Bone is a composite material consisting of mineral, organic matrix, and water. Its resistance to fracture is determined by its amount and its quality, the latter an umbrella term encompassing its structural and material properties.
Metabolic bone diseases manifesting fragility fractures (such as osteoporosis) are routinely diagnosed based on bone mineral density (BMD) and biochemical markers measurements. Although clinically useful, it is nowadays well accepted that these measures do not fully account for fracture incidence.
The emergence of bone quality led to the development of a plethora of analytical techniques (analysing bone tissue at both the macro and the micro scale) that provide information on all three components of bone (mineral, organic matrix, and water). Nevertheless, it is unlikely that a single outcome is responsible for fracture occurrence, as fracture is believed to be the culmination of a series of events. As a result, a combinatorial approach is preferred when possible.
In this presentation, the most widely used techniques for preclinical determination of bone quality will be presented. For each, what is actually measured and what is inferred will be discussed, and emphasis will be placed on potential pitfalls.
Finally, the example of idiopathic osteoporosis will be presented so as to highlight the importance of bone quality determination in the understanding of the pathophysiology of fragility fractures.