[The challenges of the bone micro-architecture]

Osteoporosis is a bone disorder that leads to increased fracture risk. It was defined by the World Health Organisation as a decrease of bone mass and a deterioration of bone quality. In clinical practice, the diagnosis of osteoporosis is based on bone mineral density (BMD) measurements assessed by dual energy X-ray absorptiometry. However, BMD assessment is not the only factor that influences bone strength. The main objective is that clinicians can use a combination of risk factors that are easily assessable, for a better prediction of osteoporosis risk fracture. Bone strength reflects both bone density and bone quality. One of the most important determinants of bone quality is the trabecular bone micro-architecture as suggested by the definition of osteoporosis. Moreover, various studies have concluded to the potential clinical interest of the bone micro-architecture. The aim of this article was to review the challenges of bone micro-architecture, characterization tools (morphological analysis, topology, texture) and imaging techniques (X-ray imaging, scanning and MRI) to assess trabecular bone micro-architecture.