[Call for attention on evaluation of bone quality based on three-dimensional interconnected bone trabecular network...

Bone trabeculae are key components of bone microstructure, and their complex three-dimensional interconnected microarchitecture is closely related to bone mechanical properties. Traditional imaging studies have been mostly limited to two-dimensional morphological analysis of bone trabeculae, with insufficient attention paid to their interconnected topology, making it difficult to comprehensively reflect bone quality characteristics. The development of ultra-high resolution CT (U-HRCT) technology has brought revolutionary breakthroughs to three-dimensional imaging of bone microstructure. Its spatial resolution can reach up to 50 μm, enabling clear visualization of the three-dimensional structure of bone trabeculae and providing a technical foundation for in vivo assessment of the interconnected trabecular network. Placing emphasis on imaging assessment of bone quality based on three-dimensional interconnected bone microstructure is of great significance for innovating the diagnosis and treatment paradigm of osteoporosis and improving the accuracy of fracture risk prediction. On the basis of systematically reviewing research progress on the three-dimensional interconnected microarchitecture of bone trabeculae, this article focuses on commenting on the technical advantages of U-HRCT in bone microstructure imaging, analyzes the equipment and technical feasibility of evaluation based on the three-dimensional interconnected trabecular network, proposes developing new pathways for bone quality imaging assessment, constructs novel imaging parameters that reflect interconnected topological features, and establishes new bone quality assessment models by integrating multi-level information. It also points out current challenges, including lack of standardization, lengthy imaging durations, and complex data processing, and emphasizes that clinical translation still requires multidisciplinary integration and collaborative advancement across endocrinology, orthopedics, radiomics, biomechanics, and AI.