研究目的

To introduce advanced imaging techniques developed to quantitatively assess aspects of bone quality and discuss their clinical value or added clinical value to DXA.

研究成果

Bone quality is no longer a cloudy concept but an ensemble of well-defined biomechanical parameters. Currently, FEA is the only in vivo imaging method to assess some of these parameters. Bone geometry can be measured by QCT, which is also the basis for FEA. DXA aBMD is a good surrogate of bone quality and currently remains the most important measurement in clinical routine. Hip fracture prediction remains challenging and more efforts should be directed to the integration of fall risk and muscle properties. QCT and FEA may eventually replace DXA for prediction of vertebral fractures but further validation is required. QCT and FEA will also play a dominant role in opportunistic screening.

研究不足

The limitations include the projectional 2D nature of DXA, inability to separate trabecular and cortical bone, dependence of aBMD on bone size, and under treatment the increase in aBMD does not reflect the observed rate of fracture reduction. For QCT, less standardization than DXA, analysis software not integrated in CT scanner and most of the software is not commercially available yet, spatial resolution not adequate to quantify trabecular architecture, and generates a wealth of parameters but it is not fully clear yet, which ones should be used for which purpose.