High-resolution peripheral quantitative computed tomography for the assessment of bone strength and structure: a review by the Canadian Bone Strength Working Group

Abstract

Bone structure is an integral determinant of bone strength. The availability of high resolution peripheral quantitative computed tomography (HR-pQCT) has made it possible to measure three-dimensional bone microarchitecture and volumetric bone mineral density in vivo, with accuracy previously unachievable and with relatively low-dose radiation. Recent studies using this novel imaging tool have increased our understanding of age-related changes and sex differences in bone microarchitecture, as well as the effect of different pharmacological therapies. One advantage of this novel tool is the use of finite element analysis modelling to non-invasively estimate bone strength and predict fractures using reconstructed three-dimensional images. In this paper, we describe the strengths and limitations of HR-pQCT and review the clinical studies using this tool.

Fig. 1

The number of publications each year that utilized high-resolution peripheral quantitative computed tomography

Fig. 2

a, A typical setup of HR-pQCT for patient measurements. At top, the casts used for securing the forearm and lower leg is shown. b, c, and d, The procedure for HR-pQCT analysis requires a ‘scout view’ x-ray of the radius or tibia (left) so that the operator can select the region of interest for scanning (solid green bar). Subsequently, three-dimensional data can be obtained in the scan region (right). e, A typical section from HR-pQCT showing the ultradistal tibia and fibula. The green line on the periosteal surface of the tibia is used to extract the bone of interest for subsequent three-dimensional analysis