Abstract
resolution (~0.100–0.200 mm) have been developed that can capture some aspects of bone micro-architecture. Alternatively 3D models created using clinical-CT and MRI can be used to virtually simulate loading on a computer and calculate bone mechanical properties. Analysed together these morphological and mechanical data sets might allow clinicians to provide screening programmes for osteoporosis and calculate individual fracture risk. Especially if applied as part of a holistic approach utilising patient meta-data on risk factors for metabolic bone disease (e.g. FRAX). As well as improve primary and secondary care by setting treat to target criteria for pharmacological therapies and planning surgical interventions or following up treatment outcomes. Conclusion In the short to mid term the expense of 3D imaging and (in the case of CT) the risks associated with ionising radiation are going to restrict image resolution. Therefore, in order to achieve the goal of bringing bone quality from bench to bedside, future research needs to be directed towards better analysis of 3D bone geometry at sub-optimal resolution.
Highlights
Measuring the health of bone is important for understanding the pathogenesis, progression, diagnosis and treatment outcomes for fragility
In order to achieve the goal of bringing bone quality from bench to bedside, future research needs to be directed towards better analysis of 3D bone geometry at sub-optimal resolution
This was because densitometry failed to take into account the importance of cortical geometry and trabecular architecture for bone strength
Summary
Measuring the health of bone is important for understanding the pathogenesis, progression, diagnosis and treatment outcomes for fragility. Clinical observations did not support the data, pharmaceutical trials revealed that anti-resorbtive therapies (such as bisphosphonates) reduced fractures to a greater degree than predicted from increases in BMD: see[6] and references therein This was because densitometry failed to take into account the importance of cortical geometry and trabecular architecture for bone strength. Many research articles have since shown that BMD accounts for only about 40–50%7 of the in vitro compressive strength of a bone whilst structure can account for as much as 30–40%8 Following these discoveries, the material (i.e. density) and structural (i.e. non-density) factors were combined into a new understanding of bone strength—termed bone quality, operationally defined as the structural and mechanical basis of bone strength[1,9]. Such a protocol would be very useful for screening, monitoring and treating
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