The Journal of Bone and Joint Surgery (American). 2008;90:68-78.
doi:10.2106/JBJS.G.01506
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Advanced Imaging of Bone Macrostructure and Microstructure in Bone Fragility and Fracture Repair

Banu B. Kalpakcioglu, MD, Saam Morshed, MD, MPH, Klaus Engelke, PhD and Harry K. Genant, MD

Corresponding author:
Harry K. Genant, MD
Department of Radiology, University of California at San Francisco, 550 Parnassus Avenue, San Francisco, CA 94143.
E-mail address: harry.genant{at}ucsf.edu

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Medtronics Sofamor Danek, Lilly, GlaxoSmithKline, Service Amgen, Roche, Merck, Scanco, General Electric, and Hologic. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 (Synarc and Osteogenix Stock) or less than $10,000 (Medtronics Sofamor Danek, Lilly, GlaxoSmithKline, Service Amgen, Roche, Merck, Scanco, General Electric, and Hologic) or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Research into the molecular and cellular pathways focusing on bone fragility and fracture-healing has led to new potential treatments to aid in fracture-healing. This research has focused on physical as well as biological modes of treatment. As new products and methods are derived, it is essential to develop effective and sensitive noninvasive means by which early changes in the fracture repair process can be detected. Specialized noninvasive and/or nondestructive techniques can provide structural information about local and systemic skeletal health, the propensity to fracture, and the pathophysiology of bone fragility.

The methods available to quantitatively assess macrostructure include computed tomography and, particularly, volumetric quantitative computed tomography. Methods for assessing microstructure of trabecular bone include high-resolution computed tomography, microquantitative computed tomography, high-resolution magnetic resonance imaging, and micromagnetic resonance imaging.

These new techniques help to illustrate the process of fracture-healing by defining the skeletal response to innovative therapies and assessing biomechanical relationships. This review presents perspectives on the advanced imaging modalities that are currently available and on recent developments that may improve the detection and understanding of bone fragility and fracture-healing.


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