Single-component imaging and ultrasound-based tools for the assessment of fracture risk

Emerging imaging and computational technologies are reshaping how osteoporosis and low bone mass are assessed. Dual-energy X-ray absorptiometry (DXA) is key for the operational definition of osteoporosis, but advances in single-component tools such as finite element analysis, trabecular bone score, DXA-based 3D shape modelling, quantitative ultrasound, radiofrequency echographic multi-spectrometry and artificial-intelligence-driven interpretation of routine radiology offer complementary insights into bone strength, microarchitecture and fracture risk. Some of these approaches provide additional fracture-risk measures beyond areal bone mineral density, whereas others enable opportunistic identification of people with low bone density in populations who would otherwise be missed. Strong pre-clinical and encouraging observational data support the use of these technologies and, although their current use in clinical practice varies with the age of the technology, they all have a potential role in the assessment of fracture risk at a variety of points in the patient journey (from screening to monitoring response to therapy). As their use becomes more widespread, monitoring performance, assessing the equitability of implementation and evaluating the health-service benefits of these tools in clinical practice will be key.