Skip to main content
SpringerLink
Log in

The epidemiology of quantitative ultrasound: A review of the relationships with bone mass, osteoporosis and fracture risk

  • Review Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Quantitative ultrasound (QUS) is a simple, inexpensive and non-invasive measure of bone which has been used in research settings for the prediction of osteoporosis. This review summarizes the current status of the epidemiology of QUS analysis, including its relationship with bone mineral density (BMD), risk of osteoporotic fracture and risk factors for osteoporosis. Although only moderately correlated with BMD, QUS appears to be as strong a predictor of osteoporotic fracture as BMD and may predict fracture independent of BMD. Risk factors for low QUS, including age, menopause, body composition and physical inactivity, seem to parallel those of low BMD. More longitudinal research is needed to confirm the clinical utility of QUS and more experimental and population-based studies are needed to determine whether the etiology of low QUS values is different from that of low bone mass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Melton LJ III. Perspectives: how many women have osteoporosis now? J Bone Miner Res 1995;10:175–7.

    Google Scholar 

  2. Black DM, Cummings SR, Melton LJ III. Appendicular bone mineral and a woman's risk of hip fracture. J Bone Miner Res 1992;7:639–46.

    Google Scholar 

  3. Looker AC, Johnston CC, Wahner HW, et al. Prevalence of low femoral bone density in older US women from NHANES III. J Bone Miner Res 1995;10:796–802.

    Google Scholar 

  4. Melton LJ III, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–11.

    Google Scholar 

  5. Ott SM. When bone mass fails to predict bone failure. Calcif Tissue Int 1993;53:S7–13.

    Google Scholar 

  6. Kleerekoper M, Villanueva AR, Stanciu J, Sudhaker Rao D, Parfitt AM. The role of three-dimensional trabecular micro-structure in the pathogenesis of vertebral compression fractures. Calcif Tissue Int 1985;37:594–7.

    Google Scholar 

  7. Brandenburger GH. Clinical determination of bone quality: Is ultrasound an answer? Calcif Tissue Int 1993;53(Suppl 1):S151–6.

    Google Scholar 

  8. Cooper C. The epidemiology of fragility fractures: Is there a role for bone quality? Calcif Tissue Int 1993;53(Suppl 1):S23–6.

    Google Scholar 

  9. Liberman UA, Weiss SR, Broil J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995;333:1437–43.

    Google Scholar 

  10. Kanis JA and the WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporosis Int 1994;4:368–81.

    Google Scholar 

  11. Langton CM, Palmer SB, Porter RW. The measurement of broadband ultrasonic attenuation in cancellous bone. Eng Med 1984;13:89–91.

    Google Scholar 

  12. Kaufman JJ, Einhorn TA. Perspectives: ultrasound assessment of bone. J Bone Miner Res 1993;8:517–25.

    Google Scholar 

  13. McKelvie ML, Palmer SB. The interaction of ultrasound with cancellous bone. Phys Med Biol 1991;36:1331–40.

    Google Scholar 

  14. Antich PP. Ultrasound study of bone in vitro. Calcif Tissue Int 1993;53(Suppl 1):S157–61.

    Google Scholar 

  15. Abendschein W, Hyatt GW. Ultrasonics and selected physical properties of bone: Clin Orthop 1970;69:294–301.

    Google Scholar 

  16. Langton CM. The role of ultrasound in the assessment of osteoporosis. Clin Rheumatol 1994;13(Suppl 1):13–7.

    Google Scholar 

  17. Bouxsein ML, Courtney AC, Hayes WC. Ultrasound and densitometry of the calcaneus correlate with the failure loads of cadaveric femurs. Calcif Tissue Int 1995;54:99–103.

    Google Scholar 

  18. Gluer CC, Wu CY, Jergas M, Goldstein SA, Genant HK. Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994;55:46–52.

    Google Scholar 

  19. Hans D, Arlot ME, Schott AM, Roux JP, Kotzki PO, Meunier PJ. Do ultrasound measurements on the os calcis reflect more the microarchitecture of bone than the bone mass? A two-dimensional histomorphometrics study. Bone 1995;15:295–300.

    Google Scholar 

  20. Poll V, Cooper C, Cawley MID. Broadband ultrasonic attenuation in the os calcis and single photon absorptiometry in the distal forearm: a comparative study. Clin Phys Physiol Meas 1986;7:375–9.

    Google Scholar 

  21. Hosie CJ, Smith DA, Deacon AD, Langton CM. Comparison of broadband ultrasonic attenuation of the os calcis and quantitative computed tomography of the distal radius. Clin Phys Physiol Meas 1987;8:303–8.

    Google Scholar 

  22. Baran DT, Kelly AM, Karellas A, et al. Ultrasound attenuation of the os calcis in women with osteoporosis and hip fractures. Calcif Tissue Int 1988;43:138–42.

    Google Scholar 

  23. Rossman P, Zagzebski J, Mesina C, Sorenson J, Mazess R. Comparison of speed of sound and ultrasound attenuation in the os calcis to bone density of the radius, femur and lumbar spine. Clin Phys Physiol Meas 1989;10:353–60.

    Google Scholar 

  24. McCloskey EV, Murray SA, Miller C, et al. Assessment of broadband ultrasound attenuation in the os calcis in vitro. Clin Sci 1990;78:227–33.

    Google Scholar 

  25. Baran DT, McCarthy CK, Leahey D, Lew R. Broadband ultrasound attenuation of the calcaneus predicts lumbar and femoral neck density in Caucasian women: a preliminary study. Ostoporosis Int 1991;1:110–3.

    Google Scholar 

  26. Agren M, Karellas A, Leahy D, Marks S, Baran D. Ultrasound attenuation of the calcaneus: a sensitive and specific discriminator of osteopenia in postmenopausal women. Calcif Tissue Int 1991;48:240–4.

    Google Scholar 

  27. Truscott JG, Simpson M, Stewart SP, et al. Bone ultrasonic attenuation in women: reproducibility, normal variation and comparison with photon absorptiometry. Clin Phys Physiol Meas 1992;13:29–36.

    Google Scholar 

  28. Gluer CC, Vahlensieck M, Gaulkner KG, Engelke K, Black D, Genant HK. Site-matched calcaneal measurements of broadband ultrasound attenuation and single X-ray absorptiometry: Do they measure different skeletal properties? J Bone Miner Res 1992;7:1071–9.

    Google Scholar 

  29. Waud CE. The relationship between ultrasound and densitometric measurements of bone mass at the calcaneus in women. Calcif Tissue Int 1992;51:415–8.

    Google Scholar 

  30. Yamazaki K, Kushida K, Ohmura A, Sano M, Inoue T. Ultrasound bone densitometry of the os calcis in Japanese women. Osteoporosis Int 1994;4:220–5.

    Google Scholar 

  31. Poet JL, Serabian IT, Camboulives H, Dufour M, Roux H. Broadband ultrasound attenuation of the os calcis: preliminary study. Clin Rheumatol 1994;13:234–8.

    Google Scholar 

  32. Lees B, Stevenson JC. Preliminary evaluation of a new ultrasound bone densitometer. Calcif Tissue Int 1993;53:149–52.

    Google Scholar 

  33. Evans WD, Crawley EO, Compston JE, Evans C, Owen GM. A comparison of broadband ultrasonic attenuation with single photon absorptiometry and qualitative computed tomography for the measurement of bone mineral content. In: Palmer SB, Langton CM, editors. Ultrasonic studies of bone. IOP short meetings series no. 6. Bristol: IOP Publishing, 1987:27–35.

    Google Scholar 

  34. Zagzebski JA, Rossman PJ, Mesina C, Mazess RB, Madsen EL. Ultrasound transmission measurements through the os calcis. Calcif Tissue Int 1991;49:107–11.

    Google Scholar 

  35. Massie A, Reid DM, Porter RW. Screening for osteoporosis: comparison between dual energy X-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporosis Int 1993;3:107–10.

    Google Scholar 

  36. Faulkner KG, McClung MR, Coleman LJ, Kingston-Sandahl E. Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites. Ostoporosis Int 1994;4:42–7

    Google Scholar 

  37. Turner CH, Peacock M, Timmerman L, Neal JM, Johnston CC Jr. Cancaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporosis Int 1995;5:130–5.

    Google Scholar 

  38. Brooke-Wavell K, Jones PRM, Pye DW. Ultrasound and dual X-ray absorptiometry measurement of the calcaneus: influence of region of interest location. Calcif Tissue Int 1995;57:20–4.

    Google Scholar 

  39. Stegman MR, Heaney RP, Recker RR. Comparison of speed of sound ultrasound with single photon absorptiometry for determining fracture odds ratios. J Bone Miner Res 1995;10:346–52.

    Google Scholar 

  40. Salamone LM, Krall EQ, Harris S, Dawson-Hughes B. Comparison of broadband ultrasound attenuation to single X-ray absorptiometry measurements at the calcaneus in postmenopausal women. Calcif Tissue Int 1994;54:90–7.

    Google Scholar 

  41. Ross P, Huang C, Davis J, et al. Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound. Bone 1995;16:325–32.

    Google Scholar 

  42. Palacios S, Menendez C, Calderon J, Rubio S. Spine and femur density and broadband ultrasound attenuation of the calcaneus in normal Spanish women. Calcif Tissue Int 1993;52:99–102.

    Google Scholar 

  43. Chesnut CH III. Noninvasive methods of bone mass measurement. In: Avioli LV, editor. The osteoporotic syndrome: detection, prevention, and treatment. New York: Wiley-Liss, 1993:77–87.

    Google Scholar 

  44. Herd RJM, Ramalingham T, Ryan PJ, Fogelman I, Blake GM. Measurements of broadband ultrasonic attenuation in the calcaneus in premenopausal and postmenopausal women. Osteoporosis Int 1992;2:247–51.

    Google Scholar 

  45. Bauer DC, Gluer CC, Genant HK, Stone K. Quantitative ultrasound and vertebral fracture in postmenopausal women. J Bone Miner Res 1995;10:353–8.

    Google Scholar 

  46. Gluer CC, Cummings SR, Bauer DC, Stone K, Pressman A, Mathur A, Genant HK. Osteoporosis: association of recent fractures with quantitative US findings. Radiology 1996;199:725–32.

    Google Scholar 

  47. Herd RJM, Blake GM, Ramalingam T, Miller CG, Ryan PJ, Fogelman I. Measurements of postmenopausal bone loss with a new contact ultrasound system. Calcif Tissue Int 1993;53:153–7.

    Google Scholar 

  48. Fordham JN, Langton C, Tulsidas H. Ultrasonic measurement of bone density in rheumatoid arthritis and osteoarthritis. In: Palmer SB, Langton CM, editors. Ultrasonic studies of bone. IOP short meetings series no. 6. Bristol: IOP Publishing 1987:47–52.

    Google Scholar 

  49. Young H, Howey S, Purdie DW. Broadband ultrasound attenuation compared with dual-energy X-ray absorptiometry in screening for postmenopausal low bone density. Osteoporosis Int 1993;3:160–4.

    Google Scholar 

  50. Moris M, Peretz A, Tjeka R, Negaban N, Wouters M, Bergmann P. Quantitative ultrasound bone measurements: normal values and comparison with bone mineral density by dual X-ray absorptiometry. Calcif Tissue Int 1995;576:6–10.

    Google Scholar 

  51. Jaworski M, Lebiedowski M, Lorenc RS, Trempe J. Ultrasound bone measurement in pediatric subjects. Calcif Tissue Int 1995;56:368–71.

    Google Scholar 

  52. Van Daele PLA, Burger H, Algra D, et al. Age-associated changes in ultrasound measurements of the calcaneus in men and women: the Rotterdam study. J Bone Miner Res 1994;11:1751–7.

    Google Scholar 

  53. Kroger H, Jurvelin J, Arnala I, et al. Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture. Acta Orthop Scand 1995;66:47–52.

    Google Scholar 

  54. Minisola S, Rosso R, Scarda A, Pacitti MT, Romagnoli E, Mazzuoli G. Quantitative ultrasound assessment of bone in patients with primary hyperparathyroidism. Calcif Tissue Int 1995;56:526–8.

    Google Scholar 

  55. Johnson K, Porter RW. Broadband ultrasonic attenuation in patients with fracture of the distal radius. In: Palmer SB, Langton CM, editors. Ultrasonic studies of bone. IOP short meetings series no. 6. Bristol: IOP Publishing 1987:65–6.

    Google Scholar 

  56. Porter RW, Johnson K, McCutchan JDS. Wrist fracture, heel bone density and thoracic kyphosis: a case control study. Bone 1990;11:211–4.

    Google Scholar 

  57. Dretakis EC, Kontakis GM, Steriopoulos CA, Dretakis CE. Decreased broadband ultrasound attenuation of the calcaneus in women with fragility fracture. Acta Orthop Scand 1994;65:305–8.

    Google Scholar 

  58. Schott AM, Weill-Engerer S, Hans D, Duboeuf F, Delmas PD, Meunier PJ. Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 1995;10:243–9.

    Google Scholar 

  59. Dretakis EK, Kontakis GM, Steriopoulos K, Dretakis K, Kouvidis G. Broadband ultrasound attenuation of the os calcis in female postmenopausal patients with cervical and trochanteric fracture. Calcif Tissue Int 1995;57:419–21.

    Google Scholar 

  60. Stewart A, Reid DM, Porter RW. Broadband ultrasound attenuation and dual energy X-ray absorptiometry in patients with hip fractures: Which technique discriminates fracture risk? Calcif Tissue Int 1994;54:466–9.

    Google Scholar 

  61. Kroger H, Tupparainen M, Honkanen R, Alhava E, Saarikoski S. Bone mineral density and risk factors for osteoporosis: a population-based study of 1600 perimenopausal women. Calcif Tissue Int 1994;55:1–7.

    Google Scholar 

  62. Mautalen C, Vega E, Gonzalez D, Carrilero P, Otano A, Silberman F. Ultrasound and dual X-ray absorptiometry densitometry in women with hip fracture. Calcif Tissue Int 1995;57:165–8.

    Google Scholar 

  63. Heaney RP, Avioli LV, Chesnut CH III, Lappe J, Recker RR, Brandenburger GH. Osteoporotic bone fragility: detection by ultrasound transmission velocity. JAMA 1989;261:2986–90.

    Google Scholar 

  64. Stegman MR, Heaney RP, Recker RR, Travers-Gustafson D, Leist J. Velocity of ultrasound and its association with fracture history in a rural population. Am J Epidemiol 1994;139:1027–34.

    Google Scholar 

  65. Resch H, Pietschmann P, Bernecker P, Krexner E, Willvonseder R. Broadband ultrasound attenuation: a new diagnostic method in osteoporosis. AJR 1990;155:825–8.

    Google Scholar 

  66. Gonnelli S, Cepollaro C, Agnussei D, Palmieri R, Rossi S, Gennari C. Diagnostic value of ultrasound analysis and bone densitometry as predictors of vertebral deformity in postmenopausal women. Osteoporosis Int 1995;5:413–8.

    Google Scholar 

  67. Damilakis JE, Dretakis E, Gourtsoyiannis NC. Ultrasound attenuation of the calcaneus in the female population: normative data. Calcif Tissue Int 1992;51:180–3.

    Google Scholar 

  68. Heaney RP, Avioli LV, Chesnut CH III, Lappe J, Recker RR, Brandenburger GH. Ultrasound velocity through bone predicts incident vertebral deformity. J Bone Miner Res 1995;10:341–5.

    Google Scholar 

  69. Porter RW, Miller CG, Grainger D, Palmer SB. Prediction of hip fracture in elder women: a prospective study. BMJ 1990;301:638–41.

    Google Scholar 

  70. Hans D, Dargent-Molina P, Schott AM, et al. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996;348:511–4.

    Google Scholar 

  71. Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM. Bone ultrasound predicts fractures strongly and independently of densitometry in older women: a prospective study. Arch Int Med in press.

  72. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995;332:767–73.

    Google Scholar 

  73. McNeil BJ, Hanley JA. Statistical approaches to the analysis of receiver operator characteristics (ROC) curves. Med Decision Making 1984;4:137–49.

    Google Scholar 

  74. Schott AM, Hans D, Garnero P, Sornay-Rendu E, Delmas PD, Meunier PJ. Age-related changes in os calcis ultrasonic indices: a 2-year prospective study. Osteoporosis Int 1995;5:478–83.

    Google Scholar 

  75. Steiger P, Cummings SR, Black DM, Spencer NE, Genant HK. Age-related decrements in bone mineral density in women over age 65. J Bone Miner Res 1992;7:625–33.

    Google Scholar 

  76. Kawana K, Kushida K, Takahashi M, et al. The effect of menopause on biochemical markers and ultrasound densitometry in healthy females. Calcif Tissue Int 1994;55:420–5.

    Google Scholar 

  77. Firooznia H, Golimbu C, Rafii M, Schwartz MS. Rate of spinal trabecular bone loss in normal perimenopausal women: CT measurement. Radiology 1986;161:735–8.

    Google Scholar 

  78. Naessen T, Mallmin H, Ljunghall S. Heel ultrasound in women after long-term ERT compared with bone densities in the forearm, spine and hip. Osteoporosis Int 1995;5:205–10.

    Google Scholar 

  79. Jones PRM, Langton CM, Carr H. Broadband ultrasonic attenuation studies in sedentary and active young male adults and in bovine cancellous and cortical bone. In: Palmer SB, Langton CM, editors. Ultrasonic studies of bone. IOP short meetings series no. 6. Bristol: IOP Publishing, 1987;37–48.

    Google Scholar 

  80. Jones PRM, Hardman AE, Hudson A, Norgan NG. Influence of brisk walking on the broadband ultrasonic attenuation of the calcaneus in previously sedentary women aged 30–61 years. Calcif Tissue Int 1991;49:112–5.

    Google Scholar 

  81. Hoshino H, Kushida K, Yamazaki K, et al. Effect of physical activity as a caddie on ultrasound measurements of the os calcis: a cross-sectional comparison. J Bone Miner Res 1996;11:412–8.

    Google Scholar 

  82. Cauley JA, Danielson ME, Gregg EW, Vogt MT, Zmuda J, Bauer DC. Calcaneal ultrasound attenuation in older African-American and Caucasian-American women. Osteoporosis Int 1997;7:100–4.

    Google Scholar 

  83. Arden NK, Baker J, Hogg C, Baan K, Spector TD. The heritability of bone mineral density, ultrasound of calcaneus and hip axis length: a study of postmenopausal twins. J Bone Miner Res 1996;11:530–4.

    Google Scholar 

  84. Arden NK, Keen RW, Lanchbury JS, Spector TD. Polymorphisms of the vitamin D receptor gene do not predict quantitative ultrasound of the calcaneus or hip axis length. Osteoporosis Int 1996;6:334–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Primary Care Internal Medicine, University of Vermont, College of Medicine, Burlington, Vermont

    E. W. Gregg PhD

  2. Departments of Epidemiology, Biostatistics, and Human Genetics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania

    E. W. Gregg PhD, A. M. Kriska, L. M. Salamone, S. J. Aderson, R. E. Ferrell, L. H. Kuller & J. A. Cauley

  3. Department of Endocrinology and Metabolism, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA

    M. M. Roberts

Authors
  1. E. W. Gregg PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. M. Kriska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. M. Salamone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. M. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. J. Aderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. E. Ferrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. H. Kuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. A. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gregg, E.W., Kriska, A.M., Salamone, L.M. et al. The epidemiology of quantitative ultrasound: A review of the relationships with bone mass, osteoporosis and fracture risk. Osteoporosis Int 7, 89–99 (1997). https://doi.org/10.1007/BF01623682

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01623682

Keywords

Search

Navigation