Ultrasound waves can affect bone and bone marrow, and widespread medical and industrial use increases the likelihood of direct or indirect exposure. This systematic review summarizes current evidence on the biological and biomechanical effects of high- and low-intensity ultrasound on skeletal tissues, with emphasis on safety. A systematic search was conducted across PubMed, ScienceDirect, Wiley Online Library, EMBASE, JSTOR, IEEE Xplore, Scopus, and Google Scholar (up to October 2024), guided by a PICO-based strategy. Studies were screened using predefined eligibility criteria, and 29 articles met the inclusion criteria for synthesis. Study quality was appraised using the Newcastle–Ottawa Scale (NOS) and the 2018 Mixed Methods Appraisal Tool (MMAT). The protocol was registered in PROSPERO (CRD42024620731). Ultrasound technology has significant implications for health and safety due to its medical and industrial applications. High-intensity ultrasound waves may cause tissue damage, reduce bone density, and even lead to necrosis. However, controlled low-intensity ultrasound can be beneficial in medical treatments and tissue healing. To minimize potential risks, it is crucial to establish safety standards and enhance public awareness regarding the appropriate use of ultrasound technology. In summary, while prolonged exposure to ultrasound may adversely affect bone density and marrow integrity, the technology retains significant value in diagnostic and therapeutic applications.
Montazeri et al. (Fri,) studied this question.