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Ultra Sound Method for Bone Density?-better than DEXA?

nathji
0 Recommendations

Dear Friends and Members of NOF,

I am posing this discussion because of something that I just learnt about and it might be of use to all of us.

Recently my 72 year old, unmarried, sister went to Nagpur, a fairly large city in Central India, which is on par with Bombay, and they have Asia's largest Medical Institute there, along with many experts in many fields. Harvard as also collaborated with a local hospital there.

This is what she had to narrate.

While her DEXA scan at the small city of Dehra Dun -- close to where I live in North India -- showed she had severe osteoporisis, with scores as bad as -4.9 in the spine and femur -- and this despite the fact that she had been walking all her life in the hot sun (exercise plus Vit D were all there)-- she opted for another bone density test at Nagpur.

The orthopedist there who is a well known doctor made her take an Ultra Sound of her heel and ankle -- and the results showed that she had only Osteopenia!! And that the Dexa results had been off the mark. This also co-related with her life style of walking in the sun all her life and thus getting plenty of exercise and Vit D--though very little milk.

I wonder how many folk here are aware of the fact that a new method, which is cheaper, and requires a small hand held knob with a computer is available for bone density measurements and is already in use in India and Europe-- and some believe the results are comparable to the DEXA scans with their huge machines.

In this method they apply ULTRA Sound waves to the Achilles Heel or the area of the foot known as "calcaneal"-- they do this by applying a little gel on the ankle and then running a small hand held knob over it -- while the computer records the results on its screen.

They say it is painless, and the feeling is like that of a gentle massage, with some ticklish feeling-- so maybe the patient can giggle while the machine is on.

It is certainly better than the claustrophoic feeling one gets under the huge DEXA machine which makes you feel as if it is going to fall down upon you!

They say that the manner in which the ultrasound waves pass through the heel tell of the hardness of the heel -- namely its bone density.

They also say that this area of the foot has compatibility with the spine and hip areas shown by DEXA.

There are some that claim that not only is this method cheaper -- but any doctor can have this in his clinic for a low cost in contrast to those multimillion dolar DEXA Scan machines!

This is known as the QUS method for bone density measurements.

For the patient, the cost is negligible as compared to the cost of the DEXA scan.

Would anyone happen to know more about this? Just type QUS versus DEXA for Bone Density in the Google Search engine and see what it says!!

They say the results for QUS are comparable if not better than DEXA. It is already prevalent in India and reputed doctors are using it.

Please let me know what you think. When the ultrasound idea came out in 1984 people at first simply debunked it --- but now more and more reputable doctors and clinics in the world are using it and also relying on its results and saying that it is not prone to the errors that come up in the DEXA scan method.

One has only to go to the Search engines on the internet to see what they say in 2008-2009. I have little knowledge about this subject and am therefore posing this question before the members of NOF, who might know better.

Thanking you.
With best wishes and regards,
Yours,
Priya

Explore topics in this discussion:

Exercise Cancer Celiac disease Boniva Falls Forteo Fractures Alendronate Physical therapy Fosamax Anemia Osteopenia Actonel Sjogren's syndrome Osteoporosis

34 replies

SaraMeeks

Dear Priya:
To the best of my understanding this heel ultrasound is still a screening tool. The DEXA scan is considered the "gold standard" for testing of bone density of the lumbar spine and hip and is, thus, the diagnostic tool. If one has the heel test done and it shows low bone mass, then the DEXA is usually suggested as the diagnostic follow-up.
If this has changed, I'd like to know about it.
Thanks for sharing.
Sara Meeks

nathji

Dear Sara,

Many thanks for your kind reply. But the site below of "healthwatchcentral" would have us believe that ultra sound is the latest and came after the DEXA and is considered better than DEXA:

"In the past, screening for osteoporosis has been performed only through a relatively costly and time consuming procedure called Dual-Energy X-Ray (DEXA). With the advent of ultrasound, it is now possible to measure bone density with a small, portable ultrasound unit designed exclusively for bone density testing."

http://www.healthwatchcentral.com/bone-density-screening-test-ultra-sound-v s-dexa/

Please check out this website which seems most definitive on the subject.

Also, my sister had the DEXA done first and it showed severe osteoporosis with scores reaching -4.9 in the spine. This was in a small city in the North of India, where they had imported the machine only in 2009.

She went to a large city, Nagpur in Central India, and there her orthopedist took her QUS or ultrasound scan of the heel which showed only osteopenia. Since this is a large city with DEXA scan machines all over, the doctor's relying on the QUS was meaningful, especially since he is one of the leading orthopedists of the city.

Her history at 72 showed that she had no symptoms,and that she had walked all her life and taken plenty of sunshine, and this was in the hot sun. However she had not taken much milk during her lifetime.

So according to the doctor this was a reliable method for measuring bone density and very inexpensive.

It is good that you have heard of the test. But I dont know how far correct the Nagpur doctor would be.
The website of healthwatchcentral would have us believe that this was a better method.

Thanking you and with best wishes,
Yours,
Priya

SaraMeeks

I will check out the website you mention.

Meanwhile, you might want to check with the NOF, NIH, WHO, NOS and other organizations to see what the current guidelines are. I have never heard that the heel test is anything more than a screening. It is touted because it is much less expensive to perform.

Char42

The DEXA is touted as the best, but I wonder, as my scores have been awful for the last 15 years. Yet after some major high activity bloody falls I had no fractures. Are those DEXA scores really accurate?
Have not seen the QUS advertised at health care providers in Winter Haven.

debbie59

Priya,
I wouldn't be surprised about that ,in light of the fact it's a lot cheaper method. It's taken awhile for the importance and much bigger dosage of vitamin D needed here. Not just for people with osteoporosis but people (children) in general. In this country about thirty years ago all the warnings about the sun and cancer came about and with that, all the sunscreens. Sunscreens are virtually found in not only sun preparations, but a whole slew of cosmetics and moisturizers. We always seem to go over board in this country. If a little is good then more must be better!!! Also Vitamin D3 is cheap and needed to absorb calcium and not all people know that or the dosages they should be getting. I understand the sun is the best way to obtain these levels and it's not a dangerous amount of time (15 minutes) but, as you know from living in Massachusetts while attending school, most parts of this country for a good 6 months of the year, even make exposing 50 to 60 % of your body to the elements very unpleasant. I'm going to ask my Dr. about the ultra-sound. Be well Debbie

SantaFe

I read an article last year in our local paper that stated having ultra sound tests was a quick, reliable, and inexpensive way to monitor if your bone-health program was working. When I asked my doctor, she just dismissed it as inferior to DEXA--I am going to pursue it further now....

Priya, has your sister ever had any fractures? I would think if her BMD was truly THAT low, she would have had fractures by now---unless she just has extraordinary bone quality.
Warmly, Santa Fe

millie123

I always enjoy your posts because they always give me something new to think about. So I'll check this out. Does your wife know you have so many female friends? :)

Mrs_Thistlebottom

Just to add fuel to the fire of this interesting discussion. . . . I am in no way downplaying the seriousness of this disease, but I wonder if the latest definition of osteoporosis has captured more women in the "net" of diagnosis--women who would otherwise be classified as having normal bone loss?

Moreover, how did the use of the Dexa became so widespread to begin with?

A quote from a 2005 article from the SeattleTimes:

"Even a former lobbyist for Merck concedes that the company's focus has been on expanding the market for Fosamax, also known by its chemical name, alendronate.

"The goal is to make the uses as broad as humanly possible," said Kurt Furst, who worked for Merck from 1997 to 2000. "Merck would tell you virtually any woman post-menopausal should go on Fosamax. That's a heck of a lot of women."

If there's a better way to measure bone density, you can bet that the powerful drug lobby is going to fight this tooth and nail.

Read the rest of the article here:

http://seattletimes.nwsource.com/html/health/sick3.html

BobWallace

I discovered my osteoporosis by accident in that I went a medical screening for ultrasound for anurisms and blocked arteries when I noticed they also did ultrasound on ankles, so I signed up out of curiosity and my report was that I had osteoporosis and a latter DEXA confirmed that diagnosis. Had I not alerted my doctor I might have had a greater problem as it took some eight years to receive my diagnosis of Celiac Disease the cause of my osteopoprosis, the number one cause in men, but unknown to me at that time.

nathji

Dear Sara,

Many thanks again for your kind reply. I have checked out an article by NIH, but this was based on the research done up to 1999. It says that QUS could help in diagnosing fracture risk more than DEXA but it was not recommended for long term use because its results were so variable -- were inaccurate even as much as 20% at times. They no longer recommended it even as an adjunct to DEXA.

Then again the article by Health Watch Central was written in 2009 -- dealing with added research over 10 years to better the equipment, and it says they came out with a machine known as QUS-2, which was superior to DEXA in its results!!

I dont know which site is correct.

But I would suppose the fact that people in the US dont use QUS as a substitute for DEXA would mean that researchers there have not found it to be satisfactory.

One thing however stands out -- as pointed out by Santa Fe above-- that if my sister had scores that were as bad as shown by the DEXA -4.9 she would have developed fractures long ago!!

But she had been feeling fit and fine all these years and walking about briskly in the hot sun!! She still doesnt know what osteoporosis means-- and was surprised when the doctor said to her "You have weak bones".

The QUS results however showed she had only Osteopenia -- which appeared more in line with her optimum health and activity. Maybe the DEXA machine was off the mark.

I had such a problem in New Delhi itself -- where one DEXA machine showed I had severe osteoporosis with T scores as bad as -3.7 for which Forteo injections were prescribed -- and another DEXA machine showing I had only osteopenia, which appeared more in line with my good health at the time. I never took the Forteo, just Actonel for 14 months and then stopped, and am OK thus far-- touch wood!

I am sure if I searched in the small towns close by I would find a QUS ultra sound machine -- though not another DEXA . But I am living in the euphoria of osteopenia as diagnosed by the latest DEXA machine and would not want any QUS report to spoil the "fun".

Thanks again.

Regards and best wishes,
Yours,
Priya


I would

nathji

Dear Bob,

Many thanks! I, too discovered my osteopenia when I went to check up on a slipped disc! I must remember to have the Celiac factor checked out!!
Best wishes and regards,
Yours,
Priya

nathji

Dear Char42,

Many thanks for writing. My sister's DEXA scores were terrible T -4.9 in the spine. Yet she was in optimum health and was walking about for hours in the hot sun!! She ought to have had some fracture over the years at the age of 72. The QUS showed she had osteopenia-- which was more in line with her health.

My DEXA in New Delhi showed T =-3.7 and I was prescribed Forteo injections, but then another DEXA done just then showed I had only Osteopenia, with T= -2.5. This was more in line with how I was feeling.

Some say that we must treat the patient and not the machine. I wonder whether they are right!

Best wishes and regards,
Yours,
Priya

nathji

Dear Debbie,

Many thanks for your kind reply. As Sara Meeks points out above, I went to the NIH site and saw that it gave only a marginal role to QUS-- stating that these machines gave inaccurate results. This was research done in 1999. The site that I saw was Health Watch Central -- has anyone heard of it? -- which spoke of recent 2009 advances in QUS which made it equivalent if not better than DEXA. I dont know which is correct but the DEXA seems to have a mountain of research behind it and is the one most used all over the world.

My experiences with DEXA as well as my sister's were dismal, but that's all we have. At least these big machines are in the hands of big doctors -- whereas the small portable QUS machines would be likely to fall into the hands of quacks that proliferate by the dozens here! That is the only consolation I have.

If ever I were mis-diagnosed I would rather be "done in" by a big DEXA machine than a paltry QUS equipment!! At least there would be some "dignity" in such a wrong diagnosis!! Like Achilles being "done in" by a great stalwart like Hector in the Trojan War.

With every good wish,
Yours,
Priya

nathji

Dear Santa Fe,

Many thanks for your kind reply. You make a very important observation-- if my sister's DEXA scores were as bad as - 4.9 then shouldn't she have had some fracture by now at the age of 72, and why was she in optimum health?

The QUS showed she had just osteopenia which was more in line with what she had been feeling. Though the machines are conflicting the patients symptoms certainly are not. We have much to think about -- that's all we can do, "think".
With best wishes,
Yours,
Priya

nathji

Dear millie123,

Thank you for liking my posts. Perhaps they are interesting because they exhibit such a wide range of ignorance! My wife loves my female friends, thank heavens! She has osteopenia.

With every good wish,

Yours,
Priya

nathji

Dear Ms Thistlebottom,

Many thanks for your interesting observation. You are quite right -- how did the DEXA become so prevalent to be the prima donna in the osteoporosis play? How do we know there are no better methods?

It is not as accurate as MRI's or even X Rays and there are margins of error depending on how well the machine points the beam at you. And machines can be out of alignment.

I must say I am fairly confused -- and what with the big companies lobbying their way in, the picture is bound to be more confusing.. I will go to the site you have suggested.. thanks again.

Best wishes,
Yours,
Priya
Yours,

SaraMeeks

Wow--do we have a lot around this.

The only thing I would like to say at this point is that I have had patients in their 90's with T scores below -5 who never fractured. You cannot go on DEXA scores alone. There are people with better scores who do fracture and people with worse ones who don't.

Also, an X-ray (I don't know about MRI) is not an accurate diagnostic tool for osteoporosis. By the time osteoporosis shows up on X-ray, a person has already lost 30-50% of bone mass so an X-ray is not very sensitive for osteoporosis.

There are some people who believe that the DEXA industry and bone scanning is actually a "scam" by drug companies to get more people diagnosed and then more drugs used. I find that a little hard to swallow; however, there certainly is a push for DEXA and also Fosamax.

littlechill

Wonderful discussion! I do not believe the drug companies are perpetrating a "scam". I think we confuse their goals. Drug companies want to make money by selling as many drugs as possible. These companies will work with the medical community to make this happen. If the focus is to make money then it makes sense to sell a drug to combat an illness, even if that "illness" can be handled with nutrition or exercise. Let's face it, there is little money in prescribing a "healthier lifestyle". The machine manufacture companies want to sell more Dexa machines because they are expensive.

It is up to each of us to find the best exercises for our bodies, eat well, rest etc. What has helped me the most is Physical Therapy and the emotional support from this website.

I don't mean to sound negative, but I gave up a long time ago, thinking that my doctor or these drug companies were "healers" and wanted to work with me as a team to help my body "fix it's self" with a little help from them.

I am very grateful for all I learn on this site.

Charlotte1215

I am becoming more skeptical every day about my osteoporosis diagnosis and the treatments recommended. For DEXA scan numbers to be comparable from year to year, the same machine -- "tuned up" in exactly the same way -- must be used. How many places have bought new, more "accurate" (and expensive) machines in the past year? Probably most radiology locations have. Therefore, your better or worse scores may or may not have anything to do with what you are doing in the way of diet and exercise or what medications you are taking. My MD dropped me as a patient because I stopped taking Forteo and refused Boniva. His reason was that I "was not satisfied" with the care he was giving. I haven't found a new MD who will take me as a patient because I was "released" by my previous MD.

nathji

Dear Sara,

Many thanks again for your learned views. When I mentioned X Rays I was meaning the general accuracy of X Rays in everything that they do -- lungs, fractures, etc. I wasnt referring to osteoporosis. I was meaning that there is no margin of error in diagnosis through them in everyday diseases.

But in these huge DEXA machines there are frightening errors --maybe because the technicians arent trained enough.

I have seen technicians laugh and joke inside the DEXA room as they adjusted the machines and took the results on computers. Then again there is no proper maintenance of these huge machines and no one even knows when they are out of order!!

Maybe with your methods of physical therapy people could work out a better lifestyle and have less of a reliance on these machines. After all the general feeling of well-being of a patient could be a better indicator than bad T scores.

We are grateful for having you amongst us to enlighten us with your knowledge and wisdom.

Yours,
Priya

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