Original Investigation| Volume 30, ISSUE 3, P516-527, March 2023

Can Ultrasonographic Measurement of Bone Cortical Thickness Predict Osteoporosis?

Published:August 29, 2022DOI:

      Rationale and Objectives

      In this study, we aimed to describe a more accessible and safe diagnostic tool for osteoporosis or osteopenia diagnosis. We utilized cortical thickness (CoT) measurement of various bones via ultrasonography and evaluated the method's accuracy relative to bone mineral density (BMD) results determined by dual-energy X-ray absorptiometry (DXA).

      Materials and Methods

      A total of 200 volunteers (all female) who agreed to participate in the study and had undergone BMD measurement (femoral or vertebral) were included in the study. Patients with normal BMD result (≥-1.0 T-score) were defined as controls. CoT measurements were made from three bones (radius, tibia, and second metatarsal) for each patient via ultrasonography.


      Radius CoT and tibial CoT measurements of both femoral and vertebral osteoporotic or osteopenic patients were significantly higher compared to controls. Second metatarsal CoT of femoral osteoporotic and osteopenic patients was also found to be significantly higher than the control group. We found tibia CoT and radius CoT to have high sensitivity and positive predictive value in identifying patients with abnormal femoral T-scores (<-1). In multivariable analyzes, radius CoT was found to be independently predictive in distinguishing patients with abnormal T-score (<-1) from controls in both the femur and vertebral BMD groups.


      Radius CoT and tibia CoT values appear to have value in predicting patients with abnormal T-scores measured via DXA. This method may be a very simple technique that can be used for early detection of osteoporosis and osteopenia, but its results need to be supported by more comprehensive studies.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhang B
        • Yu K
        • Ning Z
        • et al.
        Deep learning of lumbar spine X-ray for osteopenia and osteoporosis screening: a multicenter retrospective cohort study.
        Bone. 2020; 140115561
        • Brown C.
        Staying strong.
        Nature. 2017; 550 (S15-S7)
        • Anna U-M
        • Maria S
        • Kerstin B
        Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study.
        Diabetes Res Clin Pract. 2021; 180109064
        • Force* UPST
        Screening for osteoporosis in postmenopausal women: recommendations and rationale.
        Ann Intern Med. 2002; 137: 526-528
        • Grimal Q
        • Grondin J
        • Guérard S
        • et al.
        Quantitative ultrasound of cortical bone in the femoral neck predicts femur strength: results of a pilot study.
        J Bone Miner Res. 2013; 28: 302-312
        • Pisani P
        • Renna MD
        • Conversano F
        • et al.
        Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques.
        World J Radiol. 2013; 5: 398
        • Oo WM
        • Vasikaran Naganathan MTB
        • Hunter DJ.
        Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases.
        Quant Imaging Med Surg. 2018; 8: 100
        • Hans D
        • Baim S.
        Quantitative ultrasound (QUS) in the management of osteoporosis and assessment of fracture risk.
        J Clin Densitom. 2017; 20: 322-333
        • Williams J
        • Wilson C
        • Biassoni L
        • et al.
        Dual energy x-ray absorptiometry and quantitative ultrasound are not interchangeable in diagnosing abnormal bones.
        Arch Dis Child. 2012; 97: 822-824
        • Baroncelli GI
        • Federico G
        • Bertelloni S
        • et al.
        Assessment of bone quality by quantitative ultrasound of proximal phalanges of the hand and fracture rate in children and adolescents with bone and mineral disorders.
        Pediatr Res. 2003; 54: 125-136
        • Sentilhes L
        • Berthier A
        • Sergent F
        • et al.
        Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 763-772
        • Mather J
        • Macdermid JC
        • Faber KJ
        • et al.
        Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis.
        J Shoulder Elbow Surg. 2013; 22: 732-738
        • Achtari C
        • Hiscock R
        • BA O'reilly
        • et al.
        Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh.
        Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 389-394
        • Sai H
        • Iguchi G
        • Tobimatsu T
        • et al.
        Novel ultrasonic bone densitometry based on two longitudinal waves: significant correlation with pQCT measurement values and age-related changes in trabecular bone density, cortical thickness, and elastic modulus of trabecular bone in a normal Japanese population.
        Osteoporos Int. 2010; 21: 1781-1790
        • Camacho PM
        • Petak SM
        • Binkley N
        • et al.
        American association of clinical endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2016–executive summary.
        Endocr Pract. 2016; 22: 1111-1118
        • Richards AM
        • Coleman NW
        • Knight TA
        • et al.
        Bone density and cortical thickness in normal, osteopenic, and osteoporotic sacra.
        J Osteoporos. 2010; 2010
        • Renaud G
        • Kruizinga P
        • Cassereau D
        • et al.
        In vivo ultrasound imaging of the bone cortex.
        Phys Med Biol. 2018; 63125010
        • Barnett E
        • Nordin B.
        The radiological diagnosis of osteoporosis: a new approach.
        Clin Radiol. 1960; 11: 166-174
        • Webber T
        • Patel SP
        • Pensak M
        • et al.
        Correlation between distal radial cortical thickness and bone mineral density.
        J Hand Surg. 2015; 40: 493-499
        • Firoozi F
        • Ingber MS
        • Moore CK
        • et al.
        Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system.
        J Urol. 2012; 187: 1674-1679
        • Damilakis J
        • Adams JE
        • Guglielmi G
        • et al.
        Radiation exposure in X-ray-based imaging techniques used in osteoporosis.
        Eur Radiol. 2010; 20: 2707-2714
        • De Terlizzi F
        • Battista S
        • Cavani F
        • et al.
        Influence of bone tissue density and elasticity on ultrasound propagation: an in vitro study.
        J Bone Miner Res. 2000; 15: 2458-2466
        • Pisani P
        • Conversano F
        • Chiriacò F
        • et al.
        Estimation of femoral neck bone mineral density by ultrasound scanning: Preliminary results and feasibility.
        Measurement. 2016; 94: 480-486
        • Moilanen P
        • Määttä M
        • Kilappa V
        • et al.
        Discrimination of fractures by low-frequency axial transmission ultrasound in postmenopausal females.
        Osteoporos Int. 2013; 24: 723-730
        • Mohanty K
        • Yousefian O
        • Karbalaeisadegh Y
        • et al.
        Artificial neural network to estimate micro-architectural properties of cortical bone using ultrasonic attenuation: A 2-D numerical study.
        Comput Biol Med. 2019; 114103457
        • Cheng S
        • Tylavsky F
        • Orwoll E
        • et al.
        The Role of Collagen Abnormalities in Ultrasound and Densitometry Assessment: In VivoEvidence.
        Calcif Tissue Int. 1999; 64: 470-476
        • Specker BL
        • Schoenau E.
        Quantitative bone analysis in children: current methods and recommendations.
        J Pediatr. 2005; 146: 726-731
        • Pezzuti IL
        • Kakehasi AM
        • Filgueiras MT
        • et al.
        Imaging methods for bone mass evaluation during childhood and adolescence: an update.
        J Pediatr Endocrinol Metab. 2017; 30: 485-497
        • Krieg M-A
        • Barkmann R
        • Gonnelli S
        • et al.
        Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions.
        J Clin Densitom. 2008; 11: 163-187
        • Kaji H
        • Kosaka R
        • Yamauchi M
        • et al.
        Effects of age, grip strength and smoking on forearm volumetric bone mineral density and bone geometry by peripheral quantitative computed tomography: comparisons between female and male.
        Endocr J. 2005; 52: 659-666
        • Schneider P
        • Reiners C
        • Cointry G
        • et al.
        Bone quality parameters of the distal radius as assessed by pQCT in normal and fractured women.
        Osteoporos Int. 2001; 12: 639-646
        • Grampp S
        • Henk C
        • Fuerst T
        • et al.
        Diagnostic agreement of quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur.
        AJR Am J Roentgenol. 1999; 173: 329-334