Community-based Heel Ultrasound Screening Leads to Osteoporosis Follow-up and Treatment Recommendations

“Providing calcaneal quantitative ultrasound (US) scanning as a free screening can be an effective strategy for improving osteoporosis detection and treatment,” says Edward Fox, M.D., Penn State Hershey Bone and Joint Institute. In a recent study of adults who received free calcaneal US screening at community health fairs and telephone follow-up, Fox, Frances Tepolt, M.D., and Susan Hassenbein, CCRP, demonstrated that nearly half of those identified as high-risk for osteoporosis (T-score less than or equal to -1) sought evaluation from a health care professional within three months. The large majority of these individuals also received recommendations for further bone density evaluation and treatment (Figure).

Heel Ultrasound ScreeningParticipants, none of which had ever had a fragility fracture, were also given access to informational pamphlets about bone health and osteoporosis. Fox emphasizes, “This study is among the first to examine individuals, access to osteoporosis screening results and disease information, prior to the occurrence of any overt signs of disease, like a fragility fracture. With about half of the high-risk individuals seeking follow-up, this study supports that heel US screening has the potential to increase osteoporosis diagnosis and intervention.”

Penn State Hershey’s data is far more encouraging than a prior report showing only about 9 to 24 percent of older women with a fracture received pharmacotherapy post-fracture.1 The new findings also highlight the crucial element of education. Fox notes, “Heel US screening could be an important component of broader efforts to raise community awareness of osteoporosis and basic understanding of bone health. At the health fair, we also provided pamphlets about osteoporosis, along with screening.”

This could be one component of a broader public educational campaign, similar to those that have had success with educating potential patients about heart disease and diabetes, to dispel the myths that osteoporosis is a normal part of aging and that little can be done to treat it. Fox says, “The public needs to become aware that low bone density has very serious health risks, just as most people nowadays realize that high blood sugar, high cholesterol, and high blood pressure are each linked to serious health problems and even death. If we educate and inform people better about their risk, along with screening information, I think we could see improvements in osteoporosis detection and treatment in patients, possibly decreasing fracture incidence.”

Edward J. Fox, M.D.

Edward Joseph Fox, M.D.
Professor, Orthopaedics and Rehabilitation and Medicine
Surgeon, Orthopaedics and Musculoskeletal Oncology
PHONE: 717-531-4837
FELLOWSHIP: Musculoskeletal oncology surgery, Massachusetts
General Hospital-Harvard Medical School, Boston, Massachusetts
RESIDENCY: General surgery and orthopaedic surgery, SUNY at
Stony Brook College of Medicine, Stony Brook, New York
MEDICAL SCHOOL: University of Rochester School of Medicine and
Dentistry, Rochester, New York


1. Wilk A, Sajjan S, Modi A, Fan CP, Mavros P. 2014 Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA. Osteoporos Int. Dec;25(12):2777-86.

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