New imaging technologies in the diagnosis of osteoporosis

In the context of osteoporosis, bone quality--which encompasses trabecular and cortical micro-architecture, mass, and tissue mechanical & compositional properties--plays an important and as yet undiscovered role. Non-invasive assessment of bone quality has recently received considerable attention, as bone density alone has not been able to predict existing or future osteoporotic fractures, or to explain therapeutic effects of emerging treatments. The goal of this review, therefore, is to present imaging modalities and related analysis methods capable of assessing bone quality for improved diagnosis and care of osteoporotic individuals. The techniques described include quantitative ultrasound, quantitative computed tomography, peripheral quantitative tomography, micro computed tomography, magnetic resonance, radiographic texture analysis, as well as finite element analysis based on the above-mentioned imaging modalities. The performance of these techniques in predicting osteoporotic fracture and assessing strength indices are discussed.