Bone Quality-Beyond Bone Mineral Density

Both bone mass and quality are responsible for bone strength. Whereas bone mass is measured with bone mineral density, quantification of bone quality is more complex and involves bone architecture, texture, and mechanical parameters. Over the last decade, significant progress has been made in developing technologies to measure bone quality. These include novel low-cost modalities such as trabecular bone score measured on dual-energy X-ray absorptiometry images and quantitative ultrasound as well as more advanced imaging modalities such as multidetector computed tomography, magnetic resonance imaging, and high-resolution peripheral quantitative computed tomography. We describe the reasons to measure bone quality and present the different modalities currently used to quantify it. This article also summarizes the strengths and weaknesses as well as the clinical feasibility of these technologies.