Dual-energy X-ray absorptiometry (DXA) remains the cornerstone of clinical bone health assessment, providing an accessible and well-validated measure of areal bone mineral density (aBMD). However, bone strength is determined by more than density alone. Advances in imaging are providing new opportunities to examine the three-dimensional structure, microarchitecture and mechanical competence of bone, offering insights into skeletal health that cannot be captured by DXA alone.
This presentation will explore emerging bone imaging technologies and their applications across discovery research and clinical practice. High-resolution peripheral quantitative computed tomography (HR-pQCT) will be used to illustrate how three-dimensional imaging can separately quantify cortical and trabecular bone compartments, including volumetric bone mineral density, cortical thickness and porosity, and trabecular microarchitecture. The integration of HR-pQCT with finite element analysis further enables estimation of bone strength, effectively providing a virtual mechanical assessment of the skeleton in vivo.
The expanding application of high-resolution imaging beyond traditional peripheral skeletal sites will also be discussed. Emerging approaches to imaging the knee and ankle provide opportunities to investigate subchondral bone, joint morphology and early structural changes associated with musculoskeletal injury and osteoarthritis, supporting a broader view of the interconnected bone–joint–muscle unit.
Finally, the presentation will consider how advances in computed tomography, opportunistic imaging, automated image analysis and artificial intelligence may help bridge the gap between sophisticated research imaging and clinical practice. Emerging technologies, including photon-counting CT and image-derived digital skeletal biomarkers, have the potential to further transform how skeletal health is characterised.
Together, these developments are shifting bone imaging beyond a single measure of density towards a multidimensional assessment of bone quality, strength and musculoskeletal health, with the ultimate challenge being to determine how this additional information can meaningfully improve clinical decision-making and patient outcomes.