Microarchitecture and bone strength are two aspects that must be taken always into account when considering
osteoporosis. In this sense high-resolution quantitative CT can allow to get a more detailed analysis of bone microarchitecture,
providing several quantitative information such as: bone volume fraction (bone volume/total
volume; BV/TV), trabecular spacing (200–2000 μm), trabecular thickness (50–150 μm), trabecular number, and
cortical thickness. Since radiation dose represents an important question, HR-QCT is applied to peripheral sites,
such as the proximal tibia and distal radius referred to as HR-pQCT, providing a more detailed trabecular
and cortical bone input. In deed several clinical studies have suggested that bone strength as assessed by QCTbased
techniques may be better than aBMD by DXA at discriminating postmenopausal women with vertebral
fractures and in predicting vertebral fracture risk in elderly men.
Another imaging technique has been recently developed; in deed several studies have verified correlations between
cortical and trabecular mandibular changes on two-dimensional imaging modalities and DXA measurements
at the lumbar spine and proximal femur. However, only few studies have proposed the use of different
Cone Beam Computed Tomography (CBCT) measurements to discriminate individuals with normal skeletal
BMD from individuals with osteoporosis, analyzing some bone characteristics, such as mandibular cortical
width measurements, mandibular cortical integrity, CBCT-derived radiographic density, histogram analysis and
trabecular bone structure analysis. Furthermore, the exam has a relatively low cost and low dose compared to
other computed tomographic techniques. Although the scarcity of studies regarding the accuracy of CBCT as a
screening tool for low BMD, it suggests the potential of this imaging modality for this purpose. Linear measurements
of the inferior mandibular cortex were lower in osteoporotic individuals, indicating that morphometric
indices on CBCT should be a promising tool for identifying individuals with low BMD.


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