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
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).…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 227 participants or records.
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