Clinical evaluation of a novel ultrasound-based methodology for osteoporosis diagnosis on overweight and obese women

Osteoporosis and overweight/obesity constitute major worldwide public health burdens that are associated with aging. The gold standard for osteoporosis diagnosis is currently represented by bone mineral density (BMD) measurement through dual-energy X-ray absorptiometry (DXA). However, DXA cannot be used for early diagnosis through population mass screenings due to ionizing radiation employment. Because of this, generally, only people considered at high risk of fracture (underweight women after the menopause) undergo to osteoporosis screening. In fact, a significant risk factor for fracture is the low body mass index (BMI), while the tendency to overweight or obesity delays osteoporosis onset. Nevertheless, a high proportion of women after the menopause develop intra-abdominal adiposity, which leads to metabolic disorders and osteoporosis. This paper describes the diagnostic accuracy of a novel ultrasound (US)-based method to perform spinal densitometry. The proposed innovative methodology is based on a combined analysis of both echographic images and "raw" radiofrequency US signals. The diagnostic output is represented by the same parameters provided by DXA (BMD, T-score, Z-score). The efficiency of the proposed methodology was evaluated on a cohort of 280 overweight or obese (BMI > 25 kg/m2) female patients in the age range 45-65 years. For 81.4% of the patients, US diagnosis (osteoporotic, osteopenic, healthy) was the same of the corresponding DXA one, showing the high accuracy of the proposed US technique, especially in the youngest patients (86.4% of correct diagnoses in the age range 45-50 y). A good correlation was also found between the diagnostic parameters provided by both US and DXA methods: all obtained values of Pearson coefficient (r) were within the interval 0.66-0.76 (p<0.001). Then, this new non-ionizing approach to spinal bone densitometry has the potential for being extremely useful for early osteoporosis diagnosis through population mass screenings.