# Comparative analysis of bone density measurement techniques: a systematic review of quantitative ultrasound and dual-energy X-ray absorptiometry

## TL;DR

This systematic review compares two bone density measurement techniques, QUS and DXA, to assess their effectiveness in detecting osteoporosis.

## Contribution

The study provides a comprehensive evaluation of the correlation and diagnostic performance of QUS and DXA across diverse populations.

## Key findings

- DXA and QUS showed variable correlation (r = 0.17–0.86) in measuring bone parameters.
- QUS is suitable for preliminary screening in resource-limited settings but lacks the precision of DXA for diagnosis.
- Diagnostic performance varied across populations, with inconsistent results in pediatric and disease-specific groups.

## Abstract

Bone mineral density (BMD) and bone-related parameters are essential for osteoporosis detection. Different screening modalities are used, including quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA). This systematic review aimed to evaluate the correlation and clinical utility of DXA and QUS measurements.

A literature search (2005–2025) was conducted in PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and Cochrane Library for English-language studies. A narrative synthesis was performed to summarize the study characteristics and outcomes.

Of the 1,247 identified records, 24 studies met the inclusion criteria. DXA and QUS were used to assess bone parameters, such as BMD, bone mineral content (BMC), speed of sound (SOS), broadband ultrasound attenuation (BAU), and stiffness index (SI). The correlation between DXA and QUS varied widely (r = 0.17–0.86), with variable diagnostic performance across studies. Studies involving postmenopausal women and older populations reported similar trends, whereas the findings were inconsistent in pediatric and disease-specific populations.

QUS is suitable for preliminary screening, especially in resource-limited settings, but cannot replace DXA for definitive diagnosis. Further well-designed studies with longer follow-up are required to better define the role of QUS in osteoporosis screening.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251146250.