Comparative analysis of bone density measurement techniques: a systematic review of quantitative ultrasound and dual-energy X-ray absorptiometry

Background: Bone mineral density (BMD) and bone-related parameters are essential for osteoporosis detection. Different screening modalities are used, including quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA). This systematic review aimed to evaluate the correlation and clinical utility of DXA and QUS measurements. Methods: A literature search (2005-2025) was conducted in PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and Cochrane Library for English-language studies. A narrative synthesis was performed to summarize the study characteristics and outcomes. Results: Of the 1,247 identified records, 24 studies met the inclusion criteria. DXA and QUS were used to assess bone parameters, such as BMD, bone mineral content (BMC), speed of sound (SOS), broadband ultrasound attenuation (BAU), and stiffness index (SI). The correlation between DXA and QUS varied widely (r = 0.17-0.86), with variable diagnostic performance across studies. Studies involving postmenopausal women and older populations reported similar trends, whereas the findings were inconsistent in pediatric and disease-specific populations. Conclusion: QUS is suitable for preliminary screening, especially in resource-limited settings, but cannot replace DXA for definitive diagnosis. Further well-designed studies with longer follow-up are required to better define the role of QUS in osteoporosis screening. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251146250.