Biomechanical computed tomography—noninvasive bone strength analysis using clinical computed tomography scans

The combination of finite element modeling, biomechanics, and clinical computed tomography (CT) scanning—biomechanical CT (BCT)—is a powerful research technique for noninvasive assessment of whole‐bone strength and is now being used in clinical research studies. Well supported by cadaver studies, the technique is providing substantial new insight into drug treatment effects, can show treatment effects earlier than dual‐energy X‐ray absorptiometry (DXA), and has shown greater sensitivity than DXA in fracture risk assessment. Because the technique can be used as an ancillary “add‐on” analysis to previously acquired CT scans containing either the hip or spine, it should be possible to implement this technology clinically in a highly cost‐effective manner. This strategy, if applied to those not previously tested by DXA, has the potential to greatly increase the number of individuals identified as being at high risk for osteoporotic fracture.