Pulse-echo ultrasound to identify Hispanic women at risk for osteoporosis


“There is a large osteoporosis treatment gap that has become a global crisis in the care of this disease,” said principal investigator E. Michael Lewiecki, MD."

A prospective study comparing dual-energy X-ray absorptiometry (DXA) to pulse-echo ultrasonography (PEUS) found similar sensitivity and specificity for density index (DI) thresholds in Caucasian and Hispanic postmenopausal women, with or without osteoporosis.

The study in the Journal of Clinical Densitometry was conducted on 293 postmenopausal women, roughly divided between Hispanic (n = 140) and Caucasian (n = 153) participants, at the New Mexico Clinical Research & Osteoporosis Center in Albuquerque, from March to December 2019.

“There is a large osteoporosis treatment gap that has become a global crisis in the care of this disease,” said principal investigator E. Michael Lewiecki, MD, the center’s director. “Most patients who could benefit from treatment of osteoporosis are not receiving it.”

Principal investigator E. Michael Lewiecki, MD.

One factor contributing to the treatment gap is lack of access to high-quality bone mineral density (BMD) testing with DXA, according to Dr. Lewiecki. “A potential strategy for addressing this need is a convenient, portable, reliable screening test for osteoporosis, which PEUS may fulfill,” he said.

“However, more data are needed to validate PEUS use in diverse patient populations; thus, the reason for the study.”

PEUS software calculated DI, a value that has previously shown good correlation with BMD at the hip by DXA in postmenopausal Caucasian women in Finland and the U.S.

Those studies identified DI thresholds that discriminate patients likely to have osteoporosis with about 90% sensitivity and 90% specificity.

For the current study, osteoporosis was defined as a total hip or femoral neck T-score ≤ -2.5.

PEUS measurements at the proximal tibia and DXA BMD at the hip were evaluated, with DI calculated for each patient and compared with BMD. The performance of DI threshold values for the two populations was then assessed.

PEUS in Caucasians had an 80% sensitivity and 86% specificity, compared to 80% and 91%, respectively, in Hispanics, for identifying women with osteoporosis.

The positive predictive value for osteoporosis was 87% for Caucasians and 90% for Hispanics, with a negative predictive value of 80% for Caucasians and 82% for Hispanics.

“We now know that the DI thresholds established with this new technology can be used with confidence for Hispanic as well as Caucasian postmenopausal women,” Dr. Lewiecki told Contemporary OB/GYN

Because Hispanics comprise about 18% of the American population, and a much larger portion of the population in states such as California, Arizona, New Mexico and Texas, “it is important to evaluate any diagnostic test in this demographic group,” Dr. Lewiecki said.

“The study’s findings expand the potential for using PEUS as a screening test for osteoporosis.”

However, as with any test, “the operator must be trained and maintain quality standards,” Dr. Lewiecki said. “PEUS is no exception, although the skills required for PEUS testing are less demanding than for DXA.”

Dr. Lewiecki looks forward to the day when evaluation of skeletal health is standard practice for all postmenopausal women and older men.

“In order to reduce or eliminate the osteoporosis treatment gap, we need to identify individuals at high risk for fracture, evaluate and address factors contributing to fracture risk, and when appropriate, start pharmacological therapy,” he said.

If PEUS and other emerging technologies can contribute to the recognition of those who are at high risk,” then we have more opportunities to reduce the burden of osteoporotic fractures,” Dr. Lewiecki said.


Dr. Lewiecki reports no relevant financial disclosures.


  1. Lewiecki EM. Pulse-echo ultrasound identifies Caucasian and Hispanic women at risk for osteoporosis. J Clin Densitom. Published online May 11, 2020. doi:10.1016/j.jocd.2020.04.002.
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