Why is knowing the microarchitecture of your bones so important?
The microarchitecture of bones is more critical than density alone for several reasons:
Structural Architecture
Bone microarchitecture refers to the structural organisation of bone tissue, including the arrangement and connectivity of trabeculae (the small, rod-like structures in spongy bone) and the porosity of cortical bone. Good microarchitecture ensures that bones can withstand stress and strain more effectively, reducing the risk of fractures.
Even if bone density is high, poor microarchitecture can make bones more susceptible to breaks.
Bone Quality
Bone density measures the mineral content in bones but does not account for other crucial aspects such as the quality of the bone matrix, turnover rates, or the health of bone cells. Bone quality, which includes microarchitecture, contributes significantly to bone strength.
Research shows that bones with better microarchitecture can be stronger and more resilient, even if they have similar or slightly lower bone mineral density (BMD).
Fracture Risk Prediction
Studies have indicated that microarchitectural parameters can be better predictors of fracture risk compared to BMD alone.
For instance, older adults with similar BMD levels may have different risks of fractures depending on their bone microarchitecture. This is particularly important for conditions like osteoporosis, where the goal is to prevent fractures rather than just improve density
Bone Remodelling
Microarchitecture provides insights into the bone remodeling process, including the balance between bone resorption and formation. Healthy bone remodeling is essential for maintaining bone strength and repairing microdamage.
Disruptions in microarchitecture can indicate abnormal remodeling, leading to weaker bones despite normal or high density.
In Summary
While bone density is an important factor in assessing bone health, microarchitecture provides a more comprehensive understanding of bone strength and fracture risk.
Advances in imaging techniques, such as REMS and high-resolution peripheral quantitative computed tomography (HR-pQCT), allow for better assessment of bone microarchitecture, enhancing the ability to diagnose and manage bone-related conditions effectively.
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