Prediction of fractures in perimenopausal women: a comparison of dual energy x ray absorptiometry and broadband ultrasound attenuation.

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Abstract
OBJECTIVE: To consider whether bone mineral density (BMD) measurements can predict traumatic fractures occurring in perimenopausal women. METHODS: One thousand perimenopausal women called up for screening underwent both dual energy x ray absorptiometry (DXA) of the spine and hip, and broadband ultrasound attenuation (BUA) of the heel. Two years later, they were sent a questionnaire to discover those who had since had a fracture, and compare them with those who had not. RESULTS: About 2% of the women had sustained a fracture in the two years since attendance for screening. Fractures in this age group can be predicted weakly, but significantly, by bone mass measurements using DXA and BUA (odds ratios from 1.4 to 2.1). The lumbar spine appeared to be one of the best predictive sites (odds ratio for 1 SD reduction in BMD 2.1 (95% confidence interval 1.2 to 3.8)), but no significant differences were found between the areas under the curve in receiver operator characteristic (ROC) analysis. CONCLUSION: In this preliminary study it appeared that bone mass measurements are predictive of perimenopausal traumatic fractures in addition to postmenopausal fractures related to osteoporosis. DXA of the lumbar spine did not perform significantly better than BUA. The number of fractures occurring was low, however, and further long term follow up is required to confirm the finding.