Fracture Risk Assessment Tool and Quantitative Ultrasound for Bone Screening: A Case Series

Introduction/Background: This case series assessed the clinical utility of the Fracture Risk Assessment (FRAX) tool and quantitative ultrasound (QUS) at the distal radius to screen subjects for higher fracture risk. The current gold standard to diagnose osteoporosis is the dual-energy x-ray absorptiometry (DXA) scan. QUS is a valid and less expensive procedure for measuring properties of bone that can be performed over several body sites, including the distal radius. Our hypothesis was that the addition of QUS, to current bone health screening using FRAX alone, would identify more postmenopausal women with higher fracture risk. Case Description: In this case series, 2 postmenopausal women were screened with the FRAX tool. In addition, the nondominant distal radius was screened with QUS and the results were compared with the results of the respective subject’s DXA scans. Outcomes: The QUS measurement results placed our subjects in the same fracture risk category as their DXA scan bone mineral density scores. Discussion: In this case series, we present 2 postmenopausal women who demonstrate low fracture risk as predicted by the FRAX alone. Subsequent QUS measures detected that one of the women was at higher risk for fracture. Follow-up DXA scan confirmed that the QUS, which also directly assesses bone quality, correctly stratified the patients into low and high fracture risk categories. In addition to FRAX, QUS may be an important low-cost screening tool for physical therapists to use, to increase early referral for medical management.