The early preclinical diagnosis of osteoporosis measuring the pure trabecular bone density.

The major skeletal determinants of fracture risk are bone mass and postmenopausal bone loss with gradual destruction of trabecular bone architecture. Therefore, the management of osteoporosis is to prevent bone loss after menopause in women below 60 years of age. We need a screening test of bone mineral density (BMD) with the ability to identify correctly individuals with accelerated bone loss; unnecessary treatment has to be avoided. But without measurable extraskeletal factors, no technique assessing BMD as single test has the reasonable high sensitivity and specificity for the diagnosis of fast bone losers. It is on principle the repeated volumetric bone measurement--within 12 months--in the pure trabecular bone, especially at distal radius of the non-dominant arm with the peripheral quantitative computed tomography (pQCT), being able to detect accurately the individuals as fast bone losers with trabecular bone loss > 8 mg/cm3 or > 3.5% per year (prevalence about 35%). Only women with very high trabecular BMD (in highest quintile) have no risk for osteoporosis.