Ultrasound Echo-intensity As A Marker Of Bone Quality In Division I Female Athletes

Bone mineral density (BMD) is a key measure of bone health, with reductions linked to altered bone integrity and increased fracture risk. Dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing BMD but is costly, limiting its accessibility and feasibility for long-term monitoring. Ultrasound offers a non-invasive, portable, and affordable alternative for evaluating bone quality in athletic populations. PURPOSE: To evaluate the relationship between ultrasound-derived subchondral bone quality and DXA-derived BMD in Division I female athletes. METHODS: 49 Division I female athletes (age: 20.0 ± 1.5 years; BMI: 23.5 ± 2.2 kg/m2) participated. Athletes underwent whole body DXA scans to obtain BMD in their dominant lower limb, as well as suprapatellar ultrasound scans of their dominant leg while in maximum knee flexion. A 25x25 pixel (1.2x1.2 mm) region of interest was placed at the bone-cartilage interface of the midline of the medial femoral condyle, a key region in the patellofemoral joint that experiences high loading during activity (Figure 1). To assess localized bone characteristics, the ROI was divided into five equally sized subsections, and mean echo-intensity values were calculated for each subsection and the overall region. Pearson’s correlations were used to evaluate the relationship between DXA-derived lower limb BMD and subchondral bone ultrasound echo-intensity. RESULTS: Moderate negative correlations were observed between BMD and echo-intensity in the overall region (p = 0.005, r = -0.40), as well as the 1st (p = 0.019, r = -0.33), 2nd (p = 0.011, r = -0.36), 3rd (p = 0.003, r = -0.41), and 5th (p = 0.037, r = -0.30) subsections. CONCLUSION: Ultrasound shows promise as a practical tool for evaluating subchondral bone characteristics as it relates to DXA-derived BMD. This relationship suggests that ultrasound metrics could serve as markers of bone quality, supporting early detection and timely intervention for bone deterioration. Supported by: ChatGPT was used to enhance readability and language of this abstract.