ABSTRACT
Introduction The goal of clinical bone densitometry is clear-cut: (1) to non-invasively and accur ately evaluate bone strength (or, inversely, bone fragility) or another parameter directly related to the strength of the given bone, and (2) to be sufficiently sensitive and specific to detect even small changes in bone properties that are essential in terms of bone strength. Indeed, the very small (typically some per cent) treatment-induced changes in bone pose a big challenge to the technical and diagnostic performance of bone densitometry. Should the above goals be adequately attained, the clinical assess ment of an individual patient’s susceptibility to sustain a fragility fracture, or his or her response to drug therapy or lifestyle intervention, would be substantially facili tated. In this chapter, we carefully review some recent papers that have addressed the bone strength topic from different perspectives. We have not selected papers that have focused exclusively on methodological aspects. While fast fan-beam dual energy X-ray absorptiometry (DXA) devices are replacing pencil-beam DXA devices, and the assessment of vertebral body morphology with DXA is gaining popularity, we feel that no revolutionary improvement in bone densitometry has occurred dur ing the past few years. We therefore focus on the clinical assessment of bone structure and bone strength as well as the risk of fracture in an individual patient.
