Structural and Metabolic Assessment of Bone
The assessment of bone structure and metabolism should focus on the bone strength. Many factors are involved, and although bone density is an important component, it is not the same as bone strength. Other aspects of bone quality include bone volume, micr
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Contents 1 Introduction 2 Noninvasive Measurement of Bone Mineral Density 2.1 Radiographs 2.2 Absorptiometry 2.3 Fracture Risk Assessment Tool (FRAX) 2.4 Trabecular Bone Score (TBS) 2.5 Quantitative Ultrasound 2.6 Quantitative Computed Tomography (QCT) and Peripheral QCT (pQCT) 2.7 High-Resolution Peripheral QCT (HRpQCT) 2.8 Magnetic Resonance Imaging (MRI) 3 Invasive Techniques to Measure Structure: Bone Biopsy 3.1 Impact Microindentation 4 Metabolic Assessment of Bone 4.1 Metabolic Assessment: Laboratory Assessment of Systemic Factors Causing Bone Loss 4.2 Metabolic Assessment of Bone: Invasive Techniques 4.3 Noninvasive Assessment of Bone Formation and Resorption 4.4 Bone Formation Markers 4.5 Bone Resorption Markers 4.6 Potential of Serum Sclerostin 5 Conclusions References
Abstract
The assessment of bone structure and metabolism should focus on the bone strength. Many factors are involved, and although bone density is an important component, it is not the same as bone strength. Other aspects of bone quality R. R. Narla · S. M. Ott (*) Department of Medicine, University of Washington, Seattle, WA, USA e-mail: [email protected] # Springer Nature Switzerland AG 2020 Handbook of Experimental Pharmacology, https://doi.org/10.1007/164_2020_376
R. R. Narla and S. M. Ott
include bone volume, micro-architecture, material composition, and ability to repair damage. This chapter briefly reviews some of the methods that can be used to assess both density and quality of bone. Non-invasive measurements of density or structure include dual X-ray absorptiometry (DXA), quantitative computed tomography, ultrasound, and magnetic resonance imaging. DXA is most widely used and has advantages of safety and accessibility, but there are limitations in the interpretation of the results, and in clinical practice positioning errors are frequently seen. Invasive methods are used primarily for research. Samples of bone can be used to measure structure by histology as well as micro-computed tomography and infra-red spectroscopy or backscattered electron microscopy. Force can be directly applied to bone samples to measure the bones strength. Impact microindentation is a new minimally invasive technique that measures bone hardness. Metabolic assessment includes blood and urine tests that reflect diseases that cause bone loss, particularly problems with mineral metabolism. Tetracycline-labelled bone biopsies are the standard for measuring bone formation. Non-invasive biochemical tests of bone formation and resorption can evaluate a patient’s skeletal physiology. Keywords
Biochemical markers · Bone density · Bone strength · Dual photon absorptiometry · Histomorphometry
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Introduction
Increasing bone strength is a major goal for therapies aimed at preventing fractures. Both bone mineral density (BMD) and bone quality contribute to bone strength (Fig. 1) (Ott 2016). We will first review technologies that can be used to quantify and assess BMD and structure and then review methods including laboratory values and markers that can assess bone metab
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