Osteoporosis is a chronic pathologic condition, particularly of the elderly, in which a reduction
of bone mineral density (BMD) weakens bone, leading to the so-called fragility fractures,
most often of spine and femur. The gold standard exam for the quantitative measurement of BMD is
the dual X-ray photon absorptiometry (DXA), a radiological method. However, a relevant number of
fragility fractures occurs in the range of normal BMD values, meaning that also qualitative aspects of
bone play a role, namely bone architecture and bone geometry. Bone structure is investigated by microCT
and histomorphometry, which necessitate an invasive approach with a biopsy, usually taken at
the iliac crest, not the typical site of fragility fractures. New tools, trabecular bone score (TBS) and
hip structural analysis (HSA), obtained during DXA, can supply informations about bone structure of
spine and femur, respectively, in a not invasive way.
Therapy of osteoporosis is based on two types of drugs leading to an increase of BMD: antiresorptive
and anabolic treatments. The antiresorptive drugs inhibit the osteoclasts, whereas teriparatide and, in
part, strontium ranelate ameliorate bone structure. The present review deals with the relation between
the anabolic drugs for osteoporosis and the cited new tools which investigate bone architecture and
geometry, in order to clarify if they represent a real advantage in monitoring efficacy of osteoporosis'
Data from the studies show that increases of TBS and HSA values after anabolic therapy are small
and very close to their least significant change at the end of the usual period of treatment. Therefore,
it is questionable if TBS and HSA are really helpful in monitoring bone quality and in defining reduction
of individual fragility fracture risk during osteoporosis treatment with bone anabolic agents.