The cost of a DXA scan depends on where you get the scan done (private hospitals are more expensive than government/public hospitals) and how many sites you scan (basic lumbar spine and femoral neck scan, or more cost if a wrist scan, or vertebral fracture assessment is required). An Quantitative Ultrasound Assessment (QUA) is different from DXA, and is done as a screening examination in selected groups of individuals e.g. post-menopausal women. Hospitals do not routinely do QUA. Very often, these ultrasound measurements are done in the community as part of awareness programmes for increasing awareness of osteoporosis. People with a low ultrasound measurement should have a DXA scan. 

By definition, osteoporosis can only be diagnosed on the basis of a DXA result, not ultrasound. DXA is also more accurate and reproducible in the assessment of bone mineral density, thus should be the modality of choice in assessing bone density, and thus the presence of osteoporosis.

In our region it ranges from INR 2000 to 2500.

the test is really helpful for the diagnosis of osteoporosis.

Depends on whether it is private set up or government set up.

You can get the countrywise details in the following link:

http://www.iofbonehealth.org/sites/default/files/media/PDFs/Regional Audits/2013 -Asia_Pacific_Audit_0_0.pdf

Dear Wong Kah Hui,

The cost of the two diagnostic methods is quite different, especially because the cost and maintenance of equipment. Thus, the cost of scanning by DEXA is more expensive.

Dexa scan still is more capable in early detection of osteoporosis, but look these papers about quantitative ultrasound:

http://dx.doi.org/10.1590/1414-431X20143443

http://iwbbio.ugr.es/papers/iwbbio_040.pdf

Dear Dr Hui,

                        Please let me copy to you the answer I have just given to a similar question asked by Dr Alkhaishani.

"Osteoporosis" was first defined by Pathologists (prior to X-ray discovery) as just "the presence of an exaggerated number of pores in the bones" as a result of which the mineralized mass of the bones is impaired with no necessary alteration of its intrinsic "quality" (composition, mechanical properties, etc).

Then, X rays allowed detection of that "excess of pores" by (subjectively) appreciating a reduction of the natural "radio-opaque" characteristic of bone tissue of the bones. Thus, an expert Radiologist could diagnose "osteopoorosis" when no less than (grossly) some 30% of the mineralized bone mass was already lost (a bit late, one would say, but something is better than nothing).

Furhermore, by combining experience from Radiologists, Clinicians, Epídemiologists, etc it was possible to (grossly) correlate the lack of bone "mass" with a (more gross) proportional reduction of bone strength and (even more grossly) an enhancement of the fracture risk. Then, the "pore-related" concept passed to a "mass-related" concept (very grossly) related to a "strength-related" concept.

When DXA technology appeared, the opportunity to quantify the bone mass loss with pretty acurate numbers offered an attractive chance to generate (when "generation" is told about something emerging from the human mind we usually call it an "invention") some "scale" of "bone mineralized mass" values, based on the absorptive capacity of the minerals contained in the bone tissue placed between the emission and detection sections of the densitometer. Then we were given the "bone mineral content" (BMC, in mass units) concept as defining some property of the studied bone region. The necessary anthropometric adjustment of the BMC to standardize the measurements for small and large individuals lead to the development (invention) of the "bone mineral density" (BMD) concept. The "BMD" is an "areal" density estimation resulting from dividing the BMC by the projected area of the studied bone, expressed in mass/area units.

The availability of a BMD scale encouraged the development (invention) of a diagnosis system to diagnose... osteoporosis, despite of the fact that no pores were necessarily involved in that. Then, the problem was to define 1. what kind of alteration was being assessed by just a lower-than-normal BMD value, and 2. up to what extent a reduction of that BMD value would reflect some (correlative?) reduction in bone strength that could be relevant to fracture risk.

It was then when a curious distinction between "osteopenia" (a simple reduction in bone mass (BMD) with no impact on bone strength and fracture risk) and "osteoporosis" (a "larger" (?) reduction in bone mass (BMD) with some impact on bone strength and fracture risk). This "advance" lead to completely forget two important things, namely, 1. the already commented assimilation of "osteoporosis" to bone "pores", and 2. that bone strength is not a direct correlate of bone "mass" (BMC) or "areal density" (BMD), but the result of a combined, quite complex product of just two (exclusive) properties, namely, "bone tissue (intrinsic) mechanical quality" (concretely, bone tissue stiffness and toughness) and "bone tissue distribution" (i.e. whole bone geometric or architectural properties, or "bone design").

Regrettably, none of these two properties are captured by any BMC or "areal" BMD determination. Nevertheless, Clinicians, Epidemiologists, etc came to apply statistics that correlate DEXA-assessed BMC or BMD values with anthropometric traits, age and fracture incidence in selected populations, and there we had the BMC "Z-score" and BMD "T-score" concepts. The Z-scores applied to BMC described the bone mineral status as related to SD deviations of individual values around the regression line established between BMC and age for given age ranges in the general, healthy population. The T-scores applied to BMD described the bone mineral status as related to SD deviations of individual values around the regression line established between BMD and age as determined in some "young and health" selected population.  

Then, Epidemiologists demonstrated repeatedly nice negative correlations between BMD T-scores and fracture incidence in large population studies. Accordingly with the derived experience, a BMD T-score association with fracture risk was established in such a way that some (gross) correspondence could be proposed (invented) between BMD T-scores and bone strength. Inventions can be more or less successful, depending on unpredictable circumstances. This invention lead to the BMD T-score scale to diagnose "osteopenia" as a bone "mass" reuction not larger than 2.5 SD's, and "osteoporosis" (?) as a bone "mass" reduction larger than that limit. The WHO accepted and widely promoted the application of well-established BMC Z- and BMD T-score scales for diagnosing "osteopenias" (?) and "osteoporoses" (?) described that way. At the same time, a curious distinction between "osteopenia" and "osteoporosis" as pathological conditions was defined, the former being regarded as a "simple loss of bone mass" (a BMD T-score between -1 and -2.5) withouth any derived fracture risk, and the latter as a "severe loss of bone mass" (a BMD T-score below -2.5) with some derived fracture risk. In order to "save the appearances" concerning the (invented) correspondence between BMD T-scores and fractrure risk, a third cathegory of patients was proposed as cases with "established" osteoporosis" when a BMD T-score of less than -2.5 was complemented with the presence of a typical "osteoporotic" fracture. Strikingly, no further cathegory was defined to apply to the large number of cases with T-scores between -1.0 and -2.5 who already had a "typically osteoporotic" fracture.

It is not my purpose to criticize this kind of approach to diagnose bone fragility. There are lots of papers (the more recent, the easier to desciphrate) that put the things as they really are. What I have to do now is to answer the question about QUS application to a similar purpose in the human heel to "measure osteoporosis" as strictly stated by Dr Alkhaishani.

All what I have to tell is that, similarly to the DEXA principle (attenuation of a X-ray beam by the presence of mineral between emision and detection), BUA refers to attenuation of an US wave as it has to travel through the studied bone from suitable emision and detection devices. 

Again, I am not here to judge about the efficacy of BUA to describe or quantify "bone mineral mass" in the heel or wherever better or worse than DEXA does. There are thousands of papers dealing with every source of comparison between both technologies in many different instances. A general conclusion that seems to come out is that BUA looks to represent a relatively poorer correlate of bone "mass" than DEXA. Not to tell about its proposed correlation with bone strength, fracture risk, and (did we have forgotten that?)... "osteoporosis". 

Sincerely, I do not understand what a BUA diagnosis of "osteoporosis" mean.

Hi, I am looking for any related article to help me about measuring osteoporosis in heel bone by using quantitative ultrasound. Can anyone help me? - ResearchGate. Available from: https://www.researchgate.net/post/Hi_I_am_looking_for_any_related_article_to_help_me_about_measuring_osteoporosis_in_heel_bone_by_using_quantitative_ultrasound_Can_anyone_help_me [accessed Jan 14, 2016].