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Ultrasound of the skeleton: Review of its clinical applications and pitfalls

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Abstract

Quantitative ultrasound (QUS) is receiving considerable attention in the assessment of osteoporosis because of its ease of use, lack of radiation exposure, region of interest, and relatively low costs. These features have made the technique appealing for screening adult and pediatric patients. This article discusses some of the clinical applications, limitations, and strengths of QUS.

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References and Recommended Reading

  1. Jahnsen J, Falchj A, Mowoineke L, Aadlend B: Ultrasound measurements of calcaneus for estimation of skeletal status in patients with inflammatory bowel disease. Scan J Gastroenterol 1999, 34:7907.

    Google Scholar 

  2. Fries W, Dinca M, Luisetto G, et al.: Calcaneal ultrasound bone densitometry of the lumbar spine. Am J Gastroenterol 1998, 93:2339–2344.

    PubMed  CAS  Google Scholar 

  3. Robinson RJ, Carr I, Iqbals J, et al.: Screening for osteoporosis in Crohn’s disease: a detailed evaluation of calcaneal ultrasound. Eur J Gastroenterol Hepatol 1998, 10:137–140.

    Article  PubMed  CAS  Google Scholar 

  4. Taal, Cassidy MG, Pearson B, et al.: Usefulness of quantitative heel ultrasound compared with dual energy x-ray absorptiometry in determining bone mineral density in chronic hemodialysis patients. Nephrol Dialysis Transplant 1999, 14:1917–1921.

    Article  CAS  Google Scholar 

  5. Tribl B, Vogelsang H, Pohinka E, et al.: Broadband ultrasound attenuation of the calcaneus: a tool for assessment of bone status in patients with chronic renal failure. Acta Radiologica 1998, 39:631–641.

    Article  Google Scholar 

  6. Cheng S, Tylavsky FA, Orwolle S, Rhoj Y, Carbone LD: The role of collagen abnormalities and ultrasound in densitometry assessment: in vivo evidence. Calcif Tissue Int 1999, 64:470–476.

    Article  PubMed  CAS  Google Scholar 

  7. Copollaro C, Gonneli S, Pondrelli C, et al.: Osteogenesis imperfecta: bone turnover, bone density and ultrasound parameters. Calcif Tissue Int 1999, 65:129–132.

    Article  Google Scholar 

  8. Minisolu S, Rosso R, Scarda A, et al.: Quantitative ultrasound assessment of bone in patients with primary hyperparathyroidism. Calcif Tissue Int 1995, 56:536–538.

    Article  Google Scholar 

  9. Garton M, Martin J, Stewart A, et al.: Changes in bone mass and metabolism after surgery for primary hyperparathyroidism. Clin Endocrinol 1995, 42:493–500.

    CAS  Google Scholar 

  10. Gomez A, Cotto C, Schott AM, et al.: Hyperthyroidism influences ultrasound bone measurement in the outside calcis. Osteoporos Int 1998, 8:455–459.

    Article  Google Scholar 

  11. Njeh CP, Boivin CM, Langton CM: The role of ultrasound in the assessment of osteoporosis: a review. Osteoporos Int 1997, 7:7–22.

    Article  PubMed  CAS  Google Scholar 

  12. Gregg EW, Kriska AM, Salamone LM, et al.: The epidemiology of quantitative ultrasound: a review of the relationships with bone mass, osteoporosis and fracture risk. Osteoporo Int 1997, 7:89–99.

    Article  CAS  Google Scholar 

  13. Grampp S, Genant HK, Mathur A, et al.: Comparisons of noninvasive bone mineral measurements in assessing age-related loss, fracture discrimination and diagnostic classification. J Bone Mineral Res 1997, 12:697–711. This study evaluates the common methods of noninvasive bone mass measuring techniques. Comparisons are made of data from QCT, hip and spine DXA, radiographic absorptiometry of the hand, and ultrasound from two devices. All devices can identify similar patient parameters, but the WHO T-scoring system could not be indiscriminately applied to all device-measurements. Each device must have its own reference cut-off values.

    Article  CAS  Google Scholar 

  14. Gluer CC, Wu CY, Jerges M, et al.: Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 1994, 55:46–51. A large study evaluating fracture rates and bone ultrasound and DXA. Data show similarity of data from both techniques.

    Article  PubMed  CAS  Google Scholar 

  15. Gluer CC, Wu CY, Genant HC: Broadband ultrasound attenuation signals depend on trabecular orientation: an in vitro study. Osteoporos Int 1993, 3:185–191.

    Article  PubMed  CAS  Google Scholar 

  16. Pfeiffer M, Pollachne W, Minne HW: Ultrasound analyses of the calcaneus predict relative risk of the presence of at least one vertebral fracture and reflect different physical qualities of bone in different regions of the skeleton. Horm Metabol Res 1997, 29:76–79.

    Article  Google Scholar 

  17. Porter RW, Miller CG, Grainger D, et al.: Prediction of hip fracture in elderly women: a prospective study. BMJ 1990, 301:638–841.

    PubMed  CAS  Google Scholar 

  18. Hans D, Dargent-Molina P, Schott AM, et al.: Ultrasonic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996, 348:511–514. A large prospective study evaluating the ability of ultrasound to predict hip fractures. DXA and ultrasound show similar results.

    Article  PubMed  CAS  Google Scholar 

  19. Bauer CC, Gluer CC, Cauley JA, et al.: Broadband ultrasound attenuation predict fracture strongly and independently of densitometry in older women. Arch Intern Med 1997, 157:629–634.

    Article  PubMed  CAS  Google Scholar 

  20. Baran DT, Kelly AM, Karellas A, et al.: Ultrasound attenuation of the outside calcis in women with osteoporosis and hip fractures. Calcif Tissue Int 1988, 43:138–142.

    Article  PubMed  CAS  Google Scholar 

  21. Agren M, Karellas A, Leahey D, et al.: Ultrasound attenuation of the calcaneus: a sensitive and specific discriminator of osteopenia in postmenopausal women. Calcif Tissue Int 1991, 48:240–244.

    Article  PubMed  CAS  Google Scholar 

  22. 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, 54:466–469. One of the many small studies addressing the controversy of what is better: ultrasound or DXA. This one shows that ROC curves are better for ultrasound and are hip fractures than spinal DXA and hip fractures. The small number of observations in these types of studies limit the usefulness.

    Article  PubMed  CAS  Google Scholar 

  23. Funke M, Kopka L, Vosshenrich R, et al.: Broadband ultrasound attenuation in the diagnosis of osteoporosis: correlation with osteodensitometry and fracture. Radiology 1995, 194:77–81.

    PubMed  CAS  Google Scholar 

  24. Goldstein SR, Nachtigall Le: Quantitative ultrasound of the calcaneus: comparison with dual energy x-ray absorptiometry (DXA) of the hip. Proc Ninth Ann Meet North Am Menopause Soc, September 15–19, 1998.

  25. Ingle BM, Henrey YM, Eastell R: Discrepancies in T-scores using quantitative ultrasound [abstract]. J Bone Miner Res 1999, 14:SU263.

    Google Scholar 

  26. Chen MB, Diessel E, Fan B, et al.: Can the WHO definition of osteoporosis be applied to the QUS-2 [abstract]? J Bone Miner Res 1999, 14:SU276.

    Google Scholar 

  27. Nattras S, Orwell E, Tylavsky F, et al.: Male and ethnic reference ranges for the Sahara clinical bone sonometry [abstract]. J Bone Miner Res 1999, 14:SU280.

    Google Scholar 

  28. Danielson ME, Cauley JA, Baker CE, et al.: Familial resemblance of bone mineral density (BMD) and calcaneal ultrasound attenuation: the BMD in mothers and daughters study. J Bone Miner Res 1999, 65:117–120.

    Google Scholar 

  29. Howard GM, Nguyen TV, Harris M, et al.: Genetic and environmental contributions to the association between quantitative ultrasound and bone mineral density measurements: a twin study. J Bone Miner Res 1998, 13:1318–1327.

    Article  PubMed  CAS  Google Scholar 

  30. Hadji P, Hara O, Book K, et al.: Age changes of calcaneal ultrasonometry in healthy German women. Calcif Tissue Int 1999, 65:117–120.

    Article  PubMed  CAS  Google Scholar 

  31. Tromp AM, Smit JH, Deeg DJ, Lips P: Quantitative ultrasound measurements of the tibia and calcaneus in comparison with DXA measurements at various skeletal sites. Osteoporos Int 1999, 9:230–235.

    Article  PubMed  CAS  Google Scholar 

  32. Danese RD, Licata AA, Richmond B, Deal C: Calcaneal ultrasound-influence of activity in comparison with standard DEXA measurements in a general clinical practice. World Congress on Osteoporosis 2000, Chicago, IL, June 15–18, 2000.

  33. Brooks-Wavell K, Jones RR, Pye DW: Ultrasound and dual x-ray absorptiometry measurement of the calcaneus: influence of region of interest location. Calcif Tissue Int 1995, 57:20–24.

    Article  Google Scholar 

  34. van Daele PL, Burger H, DeLact CE, et al.: Longitudinal changes and ultrasound parameters of the calcaneus. Osteoporos Int 1997, 7:207–212. This investigation addresses the question of long-term reproducibility of ultrasound testing. It shows error rates in measuring speed of sound (SOS) and bone attenuation (BUA) over 1 to 2 years that are only partly related to measurement errors. This finding limits use of ultrasound as a monitoring tool in an individual patient.

    Article  PubMed  Google Scholar 

  35. Fournier B, Chappard C, Roux C, et al.: Quantitative ultrasound imaging at the calcaneus using an automatic region of interest. Osteoporos Int 1997, 7:363–369.

    Article  PubMed  CAS  Google Scholar 

  36. Jorgensen HL, Hassager C: Improved reproducibility of broadband ultrasound attenuation of the os calcis by using a specific region of interest. Bone 1997, 21:109–112. Investigators show that a consistent anatomic region of interest can improve reproducibility of heel ultrasound. By so doing, they reduce the coefficient of variation from 3.7% on duplicate measures to 1.2%.

    Article  PubMed  CAS  Google Scholar 

  37. Chappard C, Laugier P, Fournier B, et al.: Assessment of the relationship between broad band ultrasound attenuation and bone mineral density at the calcaneus using BUA imaging and DXA. Osteoporos Int 1997, 7:316–322. The region of interest in calcaneal ultrasound is studied in this paper. The correlation between hip DXA and ultrasound varies from 0.78 to 0.91 as a function of region measured. An important issue for clinical use.

    Article  PubMed  CAS  Google Scholar 

  38. Kolthoff N, Eikan P, Barenholdt O, Nielsen SP: Vital ultrasound measurements of the os calcis stewards: side differences and prediction of bone density in 39 persons. Acta Orthopaedica Scandinavica 1995, 66:278–282.

    Article  PubMed  CAS  Google Scholar 

  39. Leong KH: Ultrasound of the tibia-precision error, left versus right sides in correlation with bone mineral density. Annals Acad Med Singapore 1997, 26:747–749.

    CAS  Google Scholar 

  40. Wang SF, Chang CY, Shih C, Teng MM: Evaluation of tibial cortical bone by ultrasound velocity in oriental females. Br J Radio 1997, 7:1126–1130.

    Google Scholar 

  41. Lee SE, Con BS, Bouxsein ML: Tibial ultrasound velocity measured in situ predicts the material properties of tibial cortical bone. Bone 1997, 21:119–125.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Endocrinology, Metabolic Bone/Calcium Unit, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195, Cleveland, OH, USA

    Rossana D. Danese MD & Angelo A. Licata MD, PhD

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  1. Rossana D. Danese MD
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  2. Angelo A. Licata MD, PhD
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Danese, R.D., Licata, A.A. Ultrasound of the skeleton: Review of its clinical applications and pitfalls. Curr Rheumatol Rep 3, 245–248 (2001). https://doi.org/10.1007/s11926-001-0025-2

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