Use of quantitative ultrasonography in differentiating osteomalacia from osteoporosis: Preliminary study

The aim of this work was to use ultrasonographic technology to differentiat e osteoporosis from osteomalacia on the basis of different patterns of the graphic trace. Three patients with osteomalacia and three with osteoporosis , all with the same lumbar spine bone mineral density, were studied. The ve locity of the ultrasound beam in bone was measured by a DBM Sonic 1200/I de nsitometer at the proximal phalanges of the hands in all the patients. The ultrasound beam velocity was measured when the first peak of the waveform r eached a predetermined minimum amplitude value (amplitude-dependent speed o f sound) as well as at the lowest point prior to the first and second peaks , before th reached the predetermined minimum amplitude value (first and se cond minimum speeds ni sound). The graphic traces were further analyzed by Fourier analysis, and both the main frequency (f(0)) and the width of the p eak centered in the f(0) (full width at half maximum) were measured. The fi rst and second minimum speeds of sound were significantly lower in the pati ents with osteomalacia than in the osteoporosis group. The first minimum sp eed of sound was 2169 +/- 73 m/s in osteoporosis and 1983 +/- 61 m/s in ost eomalacia (P < 0.0001); the second minimum peak speed of sound was 1895 <pl us/minus> 59 m/s in osteoporosis and 1748 +/- 38 m/s in osteomalacia (P < 0 .0001). The f0 was similar in the two groups (osteoporosis, 0.85 <plus/minu s> 0.14 MHz; osteomalacia, 0.9 +/- 0.22 MHz; P = 0.72), and the full width at half maximum was significantly higher in the osteomalacia patients (0.52 +/- 0.14 MHz) than in the osteoporosis patients (0.37 +/- 0.15 MHz) (P = 0 .022). This study confirms that ultrasonography is a promising, noninvasive method that could be used to differentiate osteoporosis from osteomalacia, but further studies should be carried out before this method can be introd uced into clinical practice.