Utility of heel ultrasound bone density in men

In women, heel ultrasound (US) bone mineral density (BMD) predicts fracture risk, but the usefulness of this tool in men is unknown. We measured heel US quantitative ultrasound index (QUI) in a convenience sample of 185 men undergoing central BMD testing by dual energy X-ray absorptiometry (DXA) to determine if US could predict central BMD. DXA and heel US measurements were correlated significantly (r = 0.373-0.483, p < 0.001). Defining osteopenia. as a spine, total hip, or femoral neck T-score of <-1.5 and osteoporosis at <-2.0 or <-2.5, we determined specificity and sensitivity of heel US T-score. No cutoff provided both good sensitivity and specificity. From analysis of ethnic and age groups, the best receiver operating characterisitc curve was found in men younger than age 65 (area under curve 0.7186-0.7722). In conclusion, despite a strong correlation between heel QUI and central BMD by DXA, no heel T-score could predict osteopenia or osteoporosis with satisfactory sensitivity and specificity. Further studies are needed to determine if heel US is an independent risk factor for fracture in men.