Quantitative ultrasound in the management of osteoporosis.

Abstract

Bone mineral density (BMD) is one of the major determinants of bone strength and fracture risk (FR), but it is not the only determinant, and overlap exists in BMD values between patients with and without fractures. It is therefore important to improve the strategy in better detecting patients at high FR who will benefit from treatments (TT). Quantitative bone US(QUS) are portable and less expensive than DXA. Only few QUS measuring the heel have reached a sufficient level of validation to be routinely used. They usually measure the attenuation (BUA) and the velocity (SOS) of the US wave. It is well established that valid heel QUSs predict fragility fracture in PM women and men >65, independent of BMD. Then, heel QUS can be used in combination with other clinical risk factors (CRFs) in a model of risk assessment. Then, when DXA is available, the primary clinical use of heel QUS is to identify, in conjunction with CRF, a population at low FR in which no further diagnostic evaluation is necessary. On the other hand, if central DXA cannot be done, pharmacologic TT can be initiated if the probability, as assessed by heel QUS in conjunction with CRF, is sufficiently high.