Calcium2026

Agreement analysis and inter-method agreement of quantitative ultrasound readings, and comparison with clinical risk factors: A bimodal approach to osteoporosis screening in the community of Terengganu.

Abdullah Nur Fatihah, Ibrahim Mohd Salami, Zulkafli Wan Muhammad Azly Wan, Bakar Mohamad Zakwan Helmi Abu et al. — Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry

Summary

This study explored a practical way to screen for osteoporosis in Malaysian communities, especially where advanced scans are scarce. It found that combining ultrasound with a risk assessment tool can effectively identify people at high risk, highlighting concerns about low calcium and vitamin D intake in the region.

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Key points

Combining ultrasound with a risk assessment tool (FRAX) can help identify osteoporosis risk.
This "bimodal" screening method is useful in communities with limited access to specialized bone density scans.
The study noted low calcium and vitamin D intake among participants, which are crucial for bone health.
This approach offers a practical way to improve bone health screening, especially in rural areas.

What the study looked at

What question the study asked: How can we effectively screen for osteoporosis in communities, especially where advanced bone density scans (like DXA) are not readily available? Specifically, can combining quantitative ultrasound (QUS) with a fracture risk assessment tool (FRAX) provide a reliable alternative? How it was studied (design/participants): Researchers conducted a cross-sectional study in Terengganu, Malaysia, involving 450 participants from urban, rural, and workplace settings. They collected data on various health factors, including calcium and vitamin D intake, and assessed participants using both calcaneal quantitative ultrasound (QUS) and the FRAX tool. The study then looked at how well these two methods agreed and the consistency of QUS measurements. What it found: The study found that combining QUS and FRAX, termed a "bimodal approach," was a reliable way to identify individuals at high risk for osteoporosis. While QUS alone identified a higher percentage of at-risk individuals than FRAX, the combined approach effectively prioritized those needing further attention. The agreement between the two methods was fair overall, but notably higher in men and older adults. Importantly, the study also observed generally low calcium and vitamin D intake among participants, particularly in rural areas.

Dietary takeaway

The study highlights that many people, especially in rural areas, may not be getting enough calcium and vitamin D, which are vital for strong bones. To support bone health, consider incorporating calcium-rich foods like dairy products, leafy greens, and fortified foods into your daily diet, alongside adequate vitamin D from sunlight exposure or fortified options. Remember, this is just one study, and more research is always needed to confirm findings and guide public health recommendations.

Abstract

INTRODUCTION: Osteoporosis is an increasingly prevalent condition in Malaysia, raising concern over fracture risk and its impact on healthcare. The limited availability of dual-energy X-ray absorptiometry (DXA) necessitates the development of practical alternatives for community-based screening. This study evaluated the inter-method agreement between quantitative ultrasound (QUS) and FRAX using a bimodal approach in community-based osteoporosis screening in Terengganu, Malaysia, and assessed the intra-rater reliability of QUS readings. METHODS: A cross-sectional study was conducted between 2023 and October 2025 involving 450 participants recruited from urban, rural, and workplace settings. The data collected included age, calcium and vitamin D intake, use of osteoporosis medication, history of bone scans, physical activity, smoking status, and community bone health screening using the bimodal approach, which comprises calcaneal QUS and FRAX. Inter-rater agreement reliability between QUS and FRAX was assessed using Gwet's AC2, while intra-rater reliability of the QUS measurement was determined using the intraclass correlation coefficient (ICC). RESULTS: Overall, the calcium and vitamin D intake were relatively low, with only 43.5% of rural participants taking these supplements, and only 18.3% engaging in regular exercise. The QUS identified 52.2% of participants as prioritised (T-score less -1.5), while FRAX only 9.1% (>10% major osteoporotic fracture or 3% hip fracture). Leveraging both readings, the bimodal approach identified 227 participants at high risk. The inter-method agreement supported this outcome between QUS and FRAX, which was fair (AC2 = 0.236). It was higher in males (AC2 = 0.925) and adults aged 60-80 years (AC2 = 0.930). The QUS reading showed consistency across repeated measures, with high intra-rater reliability of QUS (ICC = 0.89). CONCLUSION: The combination of QUS and FRAX in a bimodal screening approach provides a reliable method for assessing osteoporosis risk. This strategy provides a practical foundation for enhancing bone health screening, particularly in rural communities where access to DXA is limited.

View on PubMed →DOI: 10.1016/j.jocd.2026.101720