BONE STRENGTH AND TECHNIQUES OF ASSESSMENT

Bone plays a vital role in providing structural support, protecting internal organs, storing minerals, and regulating metabolic and endocrine functions. Bone strength depends on both cortical and trabecular components, which vary in proportion across different skeletal sites. With aging, remodeling imbalances lead to bone loss, microarchitectural deterioration, and osteoporosis—a silent disease often first recognized after fragility fractures. Early detection is crucial to reduce morbidity and healthcare burden. This review discusses current and emerging techniques for assessing bone health and strength. Dual-energy X-ray absorptiometry (DEXA) remains the gold standard for measuring bone mineral density (BMD), although it is influenced by patient positioning, soft tissue composition, and prior fractures. Quantitative computed tomography (QCT), including peripheral and high-resolution variants (pQCT, HR-pQCT), provides three-dimensional assessment and detailed evaluation of trabecular microarchitecture, improving fracture risk prediction. Magnetic resonance imaging (MRI) and spectroscopy offer radiation-free assessment of bone quality, while quantitative ultrasound provides a low-cost, portable screening tool. Emerging modalities such as finite element analysis, electromechanical impedance, microwave frequency methods, and machine learning algorithms show promise for individualized risk assessment and real-time monitoring. Despite these advances, limitations in accessibility, cost, and standardization remain. Integrating these technologies into clinical practice may enhance early diagnosis, optimize treatment strategies, and improve outcomes in patients at risk for osteoporosis and fractures.