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Colleen M. Renier, BS1, AM Fernandez, MD2, Wanda Gordon, RN2, Jeanette A. Palcher, BA1, and Irina V. Haller, PhD, MS3. (1) Division of Education & Research, St. Mary's/Duluth Clinic Health System, 5AV2ME, 400 E 3rd St, Duluth, MN 55805, 218-786-3834, crenier@smdc.org, (2) Section of Rheumatology, St. Mary's/Duluth Clinic Health System, 400 East 3rd Street, Duluth, MN 55805, (3) Division of Education & Research, St. Mary's/Duluth Clinic Health System , 5AV2ME, 400 East 3rd Street, Duluth, MN 55805
Purpose: The population of northeast-Minnesota/northwest-Wisconsin is at elevated risk for osteoporosis, due to age and racial composition. Many live far from specialty care, so dual-energy x-ray absorptiometry (DXA) is inaccessible. Heel ultrasound (HUS) is an alternative, but questions about accuracy remain. The DXA-HUS Registry was designed to evaluate the correlation of HUS with DXA, and regional post-test fracture risk factors. Methods: Data included June 1998-December 2002 HUS and DXA reports, plus fracture incidence, through December 2003, from electronic records. Analysis was restricted to patients 18+ years of age. HUS and DXA t-scores were compared for tests within 12-months, using Pearson’s r, with sensitivity (SENS) and positive predictive value (+PRED) computed, following recode to Normal (>-1.0); Abnormal (<-1.0). Bivariate odds ratios (O.R.) and 95% confidence intervals, were computed and multivariate models were evaluated using stepwise logistic regression. Results: Comparing 726 pairs of HUS and DXA, Pearson’s r =0.443 (p<0.001); HUS SENS=95.1%, and +PRED=75.8%. Bivariate analysis of 5869 HUS patients, identified overall fracture and hip fracture risks (O.R.), respectively, for: abnormal HUS (2.5;5.8); history of steroid use (1.4;2.4); post-menopausal women (1.6;4.6); age 70-79 (2.3;4.9) and 80+ (3.5;10.2), compared to <70. Multivariate analysis identified overall fracture risks for: abnormal HUS (1.9); history of steroid use (1.4); age 70-79 (1.6) and 80+ (2.7), compared to <70. Hip fracture risks were found for: abnormal HUS (1.9); age 70-79 (1.7) and 80+ (2.7), compared to <70. Conclusions: Regionally, HUS lacks precision for diagnostic testing, yet is effective in screening, identifying patients at elevated risk for fractures.
Learning Objectives: At the conclusion of the session, the participant will be able to
Keywords: Screening, Risk Factors
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.