Utilizing QUS envelope statistics imaging to predict the risk of vertebral fractures in postmenopausal women

This study aims to evaluate the clinical utility of quantitative ultrasound (QUS) envelope statistics imaging in predicting the risk of vertebral fractures (VFs) in postmenopausal women, compared to conventional dual-energy X-ray absorptiometry (DXA) measurements, including bone mineral density (BMD) and T-score. A total of 63 postmenopausal women were enrolled. QUS envelope statistics imaging was performed on the L3 vertebra, analyzing parameters including the Nakagami parameter (m), scatterer clustering parameter (α), coherent to diffuse signal ratio (k), and entropy (H) for comparisons with DXA. The data were divided into three tertiles: reference, early VF risk, and high-risk groups. Odds ratios (ORs) were calculated to evaluate the predictive abilities of each parameter for VF risk. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were utilized to evaluate consistency both within subjects and across different operators. There were no significant differences in QUS parameters between subjects with and without VFs overall (p > 0.05). However, compared to DXA, the Nakagami parameter and entropy demonstrated a significant association with early VF risk, as subjects in the second tertile exhibited higher risks of VFs compared to those in the first tertile (ORs: 3.02 for m and 3.30 for H). Bland-Altman analysis indicated mean differences close to zero and ICCs exceeding 0.90 for all QUS parameters. QUS envelope statistics imaging could complement DXA in predicting VFs, particularly in detecting early fracture risk, offering a non-invasive, radiation-free alternative for osteoporosis screening.