An update on the assessment of osteoporosis using radiologic techniques (original) (raw)
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Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques
2013
Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinicallyavailable diagnostic methods are mainly based on the use of either X-rays or ultrasound (US). All X-ray based methods provide a measure of bone mineral density (BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry (DXA) is considered the current "gold standard" for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations (e.g. , use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population
Quantitative Ultrasound of Bone in Male Osteoporosis
Osteoporosis International, 2002
Quantitative ultrasound (QUS) measurement, a different approach to bone fragility assessment, has already been attempted in women with osteoporosis but rarely in men. In order to test its value and ability to identify osteoporotic men, a case-control prospective study was conducted using the Lunar Achilles, a device that measures attenuation and velocity parameters. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI), a composite parameter, were assessed through the heel of 66 osteoporotic patients, and compared with the results in 35 controls. Patients had sustained a low-trauma fracture and/or had a lumbar and/or femoral bone mineral density (BMD) more than 2.5 SD below the young male reference value. As expected, all QUS parameters were statistically lower in patients, as were the dual-energy Xray absorptiometry (DXA) measurements at the hip and lumbar spine. The two methods were compared for their ability to predict the risk of osteoporotic fractures. The odds ratios (ORs), with their 95% confidence limits, for fractures per 1 SD decrease were significant, especially for SOS and SI (OR = 2.3 [1.4-3.6] and 2.1 [1.3-3.3] respectively) and to a lesser extent for BUA (1.6 [1.0-2.4]). Our study suggests that QUS is associated with a history of low-trauma fracture in men; sensitivity is, however, less than when results are compared with BMD measurements (OR = 2.8 [1.6-5.0] and 3.4 [1.6-7.0] for lumbar spine and hip, respectively). Prospective studies are required before QUS can be recommended for clinical use in male osteoporosis.
The role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry
Rheumatology International, 2001
The aim of this study was to establish whether quantitative ultrasound (QUS) parameters could identify patients classi®ed as osteoporotic and osteopenic on the basis of dual energy X-ray absorptiometry (DEXA). One hundred and twenty-three patients (39 male, 84 female) with osteoporosis and suspected of having osteoporosis were included in this study. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured and bone mineral densities (BMD) of the lumbar spine and left hip was measured by DEXA. Subjects were classi®ed into three groups (normal, osteopenic and osteoporotic) on the basis of BMD T-scores measured by DEXA. QUS parameters of the osteoporotic group were signi®cantly lower than those of osteopenic and normal groups; there was no dierence in QUS parameters between the normal and osteopenic groups. Correlations of both right and left SOS and BUA with the spine and femoral neck BMD were moderate (r 0.343±0.539, P < 0.001). There was also reasonable correlation between DEXA and QUS T-scores (r 0.364±0.510, P < 0.001). QUS had a sensitivity of 21% and a speci®city of 95% for diagnosing osteoporosis. We concluded that, although DEXA and QUS parameters were signi®cantly correlated, QUS parameters can not predict osteopenia as de®ned by DEXA, and sensitivities and speci®cities of QUS parameters were not suciently high for QUS to be used as an alternative to DEXA.
Osteoporosis is a disorder of bone that leads to an increased risk of fracture, when it loses an excessive amount of mineral compositions. Bone densitometry techniques are useful to diagnose the disease as well as to predict the future risk of fracture. Dual energy x-ray absorptiometry (DXA) is currently considered as the ‘gold’ standard for measuring areal bone mineral density, BMD (gcm-2). Quantitative computed tomography (QCT) is used to measure volumetric BMD (g cm-3) at lumbar spine using a phantom with a dedicated software; but it cannot be used to measure femur volumetric BMD. The aim of this study was to estimate apparent physical BMD (Estvol.BMD, g cm-3) of the proximal femur from CT image with good accuracy in the evaluation of post-menopausal osteoporosis. A total number of 50 Indian women, age ranged from 20-80 years were studied. No one had previous osteoporotic fractures. Each woman, the following investigations were carried out: i) BMD of the right proximal femur by DXA whole-body bone densitometer; and ii) CT image of the right proximal femur. WHO’s diagnostic criteria based on the measured femur neck BMD was used to classify the patients. According to this, total women were divided into the following groups: i) Normal (n=23, mean ± SD age = 42.8 ±11.1 years); ii) Osteopenia (n= 17, mean ± SD age = 49.6 ±12.5 years); and iii) Osteoporosis (n=10, mean ± SD age =69.2 ±12.7 years); The CT image was analysed by Materialise’s interactive medical image control system (MIMICS) software. Hounsfield Unit (HU) was measured in the regions of the proximal femur: i) Neck; ii) Trochanter, iii) Head; and iv) Shaft; Using the measured mean HU value, Est-vol.BMD (g cm-3) was estimated. Data was analysed by SPSS statistical software package. In osteoporotic Indian women group (n=10), the Est-vol.BMD (g cm-3) of femur neck was correlated statistically significant (p=0.05) with BMD-DXA (g cm-2) of all ROI’s of the proximal femur, viz., femur neck, Ward’s triangle, trochanter, femur shaft, and total hip. The obtained square of the correlation coefficients (r2) were 0.22, 0.25, 0.23, 0.41, and 0.34 respectively. In osteoporotic women, the mean values of BMD-DXA (g cm-2) and Est-vol.BMD (g cm-3) of femur neck were significantly (p=0.01) reduced by 36.7% and 71.8% respectively, when comparing to normal healthy women. Further, in osteoporotic women, the mean values of BMD-DXA as well as Est-vol.BMD of trochanter were significantly (p=0.01) reduced by 45.7% and 80.2% respectively, when comparing to normal healthy women. It was found that the percentage decrease in Est-vol.BMD was greater in osteoporotic women than the measured BMD-DXA, and it can be useful in the evaluation of the disease.
Accuracy of quantitative ultrasound parameters in the diagnosis of osteoporosis
Open Medicine, 2010
Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were...