Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures:​ a 5-year follow-up study

Adami, Giovanni; Arioli, Giovanni; Bianchi, Gerolamo; Brandi, Maria Luisa; Caffarelli, Carla; Cianferotti, Luisella; Gatti, Davide; Girasole, Giuseppe; Gonnelli, Stefano; Manfredini, Monica; Muratore, Maurizio; Quarta, Eugenio; Quarta, Laura

Affiliations

¹Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy

²Department of Neurosciences and Rehabilitation, “Carlo Poma” Hospital, ASST-Mantova, Mantova, Italy

³SC Rheumatology, ASL 3 Genovese, Genoa, Italy

⁴Department of Experimental and Clinical Biomedical Sciences, University of Florence, Metabolic Bone Diseases Unit, University Hospital of Florence, Florence, Italy

⁵Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy

⁶O.U. of Rheumatology, “Galateo” Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy

Abstract and keywords

Purpose: To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures.

Methods: A population of Caucasian women (30–90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F’ and Group NF’, respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA.

Results: 1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9–5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0–73.3] and 67.3 [65.4–69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, −2.9 [−3.6 to −1.9] in Group F’, −2.2 [−2.9 to −1.2] in Group NF’) and DXA T-score (−2.8 [−3.3 to −1.9] in Group F’, −2.2 [−2.9 to −1.4] in Group NF’) were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of −2.5, REMS identified Group F’ patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77–3.76, p < 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20–2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80–4.39, p < 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71–4.21, p < 0.001).

Conclusions: REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.

Keywords: Fragility fracture risk; Osteoporosis diagnosis; REMS; Bone mineral density; Ultrasound; DXA

Links

DOI: 10.1016/j.bone.2020.115297

PubMed: 32092480

WoS: 000527850700024

History

Received: 2019-09-23

Revised: 2020-02-20

Accepted: 2020-02-20

Online: 2020-02-21

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Cited By (2)

Year	Entry
2021	Cortet B, Dennison E, Diez-Perez A, Locquet M, Muratore M, Nogués X, Ovejero Crespo D, Quarta E, Brandi ML. Radiofrequency echographic multi spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context. Bone. February 2021;143:115786.
2021	Ulivieri FM, Rinaudo L. Beyond bone mineral density: a new dual x-ray absorptiometry index of bone strength to predict fragility fractures, the bone strain index. Front Med. January 15, 2021;7:590139.