ultrasound to ostoporosis

8/9/2019 Ultrasound to Ostoporosis

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Scans and testsand osteoporosis


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This leaet covers specic information onscans and tests. If you would like more

general information on osteoporosis, please

ask us for a copy of our publication

All About Osteoporosis.

What is osteoporosis?

Osteoporosis occurs when the strutswhich make up the mesh-like structurewithin bones become thin causing themtobecome fragile and break easily, oftenfollowing a minor bump or fall. Thesebroken bones are often referred to as'fragility fractures'. The terms fractureandbroken bone mean the same thing.

Although fractures can occur in differentparts of the body, the wrists, hips andspine are most commonly affected. It isthese broken bones or fractures which canlead to the pain associated withosteoporosis. Spinal fractures can alsocause loss of height and curvature ofthe spine.

Strong

dense

bone

Fragile

osteoporotic

bone


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Bone density scanning is the most commonly

used diagnostic technique for osteoporosis

but other scans and tests may be used to

help understand what is happening to your

bones. Most of these tests or scans help to

predict how likely it is you will break bones

and some are specically used to diagnoseosteoporosis as it is currently dened.

Why measure bone density?

As osteoporosis causes no symptoms until

a bone is broken, it has traditionally been

difcult to pinpoint which individuals have

fragile bones prior to a fracture occurring.

With advances in technology and the

development of bone densitometry (themeasurement of bone density), it has

become possible to measure bone and

assess its density. This is particularly useful

because low bone density has been linked

to an increased risk of fracture. Osteoporosiscan now be diagnosed prior to bones

Bone density(DXA) scanning


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breaking, giving individuals, who have other

risk factors and are at high risk of fractures,the opportunity to take treatments and adopt

lifestyle changes which will reduce their risk

of breaking their bones.

How is bone density measured?The most common means of measuring

bone density involves a simple test called

dual energy x-ray absorptiometry (DXA). DXA

machines usually scan bones in the lower

spine and hip, two of the main areas at risk

from osteoporotic fractures. This is called

an axial or central scan. Other areas can

also be assessed including the forearm and

the heel using a peripheral scanner. Thesetechniques use a low radiation dose, which is

similar to natural background radiation less

than one tenth of the dosage of a chest x-ray.

A DXA scan will take between ten and twentyminutes and is not in any way unpleasant. An

axial DXA scan involves lying on a firm couch

whilst a scanning arm passes over the body

taking an image of the spine and hips. It does

not involve being enclosed in a mechanical

tunnel or having an injection. Generally, clothing

does not have to be removed but clothes with

metal should be avoided.


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Is a bone density scan

useful for everyone?

As DXA scans are not a perfect measure of

bone strength or fragility, screening everyone,

even over the age of 50, would be very

expensive and would not always pick up

those at highest risk of breaking bones.A DXA scan can tell if a bone is likely to be

fragile but other things about you will help

to predict your risk of fracture even more

accurately. Doctors have to take into account

all of their patients risk factors such as family

history or corticosteroid use, as a way of

identifying which people are at greatest risk

of breaking bones. For some people, a bone

density measurement will be necessary toensure they are at high enough risk to need a

drug treatment.

Sometimes your risk of fracture is so high

because of other risk factors, that a scan isnot necessary before treatment is prescribed.

This is particularly likely if you are over 75

years of age.

Interpretation of the results of bone density

measurements, especially of the spine,

may be more difcult after the age of 65

years. As we age, the spine can be affected

by other degenerative processes such as


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Should I have further scans in the future

to monitor my progress?

Bone density scanning is generally used to

help decide if a drug treatment is needed. If

bone density is not sufciently low to require

treatment, a repeat scan might be performed

after two to ve years to determine whethera treatment is needed at a later date. As

more is understood about what inuences

a persons risk of fracture and how the drug

treatments for osteoporosis work, repeat

scanning is now not so commonly used to

see if a treatment is working.

If a person is on a drug treatment that they

tolerate well and they have not had fractureswhilst on that treatment, then it is likely that

the drug is working (as shown in the drug

trials) and another scan is not necessary.

However, if a person does have problems

taking a treatment, or has fractures despitebeing on a treatment, then the doctor may

decide that another scan to check bone

density would be useful to make an informed

decision about what to do next.

If scans are repeated it is important they are

performed on the same machine so that

comparisons can be made.


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The National Osteoporosis Society Helpline

nurses are happy to discuss your bone

density scan results but there is no

facility for general scan interpretation.

This should take place at scanning centres,

with explanations and recommendations for

treatment sent to GPs.

How useful are DXA scans of the

forearm or other sites?

Peripheral DXA (pDXA) machines scan parts

of the body other than the hip and spine.They might scan your forearm, heel or even

nger. These scans can be used to help

decide if you need a treatment. If a pDXA

scan shows that you have very low bone

density your doctor might decide to prescribe

a treatment. However, usually when a pDXA

scan shows that you have low bone density,

your doctor would refer you for a scan of the

hip or spine. Scanning these sites will allowthem to diagnose osteoporosis and make the

best treatment decision.


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DXA of the hip and spine is a relatively

expensive procedure using a large, static

piece of equipment which is usually located

in a hospital. Research into less expensive,

more portable techniques that can predict

fracture risk has been carried out. Ultrasound

is one of these portable techniques.

What is ultrasound?

Ultrasound can be used to examine

structures inside the body. Sound waves

of extremely high frequency, inaudible to

the human ear, are beamed into the body.

The echoes of reected sound, or the rate

and path of transmission of the sound,

are used to build up an electronic imageor measurement of the structure being

examined. Ultrasound does not use radiation.

What is ultrasound used for?

Ultrasound scanning has proved useful invisualising many different parts of the body.

It can be used for scanning in pregnancy, or

imaging the liver, kidney, gallbladder, spleen,

ovaries, bladder, breasts and eyes.

Ultrasound waves may also be used to treat

soft tissue injuries, e.g. muscles, ligaments

and tendons. The treatment is thought to

improve blood ow, reduce inammation

and speed up healing.

Ultrasound scanning


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Portable and relatively inexpensive ultrasound

machines have been developed, which

are designed to look at bone structure and

strength, usually of the heel bone (calcaneus),

wrist or nger. They give a picture of the bone

and provide measurements of the speed of

the ultrasound wave through the bone or theabsorption of the beam. The measurement

is referred to as quantitative ultrasound

to distinguish it from ultrasound used for

imaging body structures.


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Can quantitative ultrasound scanning

(QUS) measurements be used to

diagnose and monitor osteoporosis?

Osteoporosis is dened according to

World Health Organisation (WHO) criteria

in terms of bone density measured by DXA

scanning, when bone density is comparedto data collected from young, healthy adult

measurements. DXA scans of the hip and

spine are, therefore, the current preferred

method for diagnosing osteoporosis.

There is currently no established, accepted

denition of osteoporosis based on QUS

measurements, so QUS cannot currently

be used to conrm the diagnosis of

osteoporosis. Ultrasound cannot be used tomonitor rates of bone loss or bone gain with

treatment.

Who may benefit from heel ultrasound?

Large studies suggested that heel ultrasound

in older women (70+) may predict hip fracture

risk as well as DXA. Heel ultrasound is also

useful in predicting osteoporotic fracture risk

in women around the time of the menopauseand of Colles (wrist) fracture in women in

their early post-menopausal years. There is

no conclusive evidence that heel ultrasound

can accurately predict fracture at other sites

in women prior to the menopause, or in men.


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There may also be problems using drug

treatments based on ultrasound readings

because research studies to determine the

benets of osteoporosis drug treatments

were all based on DXA readings. Further

research is needed.

Some people are more at risk of osteoporosis

because of factors such as early menopause

(before age 45) or long-term tablet

corticosteroid use. Identication of these

high-risk groups may be useful in pinpointingthose who may benet from a DXA scan.

QUS may sometimes be used as an improved

method of targeting women for hip and spine

DXA scanning to diagnose osteoporosis.

What does a heel ultrasound involve?

A heel ultrasound is a simple and painless

procedure, taking a few minutes. In somemachines, the heel is placed into a small

water bath machine. In others, gel is applied

to the heel, nger or wrist area and a dry

machine is used.

The test may be done at a unit that also does

DXA scanning as part of the research into

the usefulness of heel ultrasound, or within a

doctors surgery.


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If I decide to have a heel ultrasoundscan I have seen advertised locally,

what questions would be helpful?

Does the company have

a medical practitioner withresponsibility for the service?

Will the company scan anyone or

just women after the menopause?

Is the operator a healthcareprofessional with knowledge

of osteoporosis?

Is the service linked to the sale of

dietary supplements or other products?

What about the advertised heel scans

which test anyone for a fee?

Due to the difculties with using heel

ultrasound to diagnose and monitor

osteoporosis, and the lack of well-

established, normal reference ranges,

heel scans are not generally used in thesame way as DXA scans. If someone is

concerned about their bone health and

osteoporosis risk and has a QUS heel

scan, it may still be appropriate to consider

bone density measurement by DXA scanespecially when decisions need to be made

about using drug treatments.


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Computerised tomography (CT) scanning

This type of scanning uses x-rays and acomputer to take pictures of bone and put

images together. CT scanners can be used

to measure bone density and may be useful

following compression fractures in the spine,

when getting an accurate result can be moredifcult. However, CT scans use higher levels

of radiation than a DXA scan, which is usually

considered preferable.

Computerised tomography(CT) scanning


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This uses a strong magnetic eld and radio

waves to produce detailed pictures of soft

tissue such as ligaments and muscles. It

does not provide information about bone

tissue so cannot diagnose osteoporosis or

measure bone density. However, sometimes

fractures might be identied using MRI,especially hip or vertebral fractures not seen

on a normal x-ray. Often, MRI is used to

indicate if another disease is present.

Magnetic resonanceimaging (MRI) scanning


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Bone (radioisotope)scanning

Bone (radioisotope) scanning

These scans might be used to pick upfractures that have been difficult to identify

on x-ray. You are given an injection of radio

active material which will show up ashot

spots on the image that is produced. Other

tests might then be necessary to ensure thatany fractures identified are not caused by

other conditions.


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Urine and blood tests

Bone marker tests:

what are bone markers?

Throughout life, the skeleton is continually

renewing itself through a process known

as remodelling or bone turnover. In healthy

bone, the rate of bone breakdown is linked

to the rate of bone formation so that bonestrength is maintained. As we get older, the

rate at which bone is broken down increases

and exceeds the rate at which bone is formed.

This results in loss of bone and may lead to

osteoporosis and an increased risk of fracture.

During the bone remodelling process

chemicals are produced which can be

detected in the blood and urine. Theseproducts are known as biochemical markers

of bone turnover. An assessment of levels of

these markers can be used to measure the

rate of bone turnover, thus providing useful

information about factors that might affectbone strength.


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How useful is the test?

The bone marker test is simple and requiresa sample of urine or blood, which is then sent

off to the laboratory for testing. Although the

test can assess the rate at which bone is

being broken down or formed, it cannot be

used to diagnose osteoporosis or determinebone strength. Bone density scanning is

more useful to help work out how likely

fractures or broken bones are.

Bone markers may be able to assess the

effectiveness of treatment. Most treatments

for osteoporosis work by reducing the rate of

bone turnover, so monitoring bone loss using

this technique may allow adjustment of thedosage of a treatment or change to another

therapy if bone turnover is not reduced or

back to normal within six months.


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Where can I obtain the test?

The test is only currently available in specialistcentres when it is felt that the additional

information provided could affect the type of

treatment offered. They are also often used

in the research eld. Bone marker tests are

not generally available from GPs as a tool tomonitor treatment. This is because outside

of the specialist setting it is difcult to avoid

inaccuracies.

A referral to a specialist centre to see a

consultant is by GP referral only. The GP

will be able to advise whether a consultant

referral is required, as routine treatment of

osteoporosis is usually managed by the GP.


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Other blood and urine tests

Sometimes, especially at a hospitalappointment, levels of calcium in the blood

might be checked. Low blood calcium levels

do not indicate that you have osteoporosis,

but may be due to vitamin D deciency

which can be treated with supplements. Highcalcium levels in the blood can mean you

have other medical conditions that might be

causing osteoporosis or fractures.

Other blood tests may also help to check

for other diseases that cause pain or bone

fragility. Vitamin D levels may be checked

by a blood test. Low levels can indicate you

have a related condition called osteomalacia(soft bones) that can be treated with

supplements of vitamin D.


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Join the National Osteoporosis

Society todayBecome a member and support the onlyUK-wide charity dedicated to improving

the diagnosis, prevention and treatment

of osteoporosis.

You can join today, either call us or visitour website:

01761 473287

www.nos.org.uk

Our publications are free of chargebut we would welcome a donation

You can support the work of the National

Osteoporosis Society by making a single

or regular donation:

01761 473111

www.nos.org.uk

For osteoporosis information andsupport contact our Helpline:

0845 450 [email protected]


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Other leaflets and factsheetsin this range:

Anorexia nervosa and osteoporosis

Anti-epileptic drugs and osteoporosis

Breast cancer treatments and osteoporosis

Clothing, body image and osteoporosis

Coeliac disease and osteoporosis

Complementary and alternative therapiesand osteoporosis

Complex regional pain syndrome and osteoporosis Drug treatments and osteoporosis

Exercise and osteoporosis

Glucocorticoids and osteoporosis

Further Food Facts and bone - beyond calcium andvitamin D

Healthy living for strong bones

Hip protectors and osteoporosis

Hormone therapy in men and women and osteoporosis

Hyperparathyroid disease and osteoporosis

Osteoarthritis and osteoporosis

Osteogenesis imperfecta and osteoporosis Osteoporosis in children

Percutaneous vertebroplasty and balloonkyphoplasty and osteoporosis

Pregnancy and osteoporosis

The contraceptive injection (Depo Provera)

and osteoporosis

Thyroid disease and osteoporosis

Transsexual people and osteoporosis

Vibration therapy and osteoporosis

0845 130 3076 (General Enquiries)

0845 450 0230 (Helpline)

www.nos.org.uk

Camerton, Bath BA2 0PJ

ultrasound to ostoporosis

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