Evaluation of osteoporosis using calcaneal QUS and FRAX score as a screening tool in a semi urban tertiary care hospital of South India

Kannan Rajendran, Prasanna Karthik Suthakaran, Lal Devayani Vasudevan Nair, Lokesh Rajaram, Mahendrakumar Kalappan, Magesh Kumar Sivanesan


Background: Osteoporosis is a silent, often found late, underdiagnosed disease characterized by low bone mass leading to increased susceptibility to fractures. With an increasingly aging population, the proportion of patients with osteopenia and osteoporosis are increasing in both developed and developing countries. The available data on osteoporosis is scanty from India.

Methods: The objective was to measure the bone mineral density (BMD) of the patients using calcaneal Quantitative Ultrasound (QUS) and determine the risk factors along with the FRAX score. This was a hospital based cross sectional study conducted in a tertiary care hospital done on 183 out patients. BMD was measured using calcaneal QUS & T scores were calculated along with the FRAX score.

Results: The prevalence of osteoporosis was 29.5% and osteopenia was 42.1%.The age wise analysis of BMD revealed males have the tendency to lose their bone mass after the age of 40 years while in females, the trend begins a decade earlier. The mean BMD of post-menopausal females was significantly lower compared to pre-menopausal females (-2.72 ± 1.33 vs -1.63 ± 1.06, P < 0.0001).Linear regression analysis revealed a complex linear relationship between the FRAX score and the BMD and it was statistically significant.

Conclusions: Calcaneal QUS can be used as a screening tool to screen for and detect osteoporosis. It is economical, portable and easily available in many parts of the country. DEXA scan, the gold standard test to diagnose osteoporosis can be used to confirm the diagnosis in selected cases.


Osteoporosis, Osteopenia, BMD, FRAX score, Calcaneal QUS

Full Text:



Consensus Development Conference Diagnosis, prophylaxis and treatment of Osteoporosis. Am J Med. 1993;94:646-50.

International Osteoporosis foundation: The Asian Audit Epidemiology, costs and burden of osteoporosis in Asia, 2009.

Mithal A, Bansal B, Kyer CS, Ebeling P. The Asia-Pacific Regional Audit-Epidemiology, Costs, and Burden of Osteoporosis in India 2013: A report of International Osteoporosis Foundation. Ind J Endocr Met. 2014;18(4):449-54.

Keramat A, Patwardhan B, Larijani B, et al. The assessment of osteoporosis risk factors in Iranian women compared with Indian women. BMC Musculoskeletal Disorders. 2008;9:28-32.

Mohr A, Barkmann R, Mohr C, Romer FW, Schmidt C, Heller M, et al. Quantitative ultrasound for the diagnosis of osteoporosis. RöFo. 2004;176:610-7.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK.OsteoporosInt. 2008;19(4):385-97.

Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9(8):1137-41.

Shatrugna V, Kulkarni B, Kumar PA, Rani KU, Balakrishna N. Bone status of Indian women from a low-income group and its relationship to the nutritional status. Osteoporos Int.. 2005;16(12):1827-35.

Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Bone health in healthy Indian population aged 50 years and above. OsteoporosInt. 2011;22:2829.

Paul T, Asha HS, Mahesh DM, Naik D, Rajaratnam S, Thomas N, et al. The diagnosis of osteoporosis among subjects of southern Indian origin above 50 years of age – The impact of the Indian council of medical research versus Caucasian bone mineral density reference standards.Ind J EndocrMetab. 2012;16:S514-24.

Knapp KM, Blake GM, Spector TD, Fogelman I. Can the WHO definition of osteoporosis be applied to multi-site axial transmission quantitative ultrasound? OsteoporosInt. 2004;15:367-74.

Diez-Perez A, Marin F, Vila J, Abizanda M, Cervera A, Carbonell C, et al . Evaluation of calcaneal quantitative ultrasound in a primary care setting as a screening tool for osteoporosis in postmenopausal women. J ClinDensitom. 2003;6:237-45.

Saito O , Saito T , Asakura S, Akimoto T, Inoue M, Ando Y, et al. Effects of Raloxifene on Bone Metabolism in Hemodialysis Patients With Type 2 Diabetes. Int J EndocrinolMetab. 2012;10(2):464-9.

Frediani B, Acciai C, Falsetti P, Baldi F, Filippou G, Siagkri C et al. Calcaneus ultrasonometry and dual-energy X-ray absorptiometry for the evaluation of vertebral fracture risk. Calcif Tissue Int. 2006;79(4):223-9.

Chan MY, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria. OsteoporosInt. 2013;24(3):1015-22.

Sharma S, Tandon VR, Mahajan A, Kour A, Kumar D. Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS. Ind J Med Sci. 2006;60:183-9.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513-21.

Shetty S, Kapoor N, Naik D, Asha HS, Prabu S, Thomas N, et al. Osteoporosis in Healthy South Indian Males and the Influence of Life Style Factors and Vitamin D Status on Bone Mineral Density. J Osteoporos, 2014. /723238

Agrawal NK, Sharma B.Prevalence of osteoporosis in otherwise healthy Indian males aged 50 years and above. Arch Osteoporos. 2013;8:116.

Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES et al.Osteoporosis in men: an endocrine society clinical practice guideline. J ClinEndocMetab. 2012;97(6):1802-22.