AGING
March 19, 2019

Screening for Osteoporosis with Ultrasound

Ultrasounds of a bone in your heel may be a low-cost alternative to DEXA scans for osteoporosis screening.

The thinning and increasing fragility of bones that happens as we age, osteoporosis, is usually diagnosed using a dual-energy x-ray absorptiometry, or DEXA scan machine. A DEXA scan is considered the gold standard for bone health screening. Unfortunately, the size of DEXA machines, as well as their cost and the technical proficiency needed to operate them, limits how easily people concerned about bone strength can access this screening tool.

That is why a new study showing that a simple ultrasound of a bone in your heel is a valid early screening tool for bone health is welcome news. Ultrasound machines are already part of many medical practices. They use sound waves to noninvasively check fetal development in women, and injuries to tendons and ligaments. They can also provide information on bone density.

Ultrasound results were found to accurately predict bone quality as shown in the DEXA scans.

Using ultrasound machines for initial screening for osteoporosis could lead to lower costs and increased screening of populations at risk for bone disease, including postmenopausal women. “[Ultrasound] machines could be used to screen large numbers of people at places like health fairs, because the machines are affordable and easy to transport,” Carolyn Komar, lead author on the study, told TheDoctor.

“Using US [ultrasound] to scan the heel won’t give us all the information we could get from a full DEXA scan,” said Komar, but it would give doctors and patients a clear enough picture to know if they should be concerned.

The researchers looked at data from 99 people (13 men, 86 women) between the ages of 27 and 94 who were scheduled for a DEXA scan at a rural primary care facility in Lewisburg, West Virginia. They used ultrasound to scan the heel bones of the right and left foot. Blood was collected by finger stick to measure vitamin D levels.

The team recorded correlations between and within the participants' DEXA scans and ultrasounds; and between DEXA scans, ultrasound results andvitamin D levels in the blood. They also looked at how well ultrasound results predicted bone health as shown by DEXA scan.

Ultrasound results were found to accurately predict bone quality as shown in the DEXA scans. “Now that we have established this groundwork with this study, we would like to screen populations that may not traditionally get screened for bone health, such as young adults or older men,” said Komar, an associate professor of biomedical sciences at the West Virginia School of Osteopathic Medicine.

Bone density is built throughout childhood and into young adulthood. That bone density becomes the baseline from which people are going to lose bone as part of the aging process. So if people haven't built good strong bones during their childhood and young adult years, chiefly through good nutrition and weight-bearing exercise, their basic bone density might put them at risk for fractures at an earlier age.

“We don’t want to overstate that US will ever replace DEXA,” Andrea Nazar, co-author on the study and a professor of clinical science at the West Virginia School of Osteopathic Medicine said. But the kind of early information on bone density that ultrasounds can provide could mean that doctors can encourage children and young adults to make lifestyle modifications, such as improving their diets and doing more weight bearing exercise, to potentially improve the development of bone, explained Komar.

“If you can identify people early, you can implement these lifestyle modifications, instead of resorting to pharmacologic measures in patients’ later years.”

The study is published in the Journal of the American Osteopathic Association.

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