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Ultrasound Is Cost-Effective Way to Increase Bone Health Screenings, Study Finds


Ultrasound can be a cost-effective alternative to dual-energy x-ray absorptiometry, which is considered the gold standard for assessing bone health but has limited use due to the the cost, size, and technical needs required to operate the machine.

While dual-energy x-ray absorptiometry (DXA) is considered the gold standard for assessing bone health, the cost, size, and technical needs required to operate the machine limit osteoporosis screening using DXA. A new study in The Journal of the American Osteopathic Association has found that ultrasound screenings can be a less expensive alternative that increases screenings in at-risk populations.

“Using ultrasound to scan the heel won’t give us all the information we could gather with a full DXA scan,” Carolyn Komar, PhD, associate professor of biomedical sciences at West Virginia School of Osteopathic Medicine and coauthor on this study, explained in a statement. “However, it gives us a clear enough snapshot to know whether we should be concerned for the patient.”

The United States Preventive Services Task Force has estimated that half of all women and 1 in 5 men are at risk for an osteoporotic fracture during their lifetime. People who experience an osteoporotic fracture have an increased risk of mortality, with 20% dying within 6 months, and the cost burden for the United States of osteoporotic fractures is estimated at $12.2 billion to $17.9 billion annually.

The authors recruited 99 patients who were scheduled for DXA at a rural clinic in West Virginia and used ultrasonography to scan the left and right calcaneus of the patients. The data were compared with the T score, which calculates bone density, of a DXA scan of the patients’ spine, which was performed at the same visit.

The area under the curve values were 0.69 for the bone mineral density T score for the left foot and 0.68 for the right foot. Values above —1.30 for the left foot and –1.05 for the right foot were considered as predicting good versus poor bone quality as determined by DXA scan area under the curve analysis.

“Most people think our bones are static structures once we reach adulthood. On the contrary, they are dynamic and shaped by how we live,” said coauthor Andrea Nazar, DO, a family physician and professor of clinical science at West Virginia School of Osteopathic Medicine. “There are pharmacologic options to treat osteoporosis and improve bone health, but the best approach is preventive lifestyle changes.”


Komar C, Ahmed M, Chen A, et al. Advancing methods of assessing bone quality to expand screening for osteoporosis. J Am Osteopath Assoc. 2019;119(3):147-154. doi: 10.7556/jaoa.2019.025.

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