title: Clinical Evaluation of Bone Strength and Fracture Risk.
abstract: This paper seeks to evaluate and compare recent advances in the clinical assessment of the changes in bone mechanical properties that take place as a result of osteoporosis and other metabolic bone diseases and their treatments.
  
  
  
  In addition to the standard of DXA-based areal bone mineral density (aBMD), a variety of methods, including imaging-based structural measurements, finite element analysis (FEA)-based techniques, and alternate methods including ultrasound, bone biopsy, reference point indentation, and statistical shape and density modeling, have been developed which allow for reliable prediction of bone strength and fracture risk. These methods have also shown promise in the evaluation of treatment-induced changes in bone mechanical properties. Continued technological advances allowing for increasingly high-resolution imaging with low radiation dose, together with the expanding adoption of DXA-based predictions of bone structure and mechanics, as well as the increasing awareness of the importance of bone material properties in determining whole-bone mechanics, lead us to anticipate substantial future advances in this field.
authors.affiliation: McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA.
authors.forename: Chantal M J
authors.initials: CMJ
authors.lastname: de Bakker
authors.affiliation: McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Tseng
authors.affiliation: McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA.
authors.forename: Yihan
authors.initials: Y
authors.lastname: Li
authors.affiliation: McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Zhao
authors.affiliation: McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA. xiaoweil@mail.med.upenn.edu.
authors.forename: X Sherry
authors.initials: XS
authors.lastname: Liu
mesh_terms: D015502:Absorptiometry, Photon; D001706:Biopsy; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020342:Finite Element Analysis; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography
keywords: Bone material properties; Bone microstructure; Bone strength; Clinical imaging; Finite element analysis; Fracture; Osteoporosis