Imaging techniques for evaluating bone microarchitecture

At present, fracture risk prediction in the individual patient relies chiefly on bone mineral density (BMD) measurements. However, many lines of evidence indicate that the decreased bone strength characteristic of osteoporosis is dependent not only on BMD, but also on other factors, most notably bone microarchitecture. Here, we review available tools for characterizing trabecular microarchitecture (in terms of morphology, topology, and texture) and for obtaining 2D and 3D images (using radiography, computed tomography, and magnetic resonance imaging). Bone microarchitecture imaging is a noninvasive method that may improve fracture risk prediction in the individual patient, shed light on the pathophysiology of osteoporosis, and help to monitor the effects of treatments. Among the various methods available to date, magnetic resonance imaging has the advantage of involving no radiation exposure, although its limited availability restricts its usefulness for studying vast populations. Regardless of the methods selected to assess bone microarchitecture, there is a need for validated standardized parameters capable of improving fracture risk prediction in longitudinal studies.