Semin Musculoskelet Radiol 2002; 06(3): 229-232
DOI: 10.1055/s-2002-36720
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Quantitative Ultrasound in Osteoporosis

Alison Stewart1 , David M. Reid2
  • 1Postdoctoral Research Fellow, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom
  • 2Professor of Rheumatology, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom
Further Information

Publication History

Publication Date:
23 January 2003 (online)

ABSTRACT

Quantitative ultrasound (QUS) has been applied to the assessment of bone for almost two decades. The physical interaction of ultrasound and bone is complex and not completely understood. However, it is considered that QUS provides information on bone mass and structure. Although dual-energy X-ray absorptiometry (DXA) is currently considered the "gold standard" for the diagnosis of osteoporosis, through the World Health Organisation definition, there is, in some parts of the world, limited availability to axial DXA. This has stimulated interest in smaller, more portable, and less expensive techniques to indentify those at risk of osteoporotic fracture. One such quantitative method is QUS, which has the added advantage over other photon absorptiometric bone density techniques of not using ionizing radiation. This article reviews the capabilities of QUS and indicates its appropriate application in clinical practice, based on current review of the scientific literature.

REFERENCES

  • 1 Langton C M, Palmer C R, Porter R W. The measurement of broadband ultrasonic attenuation in cancellous bone.  Eng Med . 1984;  13 89-91
  • 2 Gluer C C, for the International Quantitative Ultrasound Consensus Group. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status.  J Bone Miner Res . 1997;  12 1280-1288
  • 3 Miller P D, Bonnick S L, Rosen C J. Consensus of an international panel on the clinical utility of bone mass measurements in the detection of low bone mass in the adult population.  Calcif Tissue Int . 1996;  58 207-214
  • 4 Kanis J A, Glüer C C. >for the Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry.  Osteoporo Int . 2000;  11 192-202
  • 5 Kanis J A, and the WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report.  Osteoporo Int . 1994;  4 368-381
  • 6 Grampp S, Genant H K, Mathur A. Comparison of non-invasive bone mineral measurements in assessing age-related bone loss, fracture discrimination and diagnostic classification.  J Bone Miner Res . 1997;  12 697-711
  • 7 Langton C M, Langton D K. Comparison of BMD and QUS of the calcaneus: site-matched correlation and the discrimination of axial BMD status.  Br J Radiol . 2000;  73 31-36
  • 8 Langton C M, Njeh C F, Hodgskinson R, Currey J D. Prediction of mechanical properties of the human calcaneus by broadband ultrasound attenuation.  Bone . 1996;  18 495-503
  • 9 Nicholoson P H, Muller R, Lowet G. Do quantitative ultrasound measurements reflect structure independently of density in human vertebral cancellous bone?.  Bone . 1998;  23 425-431
  • 10 Bouxsein M L, Radloff S E. Quantitative ultrasound of the calcaneus reflects the mechanical properties of calcaneal trabecular bone.  J Bone Miner Res . 1997;  12 839-846
  • 11 Hodgskinson R, Njeh C F, Currey J D, Langton C M. The ability of ultrasound velocity to predict the stiffness of cancellous bone in vitro.  Bone . 1997;  21 183-190
  • 12 Hans D, Wu C, Njeh C F. Ultrasound velocity of trabecular cubes reflects mainly bone density and elasticity.  Calcif Tissue Int . 1999;  64 18-23
  • 13 Bouxsein M, Coan C S, Lee S C. Prediction of the strength of the elderly proximal femur by bone mineral density and quantitative ultrasound measurements of the heel or tibia.  Bone . 1999;  25 49-54
  • 14 Hans D, Dargent-Molina P, Schott A M. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study.  Lancet . 1996;  348 511-514
  • 15 Bauer D C, Gluer C C, Cauley J A. Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group.  Arch Intern Med . 1997;  157 629-634
  • 16 Pluijm S MF, Graafmans W C, Bouter L M, Lips P. Ultrasound measurements for the prediction of osteoporotic fractures in elderly people.  Osteoporo Int . 1999;  9 550-556
  • 17 Mele R, Masci G, Ventura V. Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population.  Osteoporo Int . 1997;  7 552-559
  • 18 Stewart A, Torgerson D J, Reid D M. Prediction of fractures in perimenopausal women: a comparison of dual energy X-ray absorptiometry (DXA) and broadband ultrasound attenuation (BUA).  Ann Rheum Dis . 1996;  55 140-142
  • 19 Thompson P, Taylor J, Fisher A, Oliver R. Quantitative heel ultrasound in 3180 women between 45 and 75 years of age: compliance, normal ranges and relationship to fracture history.  Osteoporo Int . 1998;  8 211-214
  • 20 Ross P, Haung C, Davis J. Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound.  Bone . 1995;  16 325-332
  • 21 Heaney R P, Avioli L V, Chestnut III H C. Ultrasound velocity through bone predicts incident vertebral deformity.  J Bone Miner Res . 1995;  10 341-345
  • 22 Huang C, Ross P D, Yates A J. Prediction of fracture risk by radiographic absorptiometry and quantitative ultrasound; a prospective study.  Calcif Tissue Int . 1998;  63 380-384
  • 23 Bauer D C, Gluer C C, Genant H K, Stone K. Quantitative ultrasound and vertebral fracture in postmenopausal women.  J Bone Miner Res . 1995;  10 353-358
  • 24 Glüer C C, Cummings S R, Bauer D C. Osteoporosis: association of recent fractures with quantitative US findings.  Musculoskelet Radiol . 1996;  199 724-732
  • 25 Stewart A, Felsenberg D, Kalidis L, Reid D M. Vertebral fractures in men and women: how discriminant are bone mass requirements?.  Br J Radiol . 1995;  68 614-620
  • 26 Gonelli S, Cepollaro C, Agnusdei D. Diagnostic value of ultrasound analysis and bone densitometry as predictors of vertebral deformity in postmenopausal women.  Osteoporo Int . 1995;  5 413-418
  • 27 Cepollaro C, Gonnelli S, Pondrelli C. The combined use of ultrasound and densitometry in the prediction of vertebral fracture.  Br J Radiol . 1997;  70 691-696
  • 28 Hartl F, Tyndall A, Kraenzlin M. Discriminatory ability of quantitative ultrasound parameters and bone mineral density in a population-based sample of postmenopausal women with vertebral fractures: results of the Basel Osteoporosis Study.  J Bone Miner Res . 2002;  17 321-330
  • 29 Kung A WC, Luk K D, Chu L W, Tang G WK. Quantitative ultrasound and symptomatic vertebral fracture risk in Chinese women.  Osteopor Int . 1999;  10 456-461
  • 30 Knapp K M, Blake G M, Spector T D, Fogelman I. Multisite quantitative ultrasound: precision, age- and menopause-related changes, fracture discrimination, and T-score equivalence with dual-energy x-ray absorptiometry.  Osteopor Int . 2001;  12 456-464
  • 31 Langton C M, Ballard P A, Bennett D K, Purdie D W. Maximising the cost effectiveness of BMD referral for DXA using ultrasound as a selective population pre-screen.  Technology in Healthcare . 1997;  5 235-241
  • 32 Stewart A, Reid D M. Quantitative ultrasound or clinical risk factors-which identifies women at risk of osteoporosis?.  Br J Radiol . 2000;  73 165-171
  • 33 Benitz C L, Scheidner D I, Barrett-Connor E, Sartoris D J. Hand ultrasound for osteoporosis screening in postmenopausal women.  Osteoporo Int . 2000;  11 203-210
  • 34 Langton C M, Langton D K, Beardsworth S A. Accuracy of clinical criteria and BUA for referral for BMD assessment by DXA in osteoporotic and osteopenic perimenopausal women.  Technology in Healthcare . 1999;  7 319-330
  • 35 Sim M FV, Stone M, Johansen A. Cost effectiveness analysis of BMD referral for DXA using ultrasound as a selective pre-screen in a group of women with low trauma Colles' fractures.  Technol Health Care . 2000;  8 277-284
  • 36 Royal College of Physicians. Osteoporosis: Clinical Guidelines for Prevention and Treatment London: Royal College of Physicians 1999
  • 37 Royal College of Physicians. Osteoporosis: Clinical Guidelines for Prevention and Treatment. Update on Pharmacological Interventions and an Algorithm for Management. London: Royal College of Physicians; 2000
  • 38 Faulkner K G, von Stetten E, Miller P. Discordance in patient classification using T-scores.  J Clin Densitom . 1999;  2 343-350
  • 39 Frost M L, Blake G M, Fogelman I. Contact quantitative ultrasound: an evaluation of precision, fracture discrimination, age-related bone loss and applicability of the WHO criteria.  Osteoporo Int . 1999;  10 441-449
  • 40 Frost M L, Blake G M, Fogelman I. Can the WHO criteria for diagnosing osteoporosis be applied to calcaneal quantitative ultrasound?.  Osteoporo Int . 2000;  11 321-330
  • 41 Cheng S, Fan B, Wang L. Factors affecting broadband ultrasound attenuation results of the calcaneus using a gel-coupled quantitative ultrasound scanning system.  Osteoporo Int . 1999;  10 495-504
  • 42 Stewart A, Reid D M. Precision of quantitative ultrasound (QUS) comparison of three commercial scanners.  Bone . 2000;  27 139-143
  • 43 Looker A C, Orwoll E S, Johnston Jr C C. Prevalence of low femoral bone density in older US adults from NHANES III.  J Bone Miner Res . 1997;  12 1761-1768
  • 44 Cummings S R, Black D M, Thompson D E. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.  JAMA . 1998;  280 2077-2082
  • 45 Sahota O, San P, Cawte S A, Pearson D, Hosking D J. A comparison of the longitudinal changes in quantitative ultrasound with dual-energy x-ray absorptiometry: the four-year effects of hormone replacement therapy.  Osteoporo Int . 2000;  11 52-58
  • 46 Gonelli S, Cepollaro C, Pondrelli C. Ultrasound parameters in osteoporotic patients treated with salmon calcitonin: a longitudinal study.  Osteoporo Int . 1996;  6 303-307
  • 47 Frost M L, Blake G M, Fogelman I. Changes in QUS and BMD measurements with antiresorptive therapy: a two-year longitudinal study.  Calcif Tissue Int . 2001;  69 138-146
  • 48 Gonnelli S, Cepollaro C, Montagnani A. Heel ultrasonography in monitoring alendronate therapy: a four-year longitudinal study.  Osteoporos Int . 2002;  13 415-421
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