Bone fracture risk: Density and microarchitecture qualification

Abstract Osteoporosis is a systemic skeletal disease where an increase in bone fragility is due to low bone mass and micro-architectural deterioration of bone tissue, which occur over a long period of time without clinical significance. Currently, Double Energy X-ray Absorption (DEXA) is the gold standard for bone mineral density assessment and the diagnosis of osteoporosis, but the majority of fractures occur in patients who would not be considered at fracture risk based on their Bone Mineral Density (BMD) values. It has long been known that fracture risk depends not only on mass loss, but also on bone architecture, whose alterations are an independent factor of increased fragility. The Bone Elastic Structure Test, BES TEST®, is a recently introduced analysis that assesses bone quality as expressed by the elastic properties of the trabecular micro-architecture from a virtual biopsy of the patient and could be a helpful add-on to densitometry for predicting fragility fractures and patient monitoring. The aim of this study is the comparison of DEXA and BES TEST® ability as 3-year risk estimators in a clinical application. In the CONTROL group, the BSI T-score is significantly different from the femoral DEXA T-score (p = 0.0005). In the FRACTURED group, the BSI T-score is significantly different from both the femoral DEXA T-score (p = 0.0266) and the lumbar DEXA T-score (p = 0.0051). Inter-group t-test statistical analysis (95% significance) shows that the femoral DEXA T-score (neck) of the CONTROL and the FRACTURED groups are not significantly different (p = 0.1478), while the BSI T-score of the CONTROL and the FRACTURED groups highlights a significant difference (p = 0.0001). Despite the small number of subjects, our data seem to confirm that the BSI could be a helpful add-on to densitometry for predicting fragility fractures and patient monitoring.