• 19
    Dec
  • Quantitative ultrasound of bone: calcaneus. Conclusions and future perspectives

A substantial body of knowledge regarding the performance of QUS techniques has been gathered. To date, evidence supports the use of QUS for the assessment of fracture risk. Addi­tional clinical applications of QUS, as the assessment of rates of changes for monitoring disease progression or response to treatment, require further investigation. Moreover, QUS tech­nology has tremendous potential for further improvement and refinement. If one takes an optimistic view, it may eventually be possible to develop a truly non invasive method that will allow the investigation of relevant characteristics of skeletal status that can only be studied by invasive histomorphometric meth­ods today. QUS may also improve the evaluation of skeletal properties on a micro level and open new frontiers for more in- depth and more comprehensive investigation of bone metabo­lism, including the effect of therapeutic interventions.

Currently, the low cost of the devices makes them very attractive and this has led to their rapid dissemination in many countries. In the future, the potential for developments beyond bone densitome- try may represent an additional promoting factor. QUS will probably play a dominant role in the assessment of osteoporo­sis and potentially other skeletal disorders as well.
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Table II – Calcaneal QUS and fracture.

Author

Fracture outcome

Subjects

Velocity

BUA

Derived parameters

(RR)

(RR)

(RR)

Selected retrospective studies

Ross,1 995

Vertebral

702 women

1.5-1.7

Gonnelli, 1995

Vertebral

304 women

4.5

3.1

4.8 (Stiffness)

Schott, 1995

Hip

129 women

2.7

3.7

3.5 (Stiffness)

Thompson, 1998

All fractures

3180 women

1.5

1.4

1.5 (Stiffness)

Hartl, 2002

Vertebral

500 women

3.0 (Stiffness)

3.8 (QUI)

Ekman, 2002

Hip

99 men

1.9

1.9

2.2 (Stiffness)

Krieg, 2003

Hip

7562 women

2.5

2.3

2.7 (Stiffness)

2.1

2.4

2.4 (QUI)

Forearm

1.6

1.5

1.6 (Stiffness)

1.7

1.7

1.7 (QUI)

Other fractures

1.1

1.1

1.1 (Stiffness)

1.1

1.1

1.2 (QUI)

Gluer, 2004

Vertebral

2837 women

1.4-1.5

1.2-1.4

1.5 (Stiffness)

Gonnelli, 2004

All fractures

401 men

3.0

2.8

3.2 (Stiffness)

Prospective studies

Hans, 1996

Hip

5662 women

1.9

2.0

Bauer, 1997

Hip

6189 women

2.0

Non spine

1.3

Pluijm, 1999

Hip

132 men and

1.6

2.3

Non spine

578 women

1.3

1.6

Stewart, 2003

Forearm

1000 women

3.25

All fractures

1.39

Huopio, 2004

All fractures

422 women

1.8

1.7

1.4

Hans, 2004

Hip

5898 women

1.8-2.4

1.9-2.6

1.9-2.8 (Stiffness)

Khaw, 2004

Hip

14824 men and

2.22

1.99

Non hip

women

1.96

1.59

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