Using bone quality to assess fracture risk

By Adele L. Boskey, PhD

Fracture risk is generally assessed by clinicians based on the amount of bone that is present (bone quantity), measured by dual energy X-ray absorptiometry (DEXA) scans, and reported as a two-dimensional measurement of bone mineral density (BMD) or as a T- or Z-score that compares that BMD to the average value for a 25-year-old white woman (T-score), or an age-, gender-, and sex-matched average (Z-score).

While BMD is a good surrogate for bone quantity, BMD accounts for less than 70 percent of the predictive fracture risk. Further, BMD changes often do not correlate with the improvement in fracture risk provided by antiresorptive or anabolic therapies. To increase predictive values and better assess the efficacy of drugs being used to treat and prevent fragility fractures, investigators also consider bone quality.

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