Bone Ultrasound
Bone Ultrasound for Assessment of Fracture Risk and Bone Health for Women in Singapore
Bone Ultrasound for Assessment of Osteoporosis and Fracture Risk in Singapore
A bone ultrasound scan fine-tuned for the Singaporean population
When you do an ultrasound bone density analysis scan at The Clifford Clinic, you can expect maximum result accuracy as our inhouse bone ultrasound machine is the only machine in Singapore that interprets scan data against a baseline reference collected exclusively from a Southeast Asian population.
Your calcaneus and how it predicts fracture risk
Also known as the heel bone, the calcaneus is the largest bone of the foot and the bone that forms the heel. Broadband ultrasound attenuation (BUA) measurements of the calcaneum accesses both bone density and bone structure, thus making BUA a good indicator of both sending bone health and fracture risk.
The calcaneus is particularly suitable for bone density analysis tests as it is a weight bearing bone that is composed of over 90% metabolically active tissue (trabecular bone), allowing it to reflect greater sensitivity to osteoporotic changes (changes that make the bone weaker and more brittle).
The Clifford Clinic’s gold standard of test result accuracy
Why choose a bone ultrasound scan over conventional X-ray scans?
Dual Energy X-ray Absorptiometry (DEXA) is used in Bone Mineral Density (BMD) tests to determine bone density. Measurements for BMD tests are usually taken from the spine or hip. Unlike broadband ultrasound attenuation (BUA) that utilises ultrasound (sound waves), DEXA uses X-ray radiation. BUA is thus often considered advantageous over DEXA as:
- Bone ultrasound scans do not expose the body to radiation
- BUA measures both bone density and structure, while DEXA only measures bone density
Are bone ultrasound scans comparable to bone X-ray scans?
Hip fracture studies published in medical journal(s) indicate that BUA is a better predictor of fracture risk compared to DEXA. BUA and BMD are also highly correlated (0.6 to 0.8 degree of correlation), making BUA a good predictor of BMD as well as a good substitute for BMD measured via DEXA.
The Clifford Clinic is committed to providing you with comprehensive and accurate bone ultrasound assessment results; Normative data used in our bone ultrasound machine was calculated by the Changi General Hospital Department of Orthopaedic Surgery using only BUA values collected from a Singaporean population (sample size > 600).
How broadband ultrasound attenuation is used to calculate risk
The risk of bone fracture is determined by comparing the BUA obtained from a patient’s bone ultrasound scan against the average/mean BUA of a normative sample population; The normative sample population being the population of people used to establish the reference database and the mean BUA of the normative population representing the expected BUA of a “normal healthy individual”.
Deviation from the “normal healthy individuals” baseline reference data determines risk
Results from the bone ultrasound scan are expressed as the number of standard deviations (SD) away from the normative population’s mean BUA value, with positive or negative SD values indicating decreased or increased risk of osteoporosis/bone fracture.
The CubaClinical Ultrasound Bone Sonometer is our in-house bone ultrasound machine that measures both your T-score and Z-score.
- T-score – Number of standard deviations from normative population mean BUA at peak bone mass
- Z-score – Number of standard deviations from normative population mean BUA for a particular age
Importance of using a reference database established using our local population
A medical study conducted by Changi General Hospital showed that the BUA values of Caucasians and Singaporeans (Southeast Asians) were significantly different, with Caucasians having consistently higher BUA values.
Difference in mean BUA value / dB MHz-1 | |
Singaporean men versus Caucasian men | 9.3 |
Singaporean women versus Caucasian women | 5.0 |
The degree of deviation (how much the patient’s BUA score differs from the mean/average), changes based on the mean BUA of the population that the patient’s BUA is being compared against. It is thus imperative that the baseline for comparison is established from the same population group as the patient.
Low broadband ultrasound attenuation (BUA) indicates a higher risk of fracture
The CUBAClinical Bone Sonometer measures two parameters: BUA (Broadband Ultrasound Attenuation) and VOS (Velocity of Sound). During a bone ultrasound assessment, ultrasonic sound waves are pulsed through the heel bone. The internal structure and content of the bone affects:
- How much ultrasonic waves are absorbed by the bone (how much the wave is altered)
- he speed at which the ultrasonic waves pass through the bone
Healthy bone has greater mineral density and connectivity within the structure of the bone compared to osteoporotic bone (bone with low bone mineral density/bone mass), allowing for greater sound wave absorption and faster sound wave travel speed. Lower BUA values are thus associated with osteoporotic bone and increased fracture risk.
It is also worth noting that BUA values tend to decrease with increasing age and each SD reduction in the patient’s BUA value can be linked to a two-times increased relative risk of bone/hip fractures.
Bone ultrasound assessment is recommended for Singaporean women
As per the study conducted by the Changi General Hospital Department of Orthopaedic Surgery, Singaporean women have a lower mean BUA compared to Caucasian men, Caucasian women, and Singaporean men, indicating a higher prevalence of osteoporosis among Singaporean women. Bone ultrasound assessment is thus recommended for Singaporean women to monitor bone health and fracture risk.
Postmenopausal women have a higher risk of developing osteoporosis
Oestrogen is a female hormone essential for healthy bones, the drop in oestrogen levels post-menopause can thus lead to rapid bone density loss. Women with the following risk factors are encouraged to perform a bone ultrasound assessment to determine the health of their bone as they have an increased risk of suffering from osteoporosis:
- Suffering from absent periods for over 6 months
- Menopause before the age of 45 (early menopause)
Hysterectomy (removal of the womb) before the age of 45
Low testosterone levels increase the risk of osteoporosis in men
The exact medical cause of osteoporosis in men is currently unknown, but a link between testosterone levels and bone health has been identified. Testosterone is a male hormone that is produced by men into old age, low testosterone levels can be caused by:
- Hypogonadism
- Excessive alcohol consumption
- Steroid tablets
What to expect during a bone ultrasound assessment at The Clifford Clinic
Prior to the bone ultrasound assessment, a consultation session with our clinic’s doctor(s) will be scheduled to allow our doctor(s) to assess your general health. On the day of the bone ultrasound assessment, our clinic’s staff will remove your shoe and/or sock and apply coupling gel to your heel in preparation for the scan.
You foot will then be positioned on the sonometer and strapped in place to keep your heel secure during the bone ultrasound scan. If your foot is smaller than average or if the scan is being done on a child, a special positioning insert will be used to ensure that your/the child’s foot is properly aligned with the machine.
The ultrasound scan will only last a few minutes. No discomfort or pain will be felt during the scan as only soundwaves are being pulsed through your heel/foot. Our clinic’s doctor(s) will interpret the scan report for you post scan.
About our machine: the CUBAClinical Bone Sonometer
The McCue CUBAClinical Ultrasonic Bone Sonometry System is a precision bone analyser that uses ultrasound to calculate bone density at the heel. Ionizing radiation is not produced by the CUBAClinical. The CUBAClinical comes equipped with software that uses a reference database established using a Singaporean population. The system also possesses a 30 second settling system that prevents edema (tissue swelling caused by fluid retention) from affecting scan results.
Who is suitable a bone density test?
Anyone can take a CUBAClinical ultrasound bone density test. However, women aged 65 years and older, men aged 70 years and older, individuals with a family history of osteoporosis and/or bone fractures, and individuals who suffer from vitamin D deficiency are encouraged to do the test.
Is this a one-off scan?
Individuals who are already diagnosed with osteoporosis are also encouraged to retake the bone ultrasound assessment every 1-2 years after starting or changing osteoporosis medication to determine their responsiveness to the medication.
Is there any downtime?
No, bone ultrasound assessment done using the CUBAClinical Ultrasonic Bone Sonometry is painless and has zero downtime.