Osteoporosis is a systemic skeletal disease characterized by decreased bone mass and microstructural destruction of bone tissue, leading to fragile bones and susceptibility to fractures, significantly affecting the quality of life of patients and increasing the socioeconomic burden. The aim of this study was to investigate the independence of quantitative ultrasound (QUS) of the heel bone in the prediction of osteoporosis and associated fractures, especially its relationship with bone mineral density (BMD). We used Mendelian randomization to analyze the causal relationship between QUS and BMD, osteoporosis and fracture risk by using genetic variants as instrumental variables. The results showed a significant correlation ( P < .01) between heel QUS metrics and BMD, suggesting that QUS is not independent of BMD in assessing osteoporosis risk. Therefore, the value of QUS needs to be used in conjunction with BMD results in fracture risk assessment. The use of a Mendelian randomization design enhances the inference of causality and avoids bias in traditional observational studies. Therefore, this study employs bibliometric methodology to further supplement existing research on the relationship between QUS measurements of the calcaneus and BMD. In summary, this study emphasizes the importance of integrating BMD in clinical applications and calls for replication of the study in larger samples to further explore the relationship between QUS and BMD in order to improve screening and management strategies for osteoporosis.
Na et al. (2026) studied this question.