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Bone mass and architecture determination: state of the art

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Bone fracture occurs when the bone strength (i.e. the ability of the bone to resist a force) is less than the force applied to the bone. In the elderly, falls represent the more severe forces applied to bone. Bone density is a good marker of bone strength, and has been used widely in this respect. Nevertheless, many aspects of bone strength cannot be explained by bone density alone. For this reason there has been increasing interest in studying architectural parameters of bone, beyond bone density, which may affect bone strength. Macro-architectural parameters include e.g. bone size and geometry assessed with techniques such as radiography, dual-energy x-ray absorptiometry (DXA), peripheral quantitative computed tomography (QCT), computed tomography (CT) and magnetic resonance imaging (MRI). Micro-architectural parameters include fine cortical and trabecular structural detail which can be evaluated using high-resolution imaging techniques such as multidetector CT, MRI, and high-resolution peripheral QCT. These techniques are providing a great deal of new information on the physiological architectural responses of bone to aging, weightlessness, and treatment. This will ultimately lead to the prediction of fracture risk being improved through a combined assessment of bone density and architectural parameters.

Section snippets

Bone, bone mass and bone density

Mineralized bone tissue is composed of type-I collagen fibres (∼40% by volume) interspersed with calcium hydroxyapatite crystals (∼45% by volume). The remaining volume (∼15%) is composed of water bound to collagen or free. Bone marrow is composed of vessel sinusoids, and a variable amount of haematopoietic and fatty tissue. As opposed to isotropic tissue, which is identical in all directions, bone tissue is anisotropic and changes from one direction to another depending on functional

Determination of bone macro-architecture

Bone macro-architecture refers to overall bone geometry and covers such aspects as bone shape and size. Bone macrostructure can be assessed by radiography, DXA, QCT, peripheral QCT (pQCT) or magnetic resonance imaging (MRI), and is an important contributor to bone strength. A strong association has been reported between proximal femoral geometry and postmenopausal fracture12, 13, while biomechanical testing has shown that a combination of bone density and femoral geometry is more predictive of

Determination of bone micro-architecture

Only high-resolution techniques can depict micro-architecture. Techniques used to assess micro-architecture include CT-based (micro-CT, high-resolution pQCT, pQCT and multidetector CT) and MR-based (micro-MR, high-resolution clinical MR) techniques as well as radiography (fractal analysis). The accuracy of micro-architecture determination depends heavily on spatial resolution as well as analytical methods. Following image acquisition, addition steps may include region-of-interest extraction,

Dual x-ray absorptiometry (DXA)

Dual x-ray absorptiometry, as the name implies, measures the relative tissue absorption of a dual-energy x-ray spectrum. The dual-energy spectrum is produced in one of two ways: either a cerium filter is applied to absorb the mid-energy spectrum waves of an x-ray beam yielding effective energies of 40 and 70 keV, or a dual-energy x-ray source is utilized rapidly switching between low (∼70 kVp) and high (∼140 kVp) tube potentials.26

DXA is a projectional imaging technique which measures areal

Summary

Bone mineral density is the best single surrogate marker of bone strength and, for the immediate future, bone strength will continued to assessed most widely by DXA. There are, however, many aspects to bone strength beyond those evaluated by DXA. Currently, the increasing research use of high-resolution imaging to assess bone strength is limited by cost, availability, consensus regarding analytical standards, and irradiation limitations. These new techniques may become much more widely adopted

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