Quantitative Ultrasound Assessment of Cortical Bone Properties Beyond Bone Mineral Density

Abstract

The development of quantitative ultrasound (QUS) technologies to measure bone is motivated by the need to overcome the limitations of X-ray based methods, measuring bone mineral density (BMD) which is the gold standard to date for the diagnosis of osteoporosis. Because it uses mechanical waves, the ultrasound modality is a particularly relevant means to probe bone mechanical resistance. The vast majority of QUS technologies commercialized to date merely aim to provide surrogate markers for BMD. During the past decade, innovative QUS approaches have emerged to assess bone beyond BMD. This may be achieved by (1) specifically assessing the cortical bone compartment, independently of trabecular bone, and (2) providing intrinsic bone properties such as cortical bone thickness and material properties. One specific motivation is to estimate intracortical porosity, a quantity reflected in material properties. This article aims at an overview of recent QUS developments to measure cortical bone properties. We also draw a picture of the current knowledge on bone material properties of interest for bone QUS. We discuss the potential of ultrasound to provide novel biomarkers of bone health through the assessment of material properties.

Bulk Wave Velocities in Cortical Bone Reflect Porosity and Compression Strength

“…Ultrasound (US) methods have been developed as an alternative to DXA to provide a non-ionizing, portable, and affordable diagnostic tool for osteoporosis (Laugier and Haïat, 2011;Raum et al, 2014). Since cortical bone plays an important role in bone resistance (Mayhew et al, 2005;Holzer et al, 2009), and because a large part of bone loss arises from the cortical compartment (Zebaze et al, 2010), several US approaches have been specifically designed to assess cortical bone (Karjalainen et al, 2008;Sai et al, 2010;Minonzio et al, 2019;Renaud et al, 2018;Nguyen Minh et al, 2020;Grimal and Laugier, 2019). These approaches aim at evaluating cortical bone thickness or material properties (e.g., mass density, elasticity, bulk wave velocities), which are dramatically altered with bone pathologies.…”

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method

“…3), and thus appears to indicate a deterioration of bone quality. Given that ultrasound characterizes the overall material property of bone (e.g., Grimal and Laugier, 2019; Sievanen et al, 2001; Mutimura et al, 2016; Rivas-Ruiz et al, 2016; Lee et al, 1997; Weiss et al, 2000; Zadik et al, 2003), these observations serve to highlight the inherent complexity and diverse manifestations of F - effects in bone that go beyond changes in bone density alone. For instance, our evaluations of X-rays from selected subjects also showed a co-presence of osteosclerosis and osteoporosis (see Fig.…”

“…In view of the growing burden of fluorosis in highly exposed regions, and to allow a quantitative assessment of F - -associated changes in bone that is both simpler and more complete, we tested a non-invasive and portable ultrasound technology in a rural population, that resides in a hot spot for exposure to F - : the Rift Valley of Ethiopia. This specific technique measures the speed of sound waves (SOS) in bone, as influenced by a combination of bone parameters (e.g., microstructure, collagen composition, cortical thickness, and bone density) that are related to bone quality (Cortet et al, 2004; Grimal and Laugier, 2019; Hayman et al, 2002; Lee et al, 1997; Mutimura et al, 2016; Prevrhal et al, 2001; Rivas-Ruiz et al, 2016; Sievanen et al, 2001; Weiss et al, 2000; Zadik et al, 2003). While the SOS measure is influenced by the collection of these various bone properties, the contribution of the specific parameters to SOS is unclear, and the relevance of this measure to bone quality therefore requires further study, including in animal studies that would allow a more complete characterization.…”

Effect of Spectral Estimation on Ultrasonic Backscatter Parameters in Measurements of Cancellous Bones

“…Moreover, because of ionizing radiation, the X-ray based methods may not be desirable for monitoring the condition of bone microarchitecture for infants, pregnant women, and the elderly. Quantitative ultrasound (QUS) [24] has been applied as a noninvasive technique for bone status evaluation with the advantages [25], [26] of nonionizing radiation, safety, low cost, and portability. The piezo crystal generates the ultrasound wave propagating in bone, the propagation properties are associated with bone properties, i.e., bone densities and microstructures.…”