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Screening for Osteoporosis: An Update for the U.S. Preventive Services Task Force

Appendix Table 1. Recent Studies Comparing Performance of Bone Measurement Tests in Predicting Fractures

Study, Year (Reference) Participants, n Type of Fracture Bone Measurement Test AUC (95% CI or SE) RR for Fracture (95% CI)*
Women
Hans et al, 1996 (71) 5662 Hip DEXA femoral neck; QUS BUA; QUS SOS Not reported 1.9 (1.6-2.4);
2.0 (1.6-2.4);
1.7 (1.4-2.1)
Bauer et al, 1997 (72) 6189 Nonvertebral; hip DEXA femoral neck; SXA calcaneus; QUS BUA Not reported 1.3 (1.1-1.5)§;
1.4 (1.2-1.6);
1.3 (1.2-1.5);
2.6 (1.9-3.8)§;
2.2 (1.9-3.0);
2.0 (1.5-2.7)
Khaw et al, 2004 (73) 8328 All QUS BUA; QUS SOS Not reported 1.90 (1.36-2.66);
1.62 (1.26-2.08)
Alexandersen et al, 2005 (74) 1034 All DEXA spine; DEXA femoral neck; DEXA distal radius; QUS SOS; QUS UBPI 0.60 (0.56-0.65);
0.66 (0.62-0.71);
0.64 (0.59-0.68);
0.60 (0.56-0.65);
0.60 (0.55-0.64)

1.35 (1.19-1.54);
1.81 (1.51-2.16);
1.47 (1.28-1.68);
1.26 (1.12-1.42);
1.55 (1.26-1.90)
Gluër et al, 2005 (75) 87 Vertebral DEXA spine; QUS SOS; QUS BUA; QUS stiffness Not reported 2.13 (1.08-4.16);
2.58 (1.17-5.68);
2.13 (1.04-4.34);
2.83 (1.26-6.34)
Stewart et al, 2006 (76) 775 All DEXA lumbar spine; DEXA femoral neck; QUS BUA 0.63 (0.60-0.67);
0.59 (0.56-0.63);
0.62 (0.59-0.66)

1.80 (1.17-2.77);
2.16 (1.35-3.47);
2.25 (1.51-3.34)
Frediani et al, 2006 (77) 1534 Vertebral DEXA spine; DEXA femoral neck; QUS stiffness; QUS stiffness plus DEXA spine; QUS stiffness plus DEXA femoral neck 0.95 (0.3); 0.89 (0.3); 0.93 (0.4); 0.97 (0.2); 0.95 (0.3) 4.18 (3.05-6.82)a;
3.13 (2.76-6.90);
4.18 (3.35-7.13)
Men
Mulleman et al, 2002 (68) 102 All DEXA lumbar spine; DEXA femoral neck; DEXA hip; QUS BUA; QUS SOS; QUS stiffness 0.80 (0.71-0.88);
0.73 (0.64-0.82);
0.81 (0.71-0.88);
0.69 (0.60-0.78);
0.75 (0.66-0.83);
0.74 (0.65-0.83)
2.8 (1.6-5.0)b;
1.9 (1.1-3.2);
3.4 (1.6-7.0);
1.6 (1.0-2.4);
2.3 (1.4-3.6);
2.1 (1.3-3.3)
Khaw et al, 2004 (73) 6471 All QUS BUA; QUS SOS Not reported 1.87 (1.23-2.86)**;
1.65 (1.17-2.33)
Gonnelli et al, 2005 (69) 407 All DEXA hip; QUS stiffness; combined Not reported 3.4 (2.5-4.8);
3.2 (2.3-4.5);
6.1 (2.6-14.3)
Varenna et al, 2005 (78) 4832 Nonvertebral; hip QUS BUA; QUS SOS; QUS stiffness Not reported

1.38 (1.22-1.59)††;
1.27 (1.17-1.38);
1.14 (0.96-1.40);
2.24 (1.61-3.08)††;
2.19 (1.56-3.11);
1.71 (1.18-3.24)

Bauer et al, 2007 (70) 5608 Nonvertebral; hip DEXA femoral neck; DEXA hip; QUS BUA; QUS SOS; QUS QUI Not reported

1.6 (1.4-1.9)§;
1.6 (1.4-1.9);
1.6 (1.4-1.8);
1.6 (1.4-1.9);
1.6 (1.4-1.9);
3.5 (2.5-4.9)§;
2.9 (2.2-4.0);
2.0 (1.5-2.8);
2.2 (1.6-3.1);
2.2 (1.6-3.1)

AUC = area under the curve; BMD = bone mineral density; BUA = broadband ultrasound attenuation; DEXA = dual-energy x-ray absorptiometry; QUI = quantitative ultrasound index (combines BUA and SOS); QUS = quantitative ultrasonography measured at the calcaneus in all studies; RR = risk ratio; SOS = speed of sound; SXA = single x-ray absorptiometry; UBPI = ultrasound bone profile index.
* For studies reporting more than 1 type of fracture, results for the first type are provided first, then results for the second type.
† Adapted from the Canadian Agency for Drugs and Technologies in Health Technology Report (140). Data from references 71 and 72 included for completeness.
‡ Per SD reduction in BMD or QUS measure, adjusted for age, weight, and clinic center.
§ Per SD reduction in BMD or QUS measure, adjusted for age and clinic.
a Adjusted for years of menopause, weight, height, and body mass index.
b Per SD reduction in BMD or QUS measure.
** Per SD reduction in QUS measure, adjusted for age, previous fracture, smoking status, weight, and height.
†† Per SD reduction in QUS measure, adjusted for age, weight, calcium intake, current smoking status, regular walking outside, bedridden periods >2 mo.

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