Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques

Abstract

Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinically-available diagnostic methods are mainly based on the use of either X-rays or ultrasound (US). All X-ray based methods provide a measure of bone mineral density (BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry (DXA) is considered the current “gold standard” for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations (e.g., use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population screenings and primary care diagnosis. This has resulted in an increasing interest in developing reliable pre-screening tools for osteoporosis such as quantitative ultrasound (QUS) scanners, which do not involve ionizing radiation exposure and represent a cheaper solution exploiting portable and widely available devices. Furthermore, the usefulness of QUS techniques in fracture risk prediction has been proven and, with the last developments, they are also becoming a more and more reliable approach for assessing bone quality. However, the US assessment of osteoporosis is currently used only as a pre-screening tool, requiring a subsequent diagnosis confirmation by means of a DXA evaluation. Here we illustrate the state of art in the early diagnosis of this “silent disease” and show up recent advances for its prevention and improved management through early diagnosis.

Keywords: Diagnosis of osteoporosis, Screening techniques, X-ray based methods, Quantitative ultrasound, Peripheral sites, Bone mineral density

Core tip: Early diagnosis is the key for an appropriate osteoporosis management. To date, dual X-ray absorptiometry is the most commonly used and validated method for bone densitometry in clinical practice. Nevertheless, some important limitations like radiation dose and high costs do not allow it to be the true “gold standard technique” and make it unsuitable as a screening tool at the primary health care level for prevention purposes. As a consequence, interest in developing reliable pre-screening devices for osteoporosis assessment such as quantitative ultrasound scanners is growing up. Ultrasound-based techniques involve no radiation exposure, represent a cheap solution and they are also becoming more and more reliable for assessing bone quality.