Assessment of bone quality and strength with new technologies

Purpose of review To give an overview of advanced in-vivo imaging techniques for assessing bone quality beyond bone mineral density that have considerably advanced in recent years. Recent findings Quantitative computed tomography and finite element analysis improve fracture risk prediction at the spine, and help to better understand the pathophysiology of skeletal diseases and response to therapy by quantifying bone mineral density in different bone compartments, determining bone strength, and assessing bone geometry. With new high-resolution techniques, trabecular structure at the spine, forearm, and tibia, and cortical porosity at the forearm and tibia can be measured. Hip structure analysis and trabecular bone score have extended the usefulness of dual X-ray absorptiometry. Summary New advanced three-dimensional imaging techniques to quantify bone quality are mature and have proven to be complimentary methods to dual X-ray absorptiometry enhancing our understanding of bone metabolism and treatment.