Quantifying the material and structural determinants of bone strength

The ability of a bone to resist fracture depends on the amount of bone present, the spatial distribution of the bone mass as cortical and trabecular bone and the intrinsic properties of the bone material. Whereas low areal bone mineral density (aBMD) predicts fractures, its sensitivity and specificity is low, as over 50% of fractures occur in persons without osteoporosis by BMD testing and most women with osteoporosis do not sustain a fracture. New non-invasive imaging techniques, including three-dimensional (3D) assessments of bone density and geometry, microarchitecture and integrated measurements of bone strength such as finite element analysis (FEA), provide estimates of bone strength that can be used to increase the sensitivity and specificity of fracture risk assessment. Initial observations have shown that these techniques provide information that will improve our understanding of the pathophysiology of skeletal fragility and suggest that these techniques are likely to have a role in the clinical management of individuals at risk for fracture.