[Current problems in osteoporosis from the clinical and radiologic viewpoints]

Osteoporosis is a disease leading to enhanced fragility of bone in association with minimal trauma. This is because of thinning and rarefaction of spongy and cortical bone. Initially, osteoporosis is often only detectable in the spine; later, peripheral cortical bone is also affected. Osteoporosis mainly is a problem associated with postmenopausal bone loss (PMO). With the increasing use of technique evaluating bone density, non-PMO-associated osteoporosis can be increasingly detected. In early menopause, estrogen substitution prevents further bone loss; in severe cases strategies to increase bone mass are under investigation and are very effective in the patients tested so far. Radiological methods are of value to diagnose osteoporosis and monitor the efficacy of treatment. Density measurement of trabecular and cortical spinal bone with computed tomography seems to be the technique of choice. Peripheral measurements must still prove their value, however. The advantage of quantitative CT is its capacity, selectively and reproducibly, to determine distinct bone structures like cortical or trabecular bone. Normal lateral X-ray films of the spine are essential to assess vertebral deforming events and exclude further wedging during therapeutic trials.