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Technology Insight: noninvasive assessment of bone strength in osteoporosis

Nature Clinical Practice Rheumatology volume 4, pages 310–318 (2008)Cite this article

Abstract

Fractures that result from osteoporosis are an enormous and growing concern for public health systems; as the population ages, the number of fractures worldwide will double or triple in the next 50 years. The ability of a bone to resist fracture depends not only on the amount of bone present, but also on the spatial distribution of the bone mass, the cortical and trabecular microarchitecture, and the intrinsic properties of the materials that comprise the bone. Although low bone mineral density is one of the strongest risk factors for fracture, a number of clinical studies have demonstrated the limitations of using measurements of areal bone mineral density by dual-energy X-ray absorptiometry to assess fracture risk and to monitor responses to therapy. As a result, new, noninvasive imaging techniques that are capable of assessing various components of bone strength are being developed. These techniques include three-dimensional assessments of bone density, geometry and microarchitecture, as well as integrated measurements of bone strength by engineering analyses. Although they show strong potential, further development and validation of these techniques is needed to define their role in the clinical management of individuals with osteoporosis.

Key Points

  • The ability of a bone to resist fracture depends on the amount of bone, the spatial distribution of the bone mass, and the intrinsic properties of the materials that comprise the bone

  • Several novel, noninvasive techniques for assessment of bone strength in osteoporosis are currently being investigated in clinical studies

  • These techniques aim to quantify various determinants of bone strength, including three-dimensional bone geometry, volumetric bone density and microarchitecture

  • These techniques should be considered research tools at present, as they have not been rigorously tested for their ability to predict fracture risk or to monitor treatment response

  • Use of three-dimensional imaging modalities to assess the determinants of bone strength is a research area of high interest and relevance to clinicians

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Figure 1: Quantitative CT image of the lumbar spine.
Figure 2: Multislice, high-resolution CT images of the 12th thoracic vertebrae.
Figure 3: Assessment of trabecular architecture by HR-pQCT at the distal tibia (voxel size 82 × 82 × 82 µm).
Figure 4: Comparison of trabecular architecture assessment at the distal tibia by (A) HR-pQCT (voxel size 82 × 82 × 82 µm) and (B) high-resolution MRI (voxel size 156 × 156 × 500 µm).
Figure 5: MRI scan of the proximal femur depicting trabecular structure.
Figure 6: Finite element model of the proximal femur in a sideways fall configuration.

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Acknowledgements

The author thanks Dr RJ Fajardo for critical review and insights, and Drs S Majumdar, C Glüer, T Lang and D Kopperdahl for generously providing the images.

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  1. Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, RN115, 330 Brookline Avenue, Boston, MA 02215, USA mbouxsei@bidmc.harvard.edu

Authors and Affiliations

  1. Assistant Professor in the Department of Orthopedic Surgery, and adjunct Assistant Professor in the Department of Aerospace and Mechanical Engineering, ML Bouxsein is a Senior Research Associate in the Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston University, Boston, MA, USA.,

    Mary L Bouxsein

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Bouxsein, M. Technology Insight: noninvasive assessment of bone strength in osteoporosis. Nat Rev Rheumatol 4, 310–318 (2008). https://doi.org/10.1038/ncprheum0798

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