Advances in osteoporosis imaging.

In the assessment of osteoporosis, the measurement of bone mineral density (BMD(a)) obtained from dual energy X-ray absorptiometry (DXA; g/cm(2)) is the most widely used parameter. However, bone strength and fracture risk are also influenced by parameters of bone quality such as micro-architecture and tissue properties. This article reviews the radiological techniques currently available for imaging and quantifying bone structure, as well as advanced techniques to image bone quality. With the recent developments in magnetic resonance (MR) techniques, including the availability of clinical 3T scanners, and advances in computed tomography (CT) technology (e.g. clinical Micro-CT), in-vivo imaging of the trabecular bone architecture is becoming more feasible. Several in-vitro studies have demonstrated that bone architecture, measured by MR or CT, was a BMD-independent determinant of bone strength. In-vivo studies showed that patients with, and without, osteoporotic fractures could better be separated with parameters of bone architecture than with BMD. Parameters of trabecular architecture were more sensitive to treatment effects than BMD. Besides the 3D tomographic techniques, projection radiography has been used in the peripheral skeleton as an additional tool to better predict fracture risk than BMD alone. The quantification of the trabecular architecture included parameters of scale, shape, anisotropy and connectivity. Finite element analyses required highest resolution, but best predicted the biomechanical properties of the bone. MR diffusion and perfusion imaging and MR spectroscopy may provide measures of bone quality beyond trabecular micro-architecture.