The use of quantitative ultrasonometry in patients with glucocorticoid-induced osteoporosis

There is a great need to introduce methods to determine bone fragility in outpatient settings for chronically GC-treated patients which are easy to use, reasonably inexpensive, precise and have a high sensitivity and specificity to detect patients at risk for fractures. DXA and QUS have both been shown to predict hip fracture rates independently in prospective studies in postmenopausal women. No such studies have been done for patients under GC treatment yet. Most studies investigated patients with established GCO and only one large study has investigated patients with risk factors such as intermittent GC intake and compared DXA and QUS. No studies have been done using QCT. All studies show that QUS is equally potent in detecting patients at risk compared to DXA. There is good evidence that phalangeal QUS is highly dependent on structural changes of trabecular bone. Phalangeal QUS might thus have the advantage of detecting GC-induced structural deterioration earlier then calcaneal devices, however no clinical comparison studies have been conducted. The best would be to do longitudinal studies to see which device and site best predicts bone loss, however this requires large patient numbers and patients at risk are usually in different departments due to the difference in underlying diseases.