Quantitative Ultrasound of Bone

Quantitative Ultrasound of Bone

LASA filenames:

Contact: Natasja van Schoor


Osteoporosis is a disease of the skeleton characterised by low bone mineral density (BMD) and a micro architectural deterioration of bone tissue that results in an increased susceptibility to fractures (1). BMD, measured with dual-energy X-ray absorptiometry (DXA), is regarded as the most important parameter for the assessment of osteoporosis and fracture risk (2-4). Since a few years, quantitative ultrasound (QUS) measurements have generated widespread interest. QUS offers several advantages over DXA, since the apparatus is free of ionising radiation, relatively inexpensive and simple to apply (5). The great variety of different QUS devices available makes it possible to perform QUS measurements at several skeletal sites such as the calcaneus (heel bone), ulna, patella, phalanges (fingers) and tibia (6).

QUS measures the speed at which sound propagates through or along bone (SOS) or the pattern of attenuation of a wide range of ultrasonic frequencies in bone (BUA). It has been postulated that QUS may reflect more than bone density alone. Qualitative aspects of bone, such as elasticity and micro architectural characteristics, could also be assessed by QUS (7-9).

Measurement instruments in LASA

Subjects: subsamples

During the medical interview of the C-cycle, participants were invited to visit the VU University Medical Center (VUmc) or a health care center in the neighbourhood, where the QUS measurements were performed (n=1346). QUS measurements were also performed at the right tibia in sex-stratified subsample (n=127) of respondents who visited the VUmc.

QUS measurements were also performed at the G-cycle, in the second cohort only as a side study. A subsample of the EPOSA participants (see EPOSA website) were invited to take part in the BBMRI study in which, among others, QUS measurements were performed. In addition to the EPOSA participants, a subsample of the remaining LASA participants was invited for the BBMRI study (total N = 496).

QUS measurements of the calcaneus

QUS measurements were performed at the calcaneus with the CUBA Clinical instrument (McCue Ultrasonics, Winchester, UK) at the C-cycle. The ultrasound system consists of two transducers (emitting and receiving) faced with silicone rubber coupling pads. These are placed in direct contact on either side of the heel using a coupling gel. BUA (dB/MHz) and SOS (m/s) were measured twice in both the right and left calcaneus. The feet were repositioned after the first measurement. The coefficient of variation (CV), calculated in 20 healthy volunteers measured on five occasions consecutively within 1h, was 3.4% for BUA and 1.3% for SOS (10). At the G-cycle the measurements were performed using the Hologic Sahara densitometer (Hologic Inc., USA). At this cycle, if the two measurements at the same foot differed for more than 10 percent (BUA values), a third measurement was performed. The feet were repositioned after each measurement.

QUS measurements of the tibia

QUS measurements were performed at the right tibia using the Sound scan 2000 instrument (Myriad Ultrasound System, Rehovot, Israel) in the C-cycle. Subjects were supine with the lower leg at the right side exposed. The midpoint of the tibia was marked which is halfway between the distal apex of the patella and the medial malleolus, and a probe was placed on the skin at this point. Ultrasonic coupling gel was used to facilitate the propagation of sound between the probe and the skin. The speed of sound through the tibia was calculated from the propagation time and distance between a sound-emitting sensor at one side of the probe and a receiving sensor at the other side. By moving the probe back and forth across the tibial plane, a minimum of 150-200 velocity reading was obtained. The average of the five highest readings was calculated to render the cortical tibial ultrasound velocity (11) The CV, calculated in 16 healthy LASA subjects, was 0.4% and the standardised CV (sCV) was 4.4% (12).


Not applicable for this topic.

Variable information

It is recommended that mean values are calculated before analysing the data. Mean values can be calculated for the right and left side separately, or for both sides together.

In the G-cycle, in case of three measurements, it is necessary to calculate mean values by only using the two values which were approximately equal and ignoring the third aberrant one.

Availability of information per wave


QUS Calcaneus

QUS Tibia


1 More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=future wave 2021-2022

Previous use in LASA

  • Buizert, P.J., Van Schoor , N.M., Lips, P.T.A., Deeg, D.J.H., Eekhoff, E.M.W. (2009). Lipid Levels: A Link Between Cardiovascular Disease and Osteoporosis?Journal of Bone and Mineral Research, 24, 1103-1109.
  • Den Uyl, D., Van Schoor , N.M., Bravenboer, N., Lips, P.T.A., Lems, W.F. (2015). Low grade inflammation is associated with lower velocity of sound and broadband ultrasound attenuation in older men, but not with bone loss or fracture risk in a longitudinal aging study.Bone, 81, 270-276.
  • Dhonukshe-Rutten, R.A.M., Pluijm, S.M.F., De Groot, L.C.P.G.M., Lips, P.T.A., Smit, J.H., Van Staveren, W.A. (2005). Homocysteine and Vitamin B12 status relate to bone turnover markers, broadband ultrasound attenuation, and fractures in healthy elderly people.Journal of Bone and Mineral Research, 20, 6, 921-929.
  • Furrer, R., Van Schoor , N.M., De Haan, A., Lips, P.T.A., De Jongh, R.T. (2014). Gender-specific associations between physical functioning, bone quality, and fracture risk in older people.Calcified Tissue International, 94, 522-530.
  • Kuchuk, N.O., Pluijm, S.M.F., Van Schoor , N.M., Looman, C.W., Smit, J.H., Lips, P.T.A. (2009). Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons.Journal of Clinical Endocrinology and Metabolism, 94, 4, 1244-1250.
  • Kuchuk, N.O., Van Schoor , N.M., Pluijm, S.M.F., Smit, J.H., De Ronde, W., Lips, P.T.A. (2007). The association of sex hormone levels with quantitative ultrasound, bone mineral density, bone turnover and osteoporotic fractures in older men and women.Clinical Endocrinology, 67, 295-303.
  • Moayyeri, A., GEFOS/GENOMOS consortium (2014). Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium.Human Molecular Genetics, 23, 11, 3054-3068.
  • Pluijm, S.M.F., Van Essen, H.W., Bravenboer, N., Uitterlinden, A.G., Smit, J.H., Pols, H.A.P., Lips, P.T.A. (2004). Collagen type I alpha1 Sp1 polymorphism, osteoporosis and intervertebral disc degeneration in older men and women.Annals of the Rheumatic Diseases, 63, 71-77.
  • Pluijm, S.M.F., Dik, M.G., Jonker, C., Deeg, D.J.H., Van Kamp, G.J., Lips, P.T.A. (2002). Effects of gender and age on the association of apolipoprotein E epsilon 4 with bone mineral density, bone turnover and the risk of fractures in older people.Osteoporosis International, 13, 701-709.
  • Rabelink, N.M., Peeters, G.M.E.E., Van Schoor , N.M., Drent, M.L., Lips, P.T.A. (2011). Self-reported loss of consciousness after head trauma does not predispose to hypopituitarism in an older population.Journal of Head Trauma Rehabilitation, 26, 1, 90-97.
  • Sohl, E., De Jongh, R.T., Swart, K.M.A., Enneman, A.W., Van Wijngaarden, J.P., Van Dijk, S.C., Ham, A.C., Van der Zwaluw, N.L., Brouwer-Brolsma, E.M., Van der Velde, N., De Groot, L.C.P.G.M., Te Velde, S.J., Lips, P.T.A., Van Schoor , N.M. (2015). The association between vitamin D status and parameters for bone density and quality is modified by body mass index.Calcified Tissue International, 96, 2, 113-122.
  • Tromp, E.A.M., Smit, J.H., Deeg, D.J.H., Bouter, L.M., Lips, P.T.A. (1996). Risk factors for osteoporotic fractures in elderly people: An additional study to the Longitudinal Aging Study Amsterdam (LASA).Osteoporosis International, 6 (Suppl. 1), 154.
  • Tromp, E.A.M., Smit, J.H., Deeg, D.J.H., Lips, P.T.A. (1999). Quantitative ultrasound measurements of the tibia and calcaneus in comparison to DXA measurements at various skeletal sites.Osteoporosis International, 9, 230-235.
  • Van Schoor , N.M., Dennison, E.M., Lips, P.T.A., Uitterlinden, A.G., Cooper, C. (2007). Serum fasting cortisol in relation to bone, and the role of genetic variations in the glucocorticoid receptor.Clinical Endocrinology, 67, 6, 871-878.
  • Van Varsseveld, N.C., Sohl, E., Drent, M.L., Lips, P.T.A. (2015). Gender-Specific Associations of Serum Insulin-Like Growth Factor-1 With Bone Health and Fractures in Older Persons.The Journal of Clinical Endocrinology & Metabolism, 100, 11, 4272-4281.


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Date of last update: April 6, 2020