Comparison of calcaneal quantitative ultrasound and bone densitometry parameters as fracture risk predictors in type 2 diabetes mellitus

Abstract Aim To investigate the utility of calcaneal quantitative ultrasound compared with bone densitometry (DXA) in predicting incident low‐trauma fracture in type 2 diabetes. Methods This retrospective cohort study included a subset of participants in the Dubbo Osteoporosis Epidemiology Study who had concurrent calcaneal quantitative ultrasound and DXA measurement, comprising 809 people without type 2 diabetes and 96 with type 2 diabetes. Fracture data had been collected prospectively. Cox proportional hazard models and receiver operating curves (ROC) were used to compare calcaneal quantitative ultrasound and DXA parameters as predictors for any low‐trauma fracture. Results The median age of participants was 71 years (IQR 68–76, 50% men) for those without type 2 diabetes and 70 years (IQR 68–76, 55% men) for those with type 2 diabetes. There was no difference in low‐trauma fracture incidence between groups when stratified by sex. In those without type 2 diabetes, the hazard ratio for fracture per 1 sd decrease in broadband ultrasound attenuation and femoral neck bone mineral density (BMD) was 1.47 [95% confidence interval (CI) 1.26–1.71] and 1.39 (95% CI 1.17–1.64), respectively. The corresponding figures in type 2 diabetes were 1.81 (95% CI 1.03–3.19) for broadband ultrasound attenuation and 2.55 (95% CI 1.28–5.08) for femoral neck BMD. Conclusion Broadband ultrasound attenuation is comparable with femoral neck BMD as a predictor for low trauma incident fracture in type 2 diabetes. Calcaneal quantitative ultrasound offers several advantages over DXA and should be considered in further studies of bone health screening or in clinical practice where DXA is unavailable.