QUANTITATIVE BONE ULTRASONOGRAPHY AND QUANTITATIVE COMPUTED TOMOGRAPHY AS ALTERNATIVE METHODS TO BONE DENSITOMETRY IN THE DIAGNOSIS OF OSTEOPOROSIS

Abstract

Osteoporosis is a chronic osteometabolic disease characterized by a reduction in bone mineral density and deterioration of the microarchitecture of bone tissue, resulting in a significant increase in the risk of fractures, especially in the elderly and in postmenopausal women. As it is a silent condition, early diagnosis is essential for the prevention of clinical and socioeconomic complications. Currently, dual-energy X-ray absorptiometry (DEXA) is considered the gold standard for assessing bone mineral density; however, it presents limitations related to cost, availability, the influence of artifacts, and the inability to evaluate in detail the structural quality of bone. In this context, the document analyzes quantitative bone ultrasonography (QUS) and quantitative computed tomography (QCT) as alternative and complementary methods to DEXA in the diagnosis of osteoporosis. QUS stands out for being a portable, low-cost method free of ionizing radiation, allowing its application in population screenings and in locations with limited infrastructure. Through the analysis of parameters such as speed of sound (SOS), broadband ultrasound attenuation (BUA), and composite indices, QUS provides functional information about bone quality and fracture risk, being especially useful as an initial screening tool. QCT, in turn, enables the three-dimensional and volumetric measurement of bone mineral density, expressed in mg/cm³, allowing the differentiation between cortical and trabecular bone. This characteristic provides greater sensitivity for the early detection of structural changes, especially in the trabecular bone of the lumbar spine and hip, which are often affected in the early stages of osteoporosis. Despite its high diagnostic accuracy, QCT presents important limitations, such as higher radiation dose, high cost, and lower availability, restricting its routine use in clinical practice and directing it mainly to specific or research contexts. It is concluded that, although DEXA remains the reference method for the diagnosis of osteoporosis, QUS and QCT play relevant roles as complementary techniques, expanding the capacity for assessing bone health. The integration of these methods may contribute to earlier, more accessible, and more accurate diagnoses, favoring more effective preventive and therapeutic strategies in the management of osteoporosis.