Background: Osteoporosis is a major health problem that affects millions of women worldwide. Quantitative Ultrasound can serve as a screening test for the elderly population, for confirmation by DEXA and early management. Objective: To evaluate the efficacy of QUS in diagnosing osteopenia and osteoporosis in comparison to peripheral DEXA (pDEXA). Methods: 110 elderly participants were investigated for t–scores by pDEXA and QUS measurement. Results: QUS T–score of –2.0 was selected as a cut–off point, for an optimal use of calcaneal QUS as a first–step screening tool that could identify the majority of subjects with pDEXA T–score ≤–2.5. Conclusion: Our study shows that QUS can be used for stratifying the population into risk groups for osteoporosis and that elderly with QUS T–score ≤–2.0 are candidates for referral for DEXA measurements.