Chapter 50 - High-Resolution Imaging Techniques for Bone Quality Assessment

Abstract

The skeleton is composed of cortical and trabecular bone, both compartments contributing to bone strength and the resistance of bone to fracture. The strength of bone and risk of fracture are important outcomes in the study of growth and peak bone accrual, aging, postmenopausal bone loss, cancer-related bone loss, and conditions such as diabetes, osteogenesis imperfecta, osteoarthritis, rheumatoid arthritis, and others. Analysis of bone morphology—including the microarchitecture of trabecular bone, and the Haversian and lacunocanalicular ultrastructure of cortical bone—is critical in understanding bone mechanics, assessing fracture risk, and evaluating responses to disease, age, and therapy. Improved predictions of biomechanical properties have been found as a result of including measures of trabecular microarchitecture in statistical regressions. Trabecular microarchitecture is also critical in the evaluation of therapeutic interventions, enabling researchers to explain a greater proportion of the effect of drugs on fracture risk than BMD alone. Quantitative imaging techniques to evaluate the three dimensional microarchitecture of trabecular and cortical bone have been developed using two primary modalities—X-ray computed tomography (CT) and magnetic resonance imaging (MRI). The hallmark of the high-resolution imaging techniques is that they allow independent assessment of cortical and trabecular compartments and have the ability to resolve the microstructural features of cortical and cancellous bone.