Nuevos métodos de evaluación de la densidad y contenido mineral óseo

New techniques are discussed to complement the conventional assessment of bone mineral density (BMD) performed using radiological bone densitometry (DXA), with the aim of evaluating bone quality and estimating the risk of osteoporotic fracture. These approaches allow for a more accurate clinical assessment of bone health, early and selective initiation of targeted therapy, and monitorization of its progression.

Complementary to standard DXA studies and fully validated, the 10-year fracture risk estimation tool (FRAX), which incorporates well-established clinical risk factors, and the trabecular bone score (TBS), derived from texture analysis, are available. Hip structural analysis (HSA), although available, has not yet been clinically validated.

Beyond DXA, which has limitations such as exposure to ionizing radiation (albeit very low), the analysis of bone area rather than volume, and the inability to differentiate cortical from trabecular bone, other imaging modalities include quantitative radiological techniques such as quantitative computed tomography (QCT) and high-resolution peripheral quantitative computed tomography (HR-pQCT), which also involve radiation exposure (with higher doses). Radiaton-free techniques like quantitative ultrasound (QUS), radiofrequency echographic multi-spectrometry (REMS), and quantitative magnetic resonance imaging (QMRI) are also available. These latter methods, to varying extents, provide three-dimensional or volumetric assessments, high-resolution imaging, and the ability to distinguish between cortical and trabecular bone, thereby increasing diagnostic specificity.

The main limitations of these newer technologies include their high cost, limited availability, and, in some cases, a lack of clinical validation in large population studies. The integration of artificial intelligence into these techniques is expected to revolutionize image analysis and interpretation, as well as the automation of diagnostic processes.