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Semin Musculoskelet Radiol 2024; 28(05): 560-575
DOI: 10.1055/s-0044-1788623
Review Article

Two Decades of High-Resolution Peripheral Quantitative Computed Tomography: Present and Future Clinical Perspectives

Steven K. Boyd 
1   McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
2   Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
3   Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
› Author Affiliations Source of Funding Funding for this research has been through support from the Canadian Foundation for Innovation, the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, and the Arthritis Society.
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Abstract

Twenty years have passed since the introduction of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess human bone microarchitecture. During that time, the technique has emerged as an important research tool used by clinicians and scientists to learn about the pathophysiology of bone adaptation in the context of osteoporosis and many other bone-affected conditions. Its rich three-dimensional data is well suited for precise longitudinal monitoring of bone microarchitecture and associated patient-specific estimated bone strength.

However, uptake of HR-pQCT as a clinical diagnostic tool has been limited, in part due to challenges such as availability, regulatory approvals, and demonstrated cost effectiveness. New research suggests fracture risk assessment using HR-pQCT is comparable with current standards based on traditional bone densitometry, but its contribution to clinical care is best suited to two areas: (1) leveraging microarchitectural information to assist in treatment decisions for the large subset of patients who lie in the so-called gray zone by current fracture risk assessment, and (2) longitudinal monitoring that establishes highly refined trajectories of bone adaptation and can inform decisions to initiate treatment, monitor treatment effects, and inform cessation.

Keywords

bone microarchitecture - fracture risk assessment - osteoporosis - osteoarthritis - high-resolution peripheral quantitative computed tomography


Publication History

Article published online:
15 October 2024

© 2024. Thieme. All rights reserved.

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