXA measurement cannot be performed.

Keywords: bone ultrasound; cortical bone; osteoporosis; primary hyperparathyroidism.