Relationship Between Bone Quantitative Ultrasound and Fractures: A Meta-Analysis


  • Dr Marín is an employee of Eli Lilly, a company that investigates and commercializes bone active drugs. All other authors state that they have no conflicts of interest.


The relationship between bone QUS and fracture risk was estimated in a systematic review of data from 14 prospective studies of 47,300 individuals and 2350 incident fractures. In older women, low QUS values were associated with overall fracture risk, low-trauma fractures, and with hip, forearm, and humerus fractures separately.

Introduction: Bone quantitative ultrasound (QUS) has emerged as a promising technique to evaluate bone status. The aim of this study was to determine the association between measurements of QUS with the risk of fracture.

Materials and Methods: A meta-analysis of prospective cohort studies published between 1985 and June 2005 with a baseline measurement of QUS and subsequent follow-up for fractures was carried out. Fourteen separate study populations, consisting of about 47,300 individuals (85.4% women), with about 124,000 person-years of observation and over 2350 fractures, including 653 hip, 529 forearm, and 386 humeral fractures, were analyzed. The main outcome measure was the estimated relative risk of fracture for a decrease in bone QUS parameters of 1 SD below sex- and age-adjusted mean in women.

Results: Eleven studies evaluated QUS at the heel, with patella and phalanx (two studies each) and distal radius (one study) being scarcely used. There was not significant heterogeneity among the studies included in the review. Relative risk estimates (95% CI) for overall fractures were 1.55 (1.35–1.78) for each SD decrease in broadband ultrasound attenuation (BUA), 1.63 (1.37–1.93) for speed of sound (SOS), and 1.74 (1.39–2.17) for QUS index/stiffness index (QUI/SI). Risk estimates were similar or slightly higher for hip fractures and low-energy trauma fractures. Humeral and forearm/wrist fractures were also related with lower QUS values.

Conclusions: Measurements of bone QUS are significantly associated with nonspinal fracture risk in older women in a similar degree to DXA. QUS may be a valid alternative to evaluate fracture risk in situations where DXA is not accessible.