Discriminatory ability of calcaneal quantitative ultrasound in the assessment of bone status in patients with inflammatory bowel disease

Scientific paper - Original scientific paper

• Author: Nikša Turk
• Author: Darko Kaštelan
• Author: Silvija Čuković-Čavka
• Author: Ivana Kraljević
• Author: Mirko Koršić
• Author: Boris Vucelić
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff </= -1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than -1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff </= -1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis.

• Keywords (english): Bone Diseases, Metabolic - complications - ultrasonography; Calcaneus - ultrasonography; Inflammatory Bowel Diseases - complications - ultrasonography; Absorptiometry, Photon; Adrenal Cortex Hormones - therapeutic use; Adult; Colitis, Ulcerative - complications - ultrasonography; Crohn Disease - complications - ultrasonography; Female; Fractures, Bone - complications; Humans; Male; Middle Aged; Osteoporosis - complications - ultrasonography; Sensitivity and Specificity
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Accepted version
• Journal title: Ultrasound in Medicine & Biology
• Numbering: vol. 33, no. 6, pp. 863-869
• p-ISSN: 0301-5629
• DOI: https://doi.org/10.1016/j.ultrasmedbio.2007.01.003
• URN:NBN: urn:nbn:hr:105:192057
• Publication: 2007
• Document URL: http://doi.org/10.1016/j.ultrasmedbio.2007.01.003
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 08:51:22