Low-Frequency Ultrasound Velocity of Radius as Screening for Bone Fragility in PHPT
Overview
This study evaluated the use of portable low-frequency ultrasound velocity (VLF) at the radius as a screening tool for bone fragility in postmenopausal women with primary hyperparathyroidism (PHPT). VLF showed moderate agreement with DXA measurements and was associated with osteoporosis and fracture risk, suggesting its potential utility when DXA is unavailable.
Background
Primary hyperparathyroidism (PHPT) is characterized by elevated serum calcium and parathyroid hormone levels, leading to bone fragility predominantly affecting cortical bone such as the distal radius. Dual-energy x-ray absorptiometry (DXA) is the standard for assessing bone mineral density (BMD) and fracture risk but is not always accessible. Portable low-frequency axial transmission ultrasound (VLF) has been proposed as a screening tool for cortical bone properties and fracture risk in non-PHPT populations, but its utility in PHPT patients had not been established prior to this study.
Data Highlights
Parameter
Odds Ratio (OR)
95% Confidence Interval (CI)
Radius ultrasound T-score & Osteoporosis at lumbar/femoral sites
1.85
1.08 - 3.18
Femoral neck T-score & All fractures
1.89
1.24 - 2.89
Total hip T-score & All fractures
1.65
1.09 - 2.50
Years since menopause & All fractures
1.25
1.02 - 1.54
Femoral neck T-score & Vertebral fractures
1.96
1.23 - 3.14
Radius ultrasound T-score & Vertebral fractures
1.67
1.09 - 2.56
Trabecular bone score (TBS) & Vertebral fractures
0.78
0.60 - 0.99
Key Findings
VLF ultrasound measurement at the radius showed moderate agreement with DXA for detecting osteoporosis (Cohen’s kappa = 0.43, P < .001).
Lower radius ultrasound T-scores were significantly associated with DXA-defined osteoporosis at lumbar spine and femoral neck (OR = 1.85).
All fractures correlated with lower femoral neck and total hip T-scores and increased years since menopause.
Morphometric vertebral fractures were associated with lower femoral neck, total hip, ultradistal radius DXA T-scores, lower radius ultrasound T-scores, lower trabecular bone score, and longer time since menopause.
VLF ultrasound demonstrated potential as a screening tool for skeletal fragility in PHPT patients when DXA is not available.
Clinical Implications
Portable low-frequency ultrasound velocity measurement at the radius can serve as a practical preliminary screening tool for bone fragility in postmenopausal women with PHPT, especially in settings lacking DXA access. Its use may help identify patients at higher risk of osteoporosis and fractures who require further DXA evaluation or intervention. However, it should not replace DXA but rather complement it when DXA is unavailable.
Conclusion
Radius VLF ultrasound correlates moderately with DXA and is associated with fracture risk in PHPT patients, supporting its role as a screening modality prior to DXA. This approach may improve fracture risk assessment in clinical settings where DXA is inaccessible.
References
Marcocci et al. 2024 -- Link Between Low-Frequency Ultrasound Velocity of the Radius and Bone Fragility in Patients with Primary Hyperparathyroidism
