A Clinical Application of the Bone Structure Index

It has been recently estimated that about 30% of women and 20% of men over 50 will develop osteoporosis, a disease characterized by decreasing bone strength. Although low bone mineral density is generally associated with higher fracture risk, the spatial arrangement of the trabecular structure is a second key factor of bone resistance [1] and about 40-60% of the fractures affect people that can be considered at moderate risk on the basis of densitometry (DXA) assessment alone [2, 3]. Hence the need to develop innovative and low-cost diagnostic methods that can be used together with the consolidated systems. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on a virtual biopsy of the patient. The bone structure images are acquired by planar radiograms in the proximal epiphysis of the three central proximal phalanges of the non-dominant hand, a peripheral site of the human body [4-7]. In this work, we describe a recent application of the BSI in a clinical setting.