ORIGINAL ARTICLE Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound A. Díez-Pérez & J. González-Macías & F. Marín & M. Abizanda & R. Alvarez & A. Gimeno & E. Pegenaute & J. Vila & for the ECOSAP study investigators Received: 5 September 2006 / Accepted: 16 November 2006 / Published online: 18 January 2007 # International Osteoporosis Foundation and National Osteoporosis Foundation 2007 Abstract Summary The relationship between osteoporosis risk fac- tors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmen- opausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk. Introduction Low-trauma, non-spinal fractures are a grow- ing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non- spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models. Methods 5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporo- sis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture. Results Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/ wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for Osteoporos Int (2007) 18:629–639 DOI 10.1007/s00198-006-0297-5 A preliminary report of this study was presented at the plenary poster session of the 27th Annual Meeting of the American Society for Bone and Mineral Research, Nashville, TN, November, 22–27, 2005. For a complete list of ECOSAP investigators, see Appendix. The first and second authors equally contributed to the research and the manuscript. A. Díez-Pérez Bone Research Unit, Department of Internal Medicine, Hospital Universitario del Mar, Universidad Autónoma, Barcelona, Spain J. González-Macías Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain F. Marín Department of Medical Research, Eli Lilly and Company, Madrid, Spain M. Abizanda Primary Care Centre Gran Vía, Barcelona, Spain R. Alvarez Area X, Primary Care, Madrid, Spain A. Gimeno Primary Care Centre La Alcudia, Valencia, Spain E. Pegenaute Primary Care Centre Coronel de Palma, Madrid, Spain J. Vila Statistics Support Unit, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain A. Díez-Pérez (*) Unidad de Investigación en Fisiopatología Osea y Articular, Hospital del Mar-IMIM, Paseo Marítimo 25-29, 08003 Barcelona, Spain e-mail: adiez@imas.imim.es