Pulse-echo ultrasound measurement in osteoporosis screening: a pilot study in older patients

A mere 25% of patients who need treatment for osteoporosis receive appropriate therapy, partly due to the time-consuming and stressful diagnostic workup for older patients with functional decline.

The purpose of the present study was to investigate the accuracy of pulse-echo ultrasound measurement of the lower leg for the detection of osteoporosis in older patients, and evaluate the effect of a proposed diagnostic algorithm.

Cortical thickness and the so-called density index (DI) were measured prospectively on the lower leg with a pulse-echo ultrasound (PEUS) device. The accuracy of the device was compared with dual-energy X-ray absorptiometry (DXA) of the hip. We calculated algorithms combining FRAX® scores and PEUS measures as a guide for specific treatment of osteoporosis.

Three hundred and thirty-three patients aged on average 81 years (82.1% women, 275/333) were included in the study. The sensitivity of the ultrasound device versus DXA for the detection of osteoporosis was 94.4% (84/89), and the specificity was 59% (144/247). The gender-specific sensitivity was 96.2% (75/78) for women and 81.8% (9/11) for men.

Clinical decisions for the specific treatment of osteoporosis could be based on the proposed algorithm, without additional DXA measurements, in 90.9% (303/333) of the patients.

Older patients with a similar risk profile as in our study population may benefit from PEUS, as it is a non-invasive, cost-effective, and efficient diagnostic tool with high accuracy in screening patients for osteoporosis and the risk of fractures.