The challenges of diagnosing osteoporosis and the limitations of currently available tools

Table 1 Summary of treatment-related changes in human skeletal architecture. Only published studies that reported defined skeletal architectural indices were included in the Table

	Areal BMD		HR-pQCT, QCT				QCT			Bone biopsy/QCT
Location	Spine	Hip	Radius/Tibia				Spine			Hip
Measure	BMD (Approx. % increase)		Per.Diam	CoPo	CtTh	Tb	CoPo	CtTh	BV/TV	CoPo	CtTh	BV/TV
Bisphosphonates	4^(a)	2-2.5^(a)		↓,NS^(g)	↑ ^(g)	↑,NS^(g)				↓ ^(m)		NS^(m)
Denosumab	5.5^(b)	3^(b)		↓,NS^(h)	↑ ^(h)	↑ ^(h)				↓ ⁽ⁿ⁾
Teriparatide	9^(c)	3^(c)	↑ ^(f)	↑,NS⁽ⁱ⁾	↑,NS ⁽ⁱ⁾	↑,↓⁽ⁱ⁾		NS^(j)	↑ ^(k)	↑ ⁽⁰⁾	↑ ^(p)	↑ ^(p)
Abaloparatide	11^(d)	4^(d)
Romosozumab	13.5^(e)	6.5^(e)						↑ ^(l)	↑ ^(l)			↑ ^(l)

BMD bone mineral density, Per.Diam periosteal diameter, CoPo cortical porosity, CtTh cortical thickness; Tb trabecular indices; BV/TV bone volume/tissue volume, NS not significant, HR-pQCT high-resolution peripheral quantitative computed tomography, QCT quantitative computed tomography
Notes:
a. 12 months of treatment [53, 54, 56, 81, 82]
b. 12 months of treatment [65]
c. 18 months of treatment [66]
d. 18 months of treatment [67]
e. 12 months of treatment [68, 69]
f. [71]
g. Cortical volumetric BMD (Ct vBMD) as a surrogate for CtPo, Tb = Tb vBMD [83]; CtTh significant only for tibia, Tb vBMD increased at tibia [84]; Ct vBMD as a surrogate for CtPo with difference only in tibia [85, 86]
h. CoPo as a surrogate for Ct vBMD, Tb as a marker of trabecular volumetric BMD (Tb vBMD) [83]; [70, 87]
i. 24 months of treatment [70]; 18 months of treatment, increase in plate Tb number and thickness [88]; 18 months of treatment, increase in trabecular number [89]; 18 months of treatment, increase in CtTh in tibia only, reduction in trabecular thickness [90]
j. [91]
k. [92]
l. [91, 93]
m. [94]
n. [95]
o. [96]
p. [97]

ISSN: 2055-8260