Abstract
For long time, osteoporosis (OP) was exclusively associated with an overall bone mass reduction, leading to lower bone strength and to a higher fracture risk. For this reason, the measurement of bone mineral density through dual X-ray absorptiometry was considered the gold standard method for its diagnosis. However, recent findings suggest that OP causes a more complex set of bone alterations, involving both its microstructure and composition. This review aims to provide an overview of the most evident osteoporosis-induced alterations of bone quality and a résumé of the most common imaging techniques used for their assessment, at both the clinical and the laboratory scale. A particular focus is dedicated to the micro-computed tomography (micro-CT) due to its superior image resolution, allowing the execution of more accurate morphometric analyses, better highlighting the architectural alterations of the osteoporotic bone. In addition, micro-CT has the potential to perform densitometric measurements and finite element method analyses at the microscale, representing potential tools for OP diagnosis and for fracture risk prediction. Unfortunately, technological improvements are still necessary to reduce the radiation dose and the scanning duration, parameters that currently limit the application of micro-CT in clinics for OP diagnosis, despite its revolutionary potential.
Highlights
Osteoporosis (OP) is a worldwide skeletal disease affecting the elderly population, with a very high incidence in post-menopausal women
Besides a complete overview of the modifications of bone microstructure and composition due to OP occurrence, this review addresses the evolution of the most common techniques adopted for bone investigation, with a particular focus on the characteristics and potentialities of the most up-to-date computed tomography (CT) instruments in the assessment of OP-induced variations in bone structure and material composition
The value of the areal bone mineral density (BMD) measured through DXA was considered the gold standard for OP diagnosis and for fracture risk prediction
Summary
Osteoporosis (OP) is a worldwide skeletal disease affecting the elderly population, with a very high incidence in post-menopausal women. Sci. 2020, 10, 8939 life expectancy of the elderly are estimated to increase by more than two-fold over the 25 years, osteoporotic fractures still represent an important clinical issue with a significant impact on the cost for health care systems. Several works in the literature interestingly describe the most common equipment used for bone characterisation and bone strength prediction Among them, it is worth mentioning the works of Genant and collaborators [4,11,12,13], describing the potentialities and the drawbacks of the most common instruments adopted for bone analysis both at the clinic and laboratory research level. A final section is dedicated to finite element method (FEM) analysis, based on bone micro-CT images, that enables the computational simulation of bone behavior under different load conditions and, represents a potential and revolutionary tool for a more precise fracture risk prediction
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