Bone Density versus Bone Quality as a Predictor of Bone Strength

Abstract

Bone mineral density (BMD) is considered to be the standard method to evaluate bone strength and stratify risk of fracture Kanis et al. [1,2]. However, while easy to administer, the limitation of relying on BMD measurements is that they are uniplanar measurements in terms that the three-dimensional structure of bone is reduced to two dimensions and then the BMD values are computed. Also BMD measures only the mineral component of bone and does not give any information regarding its microstructure. Materials engineering has demonstrated that all the material properties including mechanical properties are a function of material microstructure understood as spatial properties and arrangement of constituent basic structural elements; in the case of bone these being the trabeculae. Thus the evaluation of bone microstructure plays important role in defining material properties of bone including the bone Strength.