Clinical Applications

  • Reinhard BarkmannEmail author
  • Claus-C. Glüer


Quantitative Ultrasound (QUS) methods measure aspects of bone strength which are associated with the fragility of the bone. It has been proven that QUS (at least for some devices measuring at the heel bone) can predict osteoporotic fractures in elderly women with a predictive power similar to that of the recommended method DXA, which measures x-ray attenuation in the mineral phase of the bone to calculate a bone mineral density. However, the use of QUS in clinical practice is still uncertain. Unsolved quality assurance issues, the diversity of the approaches and the unanswered question, if patients with low QUS results will most likely profit from a therapy still limit the prospects of the method for widespread clinical use. Nevertheless, QUS has the potential for a clinical application. Advantages over DXA are the smaller size and lower price of the devices and the lack of ionizing radiation. Once the mentioned problems will be solved, QUS could become an important part in osteoporosis management, at least in rural environments and less-developed countries with limited access to DXA.


Diagnosis Fracture risk Monitoring Osteoporosis Quality control Treatment 


  1. 1.
    M. L. Bouxsein, B. S. Coan, and S. C. Lee, “Prediction of the strength of the elderly proximal femur by bone mineral density and quantitative ultrasound measurements of the heel and tibia,” Bone 25(1), 49–54 (1999).CrossRefPubMedGoogle Scholar
  2. 2.
    E. M. Lochmüller, R. Müller, V. Kuhn, C. A. Lill, and F. Eckstein, “Can novel clinical densitometric techniques replace or improve DXA in predicting bone strength in osteoporosis at the hip and other skeletal sites?,” J Bone Miner Res 18(5), 906–912 (2003).CrossRefPubMedGoogle Scholar
  3. 3.
    F. Marin, J. Gonzalez-Macias, A. Diez-Perez, S. Palma, and M. Delgado-Rodriguez, “Relationship between bone quantitative ultrasound and fractures: a meta-analysis,” J Bone Miner Res 21(7), 1126–1135 (2006).CrossRefPubMedGoogle Scholar
  4. 4.
    M. A. Krieg, R. Barkmann, S. Gonnelli, A. Stewart, D. C. Bauer, L. Del Rio Barquero, J. J. Kaufman, R. Lorenc, P. D. Miller, W. P. Olszynski, C. Poiana, A. M. Schott, E. M. Lewiecki, and D. Hans, “Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions,” J Clin Densitom 11(1), 163–187 (2008).CrossRefPubMedGoogle Scholar
  5. 5.
    R. Barkmann, “Quantitative Ultrasound,” in Radiology of Osteoporosis, 2nd edn. S. Grampp, ed. (Springer, Heidelberg, 2008), pp. 163–173.Google Scholar
  6. 6.
    C. F. Njeh, D. Hans, T. Fuerst, C. C. Glüer, and H. K. Genant, Quantitative Ultrasound: Assessment of Osteoporosis and Bone Status (Martin Dunitz, London, 1999).Google Scholar
  7. 7.
    C. C. Gluer, “Quantitative Ultrasound – it is time to focus research efforts,” Bone 40(1), 9–13 (2007).CrossRefPubMedGoogle Scholar
  8. 8.
    R. S. Siffert and J. J. Kaufman, “Ultrasonic bone assessment: “the time has come,” Bone 40(1), 5–8 (2007).CrossRefPubMedGoogle Scholar
  9. 9.
    C. Cepollaro, S. Gonnelli, A. Montagnani, C. Caffarelli, A. Cadirni, S. Martini, and R. Nuti, “In vivo performance evaluation of the Achilles Insight QUS device,” J Clin Densitom 8(3), 341–346 (2005).CrossRefPubMedGoogle Scholar
  10. 10.
    C. C. Gluer, R. Barkmann, T. Blenk, A. Stewart, S. Kolta, J. Finigan, C. Graeff, J. Von der Gablentz, I. Eastell, D. M. Reid, C. Roux, and D. Felsenberg, “Quantitative ultrasound predicts incident vertebral and hip fractures at least as strongly as DXA: the OPUS study,” J Bone Miner Res 22, S21–S21 (2007).Google Scholar
  11. 11.
    M. A. Krieg, J. Cornuz, C. Ruffieux, G. Van Melle, D. Buche, M. A. Dambacher, D. Hans, F. Hartl, H. J. Hauselmann, M. Kraenzlin, K. Lippuner, M. Neff, P. Pancaldi, R. Rizzoli, F. Tanzi, R. Theiler, A. Tyndall, C. Wimpfheimer, and P. Burckhardt, “Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or = 70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study,” J Bone Miner Res 21(9), 1457–1463 (2006).CrossRefPubMedGoogle Scholar
  12. 12.
    “Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis,” Am J Med 94(6), 646–650 (1993).Google Scholar
  13. 13.
    C. Simonelli, R. A. Adler, G. M. Blake, J. P. Caudill, A. Khan, E. Leib, M. Maricic, J. C. Prior, S. R. Eis, C. Rosen, and D. L. Kendler, “Dual-Energy X-Ray Absorptiometry Technical issues: the 2007 ISCD Official Positions,” J Clin Densitom 11(1), 109–122 (2008).CrossRefPubMedGoogle Scholar
  14. 14.
    M. L. Frost, G. M. Blake, and I. Fogelman, “Can the WHO criteria for diagnosing osteoporosis be applied to calcaneal quantitative ultrasound?,” Osteoporos Int 11(4), 321–330 (2000).CrossRefPubMedGoogle Scholar
  15. 15.
    K. G. Faulkner, E. von Stetten, and P. Miller, “Discordance in patient classification using T-scores,” J Clin Densitom 2(3), 343–350 (1999).CrossRefPubMedGoogle Scholar
  16. 16.
    D. Hans, R. Rizzoli, D. Thiebaud, K. Lippuner, S. Allaoua, L. Genton, F. Luzuy, M. A. Krieg, P. Jaeger, and D. O. Slosman, “Reference data in a Swiss population. Discordance in patient classification using T-scores among calcaneum, spine, and femur,” J Clin Densitom 4(4), 291–298 (2001).CrossRefPubMedGoogle Scholar
  17. 17.
    NIH, “Osteoporosis prevention, diagnosis, and therapy,” JAMA 285(6), 785–795 (2001).Google Scholar
  18. 18.
    C. C. Glüer, R. Eastell, D. M. Reid, D. Felsenberg, C. Roux, R. Barkmann, W. Timm, T. Blenk, G. Armbrecht, A. Stewart, J. Clowes, F. E. Thomasius, and S. Kolta, “Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS Study,” J Bone Miner Res 19(5), 782–793 (2004).CrossRefPubMedGoogle Scholar
  19. 19.
    G. M. Blake, D. J. Chinn, S. A. Steel, R. Patel, E. Panayiotou, J. Thorpe, and J. N. Fordham, “A list of device-specific thresholds for the clinical interpretation of peripheral x-ray absorptiometry examinations,” Osteoporos Int 16(12), 2149–2156 (2005).CrossRefPubMedGoogle Scholar
  20. 20.
    K. G. Faulkner, M. R. McClung, L. J. Coleman, and E. Kingston-Sandahl, “Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites,” Osteoporos Int 4(1), 42–47 (1994).CrossRefPubMedGoogle Scholar
  21. 21.
    L. Rosenthall, A. Tenenhouse, and J. Caminis, “A correlative study of ultrasound calcaneal and dual-energy X-ray absorptiometry bone measurements of the lumbar spine and femur in 1000 women,” Eur J Nucl Med 22(5), 402–406 (1995).CrossRefPubMedGoogle Scholar
  22. 22.
    R. Barkmann, S. Dencks, P. Laugier, F. Padilla, K. Brixen, J. Ryg, A. Seekamp, L. Mahlke, A. Bremer, M. Heller, and C. C. Gluer, “Femur ultrasound (FemUS)-first clinical results on hip fracture discrimination and estimation of femoral BMD,” Osteoporos Int (2009).Google Scholar
  23. 23.
    J. A. Kanis, N. Burlet, C. Cooper, P. D. Delmas, J. Y. Reginster, F. Borgstrom, and R. Rizzoli, “European guidance for the diagnosis and management of osteoporosis in postmenopausal women,” Osteoporos Int 19(4), 399–428 (2008).CrossRefPubMedGoogle Scholar
  24. 24.
    S. Boonen, R. F. Laan, I. P. Barton, and N. B. Watts, “Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies,” Osteoporos Int 16(10), 1291–1298 (2005).CrossRefPubMedGoogle Scholar
  25. 25.
    D. Hans, C. Durosier, J. A. Kanis, H. Johansson, A. M. Schott-Pethelaz, and M. A. Krieg, “Assessment of the 10-year probability of osteoporotic hip fracture combining clinical risk factors and heel bone ultrasound: the EPISEM prospective cohort of 12,958 elderly women,” J Bone Miner Res 23(7), 1045–1051 (2008).CrossRefPubMedGoogle Scholar
  26. 26.
    A. Moayyeri, S. Kaptoge, N. Dalzell, S. Bingham, R. N. Luben, N. J. Wareham, J. Reeve, and K. T. Khaw, “Is QUS or DXA better for predicting the 10-year absolute risk of fracture?,” J Bone Miner Res 24(7), 1319–1325 (2009).CrossRefPubMedGoogle Scholar
  27. 27.
    S. Gonnelli, C. Cepollaro, A. Montagnani, S. Martini, L. Gennari, M. Mangeri, and C. Gennari, “Heel ultrasonography in monitoring alendronate therapy: a four-year longitudinal study,” Osteoporos Int 13(5), 415–421 (2002).CrossRefPubMedGoogle Scholar
  28. 28.
    S. Gonnelli, G. Martini, C. Caffarelli, S. Salvadori, A. Cadirni, A. Montagnani, and R. Nuti, “Teriparatide’s effects on quantitative ultrasound parameters and bone density in women with established osteoporosis,” Osteoporos Int 17(10), 1524–1531 (2006).CrossRefPubMedGoogle Scholar
  29. 29.
    M. A. Krieg, A. F. Jacquet, M. Bremgartner, S. Cuttelod, D. Thiebaud, and P. Burckhardt, “Effect of supplementation with vitamin D3 and calcium on quantitative ultrasound of bone in elderly institutionalized women: a longitudinal study,” Osteoporos Int 9(6), 483–488 (1999).PubMedGoogle Scholar
  30. 30.
    M. L. Frost, G. M. Blake, and I. Fogelman, “Changes in QUS and BMD measurements with antiresorptive therapy: a two-year longitudinal study,” Calcif Tissue Int 69(3), 138–146 (2001).CrossRefPubMedGoogle Scholar
  31. 31.
    D. Hans, A. M. Schott, M. E. Arlot, E. Sornay, P. D. Delmas, and P. J. Meunier, “Influence of anthropometric parameters on ultrasound measurements of Os calcis,” Osteoporos Int 5(5), 371–376 (1995).CrossRefPubMedGoogle Scholar
  32. 32.
    S. Cheng, C. F. Njeh, B. Fan, X. Cheng, D. Hans, L. Wang, T. Fuerst, and H. K. Genant, “Influence of region of interest and bone size on calcaneal BMD: implications for the accuracy of quantitative ultrasound assessments at the calcaneus,” Br J Radiol 75(889), 59–68 (2002).PubMedGoogle Scholar
  33. 33.
    M. A. Paggiosi, A. Blumsohn, R. Barkmann, and R. Eastell, “Effect of temperature on the longitudinal variability of quantitative ultrasound variables,” J Clin Densitom 8(4), 436–444 (2005).CrossRefPubMedGoogle Scholar
  34. 34.
    M. Iki, E. Kajita, S. Mitamura, H. Nishino, T. Yamagami, and N. Nagahama, “Precision of quantitative ultrasound measurement of the heel bone and effects of ambient temperature on the parameters,” Osteoporos Int 10(6), 462–467 (1999).CrossRefPubMedGoogle Scholar
  35. 35.
    W. D. Evans, E. A. Jones, and G. M. Owen, “Factors affecting the in vivo precision of broad-band ultrasonic attenuation,” Phys Med Biol 40(1), 137–151 (1995).CrossRefPubMedGoogle Scholar
  36. 36.
    P. O. Kotzki, D. Buyck, D. Hans, E. Thomas, F. Bonnel, F. Favier, P. J. Meunier, and M. Rossi, “Influence of fat on ultrasound measurements of the os calcis,” Calcif Tissue Int 54(2), 91–95 (1994).CrossRefPubMedGoogle Scholar
  37. 37.
    C. Chappard, E. Camus, F. Lefebvre, G. Guillot, J. Bittoun, G. Berger, and P. Laugier, “Evaluation of error bounds on calcaneal speed of sound caused by surrounding soft tissue,” J Clin Densitom 3(2), 121–131 (2000).CrossRefPubMedGoogle Scholar
  38. 38.
    A. Johansen and M. D. Stone, “The effect of ankle oedema on bone ultrasound assessment at the heel,” Osteoporos Int 7(1), 44–47 (1997).CrossRefPubMedGoogle Scholar

Copyright information

© Springer Netherlands 2011

Authors and Affiliations

  1. 1.Arbeitsgruppe Medizinische Physik, Klinik für Diagnostische RadiologieUniversitätsklinikum Schleswig-HolsteinKielGermany

Personalised recommendations