Current imaging techniques in osteoporosis

Osteoporosis is a global pandemic affecting children, men and women of all ages and ethnicities. Millions of people suffer fragility fractures each year around the world as a result of this bone disease, which can have devastating consequences for them, including permanent disability and death. Many fractures are preventable by identifying people at high risk for fracture and falls, and diagnosing those who already have osteoporosis, before they fracture. Rheumatologists commonly encounter people with fragile bones, either as an isolated entity, or a co-morbidity to their underlying rheumatic illness or treatment. Imaging in osteoporosis can be used to make a diagnosis, while measurements of bone and body tissues, most commonly bone mineral density, can be used to identify those at risk and monitor them following treatment. Modern densitometry scanners may have multiple new features including measures of hip geometry, trabecular bone score, finite element analysis, fat and muscle mass, and may have additional imaging features including vertebral fracture assessment and atypical femoral fracture screening. When used correctly, these tools provide invaluable information for the assessment of the effectiveness of interventions in clinical studies, and patient management in clinical practice. In this article we review osteoporosis imaging techniques, with an emphasis on dual-energy x-ray absorptiometry, and how to apply and interpret them in modern rheumatology practice.