Assessment of the effect of strontium, lead and aluminum on dual-energy x-ray absorptiometry and quantitative ultrasound using trabecular bone-mimicking phantoms

Dual-energy X-ray absorptiometry (DXA) is the gold standard of bone densitometry. However, inaccurate estimation of areal bone mineral density (aBMD) is of concern when calcium in bone mineral is partially substituted with bone-seeking elements such as strontium, lead and aluminum. Quantitative ultrasound (QUS) is an alternative bone densitometry technique that can assess bone health based on the measurement of acoustic parameters. This study aims to investigate the effect of the clinically relevant concentrations of bone-seeking elements on aBMD measured by DXA and the acoustic parameters measured by QUS, using trabecular bone-mimicking phantoms. Statistically significant linear relationship was observed between aBMD and strontium concentration. For clinically relevant concentrations of lead and aluminum, the deviation in aBMD measurements was within 1% coefficient of variation of DXA. No statistically significant deviation was observed in stiffness index measurement by QUS in the presence of any of the three bone-seeking elements