A cross-sectional assessment of osteoporosis and its risk factors using ultrasound-derived T scores and fracture risk assessment tool in an Indian population

Abstract Background: Osteoporosis is a major global health problem, affecting approximately one in five people worldwide, with a pooled prevalence of 18.3%. Early diagnosis using quantitative ultrasound (QUS) combined with the fracture risk assessment tool (FRAX) can reduce osteoporotic fractures. Objectives: This study aimed to assess the occurrence of osteoporosis and osteopenia in adults, evaluate associated risk factors, and estimate fracture risk using QUS and FRAX. Materials and Methods: A cross-sectional study was conducted among 265 participants. Sociodemographic data, osteoporosis risk factors, fracture history, and reproductive history (for women) were collected. Height and weight were measured, and bone mineral density at the right calcaneus was determined using a Paltech CM 200 densitometer. Bone health was classified by T-score (normal: ≥−1.0; osteopenia: −2.5 to −1.0; osteoporosis: ≤−2.5). Fracture risk was calculated with the India-specific FRAX tool automated through a Python script. Statistical analyses were performed in R using Chi-square, Fisher’s exact, and Kruskal–Wallis tests. Results: Of the 265 participants, 108 (40.8%) had osteoporosis, 76 (28.7%) osteopenia, and 81 (30.6%) normal bone health. Osteoporosis was significantly associated with female sex ( P = 0.0282), age over 35 years ( P < 0.001), parity ( P = 0.000023), and postmenopausal status ( P < 0.0001). The mean 10-year major osteoporotic fracture probability was 1.67 ± 1.26, and hip fracture probability was 0.27 ± 0.43. Conclusion: The use of QUS and FRA tools demonstrates their value in identifying individuals at heightened risk, supporting the need for screening and tailored interventions to prevent osteoporosis-related morbidity.