Osteoporosis is a metabolic disorder that manifests changes in bone density and structure accompanied by an increased susceptibility to fractures. Recent studies have demonstrated the potential contributions of trabecular bone microarchitecture in the assessment of the therapeutic efficacy of emerging treatments, and also in the assessment of fracture risk. The main goal of this paper is to emphasize the clinical implementation of bone microarchitecture measurements. Thus, this paper provides an overview of the main imaging modalities for depicting trabecular bone microarchitecture and a corresponding description of common computed structural bone parameters. The imaging modalities presented to characterize the complex three-dimensional trabecular bone network include micro-CT, quantitative CT, and magnetic resonance imaging. Two-dimensional analyses of radiographic patterns are also discussed. Results demonstrating the ability to distinguish between different populations based on trabecular bone microarchitecture in longitudinal studies are also presented for the various imaging modalities.
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