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Research Article

Vol. 11 No. 2 (2008)

The Correlation between Phalangeal Quantitative Ultrasonography and Dual Energy X-ray Absorptiometry in Women with Premature Ovarian Failure

  • Tandip S Mann
  • Alison H McGregor
  • Rajesh Patel
November 2, 2020


Objectives –With the growing demand for bone densitometry services there is a need for simple, cost-effective and ideally mobile devices which can identify individuals who are at risk of osteoporotic fracture. When new devices are evaluated, it is useful to examine the correlation with the established ‘gold standard’ technique of dual x-ray absorptiometry (DXA). This study examined the correlation between quantitative ultrasound (QUS) measurements performed at the phalanges and conventional DXA measurements of the spine and hip in women with premature ovarian failure – a known risk factor for osteoporosis. Methods - Thirteen white Caucasian women suffering from premature ovarian failure and 19 age- and sex-matched controls were recruited into the study. DXA measurements were performed at the spine and hip, followed by quantitative ultrasonography at phalanges II-V of the non-dominant hand. Results – Significant correlations were observed between the bone transit time (BTT) value from the Bone Profiler and bone mineral density measured at the spine (r=0.66). The spine Z-scores also correlated with many of the ultrasound values (r=0.44 - 0.63). Significant inverse correlations were observed between BMI, weight and ultrasound parameters (r = -0.48 to -0.78). Conclusion – We have reported moderate but significant correlations between phalangeal QUS and DXA parameters. The strongest correlation was observed between BTT and spine BMD, as well as between the Z-scores from the two devices. QUS parameters also demonstrated an inverse correlation with weight and BMI.


  1. Cooper C, Campion G, Melton LJ Hip fractures in the elderly; a world-wide projection. Osteoporosis Int 1992; 2:285-289.
  2. Ray NF, Chan JK, Thamer M, Melton LJ Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12:24-35
  3. Kanis JA, Delmas P, Burckhardt P et al. on behalf of the European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and treatment of osteoporosis. Osteoporosis Int 1997; 7:390-406.
  4. Black DM, Thompson DE, Bauer DC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the fracture intervention trial. J Clin Endocrinol Metab 2000; 85:4118-4124.
  5. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl JMed 2001; 344:333-340.
  6. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1-34) fragment on spine and non-spine fractures and bone mineral density in postmenopausal osteoporosis. N Engl J Med 2001; 344:1434-1441
  7. Delmas PD, Ensrud KE,Adachi JD, et al. Efficacy of raloxifene on vertebral fracture risk in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2001; 87:3609-3617.
  8. Royal College of Physicians Osteoporosis: clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. RCP 2000, London.
  9. US Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Arch Intern Med 2002; 137:526-528.
  10. Bonjour J-P and Rizzoli R. Bone acquisition in adolescence. In Marcus R, Feldman D, Kelsey J (eds). Osteoporosis 1996; pp465-476. Academic Press, San Diego.
  11. Kanis JA, Gluer C-C. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporosis International. 2000; 11: pp. 192-202.
  12. Cashman KD. Calcium intake, calcium bioavailability and bone health. British Journal of Nutrition. 2002; 87 (Supplement S2): pp. S169-S177.
  13. Rideout CA, McKay HA, Barr SI. Self-reported lifetime physical activity and areal bone mineral density in healthy postmenopausal women: the importance of teenage activity. Calcified Tissue International. 2006; 79 (4): pp. 214-222.
  14. Pons F, Peris P, Guanabens N et al. The effect of systemic lupus erythematosus and long-term steroid therapy on bone mass in pre-menopausal women. British Journal of Rheumatology. 1995; 34: pp. 742-6.
  15. Chappard D, Josselin N, Rouge-Maillart C, et al. Bone microarchitecture in males with corticosteroid-induced osteoporosis. Osteoporosis International. 2007; 18 (4): pp. 487-494.
  16. Bainbridge PR, Eastell R. Indications for bone densitometry: do they identify patients with low bone mineral density? Current research in osteoporosis and bone mineral management. British Journal of Radiology. 1998; 5: pp. 5-6.
  17. Seriolo B, Paolino S, Sulli A, et al. Bone metabolism changes during anti-TNF-alpha therapy in patients with active rheumatoid arthritis. Annals of the New York Academy of Sciences. 2006; 1069 (1): pp. 420-7.
  18. Aitken JM, Hart DM, Anderson JB, et al. Osteoporosis after oophorectomy for non-malignant disease in premenopausal women. British Medical Journal. 1973; 2: pp. 325-8.
  19. Genant HK, Cooper C, Poor G et al. Interim report and recommendations of the World Health Organisation task-force for osteoporosis. Osteoporosis International. 1999; 10: pp. 259-264.
  20. Ensrud KE, Palermo L, Black DM, et al. Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. Journal of Bone and Mineral Research. 1995; 10: pp. 1778-87.
  21. Kazerooni T, Talei AR, Sadeghi-Hassanabadi A, et al. Reproductive behaviour in women in Shiraz, Islamic Republic of Iran. Eastern Mediterranean Health Journal. 2000; 6 (2): pp. 517-521.
  22. Uygur D, Sengul O, Bayar D, et al. Bone loss in young women with premature ovarian failure. Archives of Gynecology and Obstetrics. 2005; 273: pp. 17-19.
  23. Johnell O, Kanis JA, OdenA, et al. Predictive value of BMD for hip and other fractures. Journal of Bone and Mineral Research. 2005; 20: pp. 1185-94.
  24. National Osteoporosis Foundation Risk assessment. In: Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation 1998;Washington DC, USA.
  25. International Society for Clinical Densitometry. Official Positions and Official Pediatric Positions of the ISCD 2007.
  26. Alexandersen P, de Terlizzi F, Tanko LB, et al. Comparison of quantitative ultrasound of the phalanges with conventional bone densitometry in healthy postmenopausal women. Osteoporosis International. 2005; 16: pp. 1071-78.
  27. Gluer CC, Wu CY, Genant HK. Broadband ultrasound attenuation signals depend on trabecular orientation: an in vitro study. Osteoporosis International. 1993; 3: pp. 185-191.
  28. Bouxsein ML, Radloff SE. Quantitative ultrasound of the calcaneus reflects the mechanical properties of calcaneal trabecular bone. Journal of Bone and Mineral Research. 1997; 12: pp. 839-46.
  29. Frost ML, Blake GM, Fogelman I. Does quantitative ultrasound imaging enhance precision and discrimination? Osteoporosis International. 2000; 11: pp. 425-433.
  30. Frost ML, Blake GM, Fogelman I. Contact quantitative ultrasound: an evaluation of precision, fracture discrimination, age-related bone loss and applicability of the WHO criteria. Osteoporosis Interantional. 1999; 10: pp. 441-449.
  31. He YQ, Fan B, Hans D, et al. Assessment of a new quantitative ultrasound calcaneus measurement: precision and discrimination of hip fractures in elderly women compared with dual X-ray absorptiometry. Osteoporosis International. 2000; 11 (4): pp. 354-360.
  32. Bauer DC, Gluer CC, Cauley JA, et al. Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. Archives of Internal Medicine. 1997; 157: pp. 629-634.
  33. Woodhouse A, Black DM. BMD at various sites for the prediction of hip fractures: a meta analysis. Journal of Bone and Mineral Research. 2000; 15: pp. 1-145.
  34. Johansen A, Stone MD. The effect of ankle oedema on bone ultrasound assessment at the heel. Osteoporosis International. 1997; 7: pp. 44-47.
  35. Cadossi R, Cane V. Pathways of transmission of ultrasound energy through the distal metaphysis of the second phalanx of pigs. Osteoporosis International. 1996; 6: pp. 196-206.
  36. Kleerekoper M, Nelson DA, Flynn MJ, et al. Comparison of radiographic absorptiometry with dual-X-ray absorptiometry and quantitative computed tomography in normal older white and black women. Journal of Bone and Mineral Research. 1994; 9: pp. 1745-9.
  37. Di Stefano M and Isaia GV. Ability of ultrasound bone profile score(UBPS) to discriminate between fractured and not fractured osteoporotic women. Ultrasound in Medicine & Biology 2002; 28(11-12), pp1485-1489.
  38. PluskiewiczW, Drozdzowska B. Quantitative ultrasound (QUS) at the calcaneus and hand phalanges in Polish healthy postmenopausal women. Ultrasound in Medicine and Biology. 2001; 27 (3): pp. 373-7.
  39. Guglielmi G, de Terlizzi F, Torrente I, et al. Quantitative ultrasound of the hand phalanges in a cohort of monozygotic twins: influence of genetic and environmental factors. Skeletal Radiology. 2005; 34 (11): pp. 727-735.
  40. Pocock NA, Babichev A, Culton N, et al. Temperature dependency of quantitative ultrasound. Osteoporosis International. 2000; 11: pp. 316-320.
  41. Ventura V, Mauloni M, Mura M, et al. Ultrasound velocity changes at the proximal phalanxes of the hand in pre-, peri- and postmenopausal women. Osteoporosis International. 1996; 6: pp. 368-375.
  42. Joly J, Westhovens R, Borghs H, et al. Reference curves and diagnostic sensitivity for a new ultrasound device for the phalanges, the DBMsonic 1200, in Belgian women. Osteoporosis International. 1999; 9 (4): pp. 284-9.
  43. Shepherd J, Fan B, Lu Y, et al. Comparison of BMD precision for Prodigy and Delphi spine and femur scans. Osteoporosis International. 2006; 17 (9): pp. 1303-8.
  44. Montagnani A, Gonnelli S, Cepollaro C, et al. Usefulness of bone quantitative ultrasound in management of osteoporosis in men. Journal of Clinical Densitometry. 2001; 4 (3): pp. 231-7.
  45. Valerio G, del Puente A, Buono P, et al. Quantitative ultrasound of proximal phalanges in patients with type I diabetes mellitus. Diabetes Research and Clinical Practice. 2004; 64 (3): pp. 161-6.
  46. Halaba ZP, Konstantynowicz J, Pluskiewicz W, et al. Comparison of phalangeal ultrasound and dual energy X-ray absorptiometry in healthy male and female adolescents. Ultrasound in Medicine and Biology. 2005; 31 (12): pp. 1617-22.
  47. Rico H,Aguado F,Arribas I, et al. Behaviour of phalangeal bone ultrasound in normal women with relation to gonadal status and body mass index. Osteoporosis International. 2001; 12: pp. 450-5.
  48. Alenfeld FE, Wuster C, Funck C, et al. Ultrasound measurements at the proximal phalanges in healthy women and patients with hip fractures. Osteoporosis International. 1998; 8: pp. 393-8.
  49. Gregg EW, Kriska AM, Salamone LM, et al. Correlates of quantitative ultrasound in the Women’s Healthy Lifestyle Project. Osteoporosis International. 1999; 10: pp. 416-424.
  50. Royal College of Physicians. Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. London: RCP; 2002.
  51. Wuster C, Albanese C, De Aloysio D, et al. Phalangeal Osteosonogrammetry Study: age-related changes, diagnostic sensitivity, and discrimination power. Journal of Bone and Mineral Research. 2000; 15: pp. 1603-14.
  52. Mele R, Masci G, Ventura V, et al. Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population. Osteoporosis International. 1997; 7 (6): pp. 550-7.
  53. KriegMA, Cornuz J, Ruffieux C, et al. Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women ≥70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study. Journal of Bone and Mineral Research. 2006; 21 (9): pp. 1457-63.
  54. Rico H, Revilla M, Fraile E, et al. Metacarpal cortical thickness by computer radiography in osteoporosis. Bone. 1994; 15: pp. 303-6.
  55. Schneider J, Bundschuh B, Spath C, et al. Discrimination of patients with and without vertebral fractures as measured by ultrasound and DXA osteodensitometry. Calcified Tissue International. 2004; 74 (3): pp. 246-254.
  56. Roben P, Barkmann R, Ullrich S, et al. Assessment of phalangeal bone loss in patients with rheumatoid arthritis by quantitative ultrasound. Annals of the rheumatic diseases. 2001; 60: pp. 670-7.
  57. Pluskiewicz W, Drozdzowska B. Ultrasound measurements of proximal phalanges in Polish early postmenopausal women. Osteoporosis International. 1998; 8: pp. 578-583.
  58. Hartl F, Tyndall A, Kraenzlin M, et al. Discriminatory ability of quantitative ultrasound parameters and bone mineral density in a population-based sample of postmenopausal women with vertebral fractures: result of the Basel Osteoporosis Study. Journal of Bone and Mineral Research. 2002; 17: pp. 321-330.
  59. Guglielmi G, Cammisa M, De Serio A, et al. Phalangeal US velocity discriminates between normal and vertebrally fractured subjects. European Radiology. 1999; 9: pp. 1632-7.
  60. Pluskiewicz W, Nowakowska J. Bone status after long-term anticonvulsant therapy in epileptic patients: evaluation using quantitative ultrasound of calcaneus and phalanges. Ultrasound Med Biol. 1997; 23: pp. 553-8.
  61. Pongchaiyakul C, Panichkul S, Songpatanasilp T et al. A normogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement. Osteoporosis International. 2007; 18: pp. 525-531.


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