New perspectives in echographic diagnosis of osteoporosis on hip and spine

Abstract

SummaryCurrently, the accepted "gold standard" method for bone mineral density (BMD) measurement and osteoporosis diagnosis is dual-energy X-ray absorptiometry (DXA). However, actual DXA effectiveness is limited by several factors, including intrinsic accuracy uncertainties and possible errors in patient positioning and/or post-acquisition data analysis. DXA employment is also restricted by the typical issues related to ionizing radiation employment (high costs, need of dedicated structures and certified operators, unsuitability for population screenings). The only commercially-available alternative to DXA is represented by "quantitative ultrasound" (QUS) approaches, which are radiation-free, cheaper and portable, but they cannot be applied on the reference anatomical sites (lumbar spine and proximal femur). Therefore, their documented clinical usefulness is restricted to calcaneal applications on elderly patients (aged over 65 y), in combination with clinical risk factors and only for the identification of healthy subjects at low fracture risk. Literature-reported studies performed some QUS measurements on proximal femur, but their clinical translation is mostly hindered by intrinsic factors (e.g., device bulkiness). An innovative ultrasound methodology has been recently introduced, which performs a combined analysis of B-mode images and corresponding "raw" radiofrequency signals acquired during an echographic scan of the target reference anatomical site, providing two novel parameters: Osteoporosis Score and Fragility Score, indicative of BMD level and bone strength, respectively. This article will provide a brief review of the available systems for osteoporosis diagnosis in clinical routine contexts, followed by a synthesis of the most promising research results on the latest ultrasound developments for early osteoporosis diagnosis and fracture prevention.

Conservative Treatment of Degenerative Lumbar Scoliosis

“…Alternately, REMS measurement can be used. It relies on a machine algorithm and takes into consideration the entire bony profile including the vertebral microarchitecture, compact bone to trabecular bone mineral density ratio, and collagen index, thus reducing the many errors that are associated with the DEXA measurement [64,65].…”

Computational Modeling of Long Bone Microstructure and Ultrasonic Evaluation of the Fracture Healing Process

“…Specifically, there is increased interest during the last few decades in QUS techniques aiming to correlate ultrasonic propagation parameters with material and structural changes in pathological cases (Preininger et al 2011, Machado et al 2010, Casciaro et al 2015, Barbieri et al 2011. More recently, the use of numerical methods for the ultrasonic evaluation of bone diseases has provided supplementary information to experimental findings due to the rapid evolution of imaging modalities, such as micro-computed tomography (μ-CT) and scanning acoustic microscopy (SAM), and the availability of robust computational tools (Rohde et al 2014, Potsika et al 2014, Moilanen et al 2007.…”

“…Finally, the backscattering method uses a single transducer as an emitter and receiver and is applied in bone regions (i.e. the hip, spine) in which through-transmission measurements are difficult to be performed (Casciaro et al 2015). The integrated reflection coefficient, the broadband ultrasound backscatter and apparent integrated backscatter (AIB), the time slope of apparent backscatter and the frequency slope of apparent backscatter are the main measured parameters (Liu et al 2015, Karjalainen et al 2012).…”

Ultrasonic evaluation of intact, healing and osteoporotic long bones

“…Several experimental and computational studies have been presented during the last few decades aiming to correlate QUS propagation parameters with bone defects as well as material and geometrical changes in pathological cases (Casciaro et al 2015, Barbieri et al 2011, Kaufman et al 2007. Computational studies give insight to complicated wave propagation phenomena which cannot be investigated via traditional clinical and experimental procedures.…”

“…The FAS velocity and attenuation, as well as the propagation of guided waves are the parameters of interest. On the other hand, in backscattering measurements a single transducer is used rendering this method more convenient for skeletal sites such as the hip and spine where through-transmission measurements are difficult to be conducted (Casciaro et al 2015). Typical parameters of interest include the integrated reflection coefficient, the broadband ultrasound backscatter and apparent integrated backscatter (AIB), the time slope of apparent backscatter and the frequency slope of apparent backscatter which have been widely applied for the ultrasonic evaluation of cancellous bone (Liu et al 2015, Hoffmeister et al 2012, Karjalainen et al 2012.…”