The development of new diagnostic techniques for detection and monitoring of osteoporosis is of paramount importance. The clinical trials referred to above require accurate, safe, non-invasive methods to assess the efficacy of treatment. The major techniques utilized today can be separated into two categories, one class based on ionizing radiation (radiological), and the other on nonionizing radiation. Radiation-based techniques are the primary tools today for assessment of bone mass. These techniques include dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). DXA is the most widely used clinical technique for determination of bone density. The usefulness of DXA is based on its ability to accurately measure bone density without artifacts arising due to fluid or soft tissue thickness. The one weakness of DXA arises from the fact that bone density assessment is based on a projectional technique, and in reality provides only an areal density. QCT is applied often for assessment of vertebral trabecular bone density as this technique is able to discriminate between the cortical and trabecular envelopes. The third technique which deserves mention is the digital imaging assessment of bone radiographs and subsequent implementation of fractal, textural, and other analysis techniques. The most exciting new developments in physical bone diagnostics is the non-ionizing radiation based techniques of ultrasound and magnetic resonance imaging.
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