Despite a plethora of diagnostic tests, not a single one leaps to the fore as a likely replacement for bone densitometry.
When the best test that we have for a disease misses a third of cases, there is clearly room for improvement.
This is the situation we are in with regards to bone densitometry and osteoporosis.
Clearly there is a market gap. However, bone densitometry has set a high bar by meeting all ten of the WHO criteria for a screening test, and as no other modality can yet make the same claim to fame, they are all playing second fiddle.
It’s understandable, then, that as Dr S Bobo Tanner meanders through an extensive list of complementary diagnostic tests in the Gluck Memorial Lecture at ACR2023, not a single one leaps to the fore as a likely replacement.
Dr Tanner, who is the director of the osteoporosis clinic at Vanderbilt University Medical Centre, clearly has an extensive knowledge and thorough understanding of the challenges.
He covers the differences between measuring tensile strength, compressive endurance and resistance to forceful impact. The concepts of measuring macro vs nano structure of the bone are touched on. There is mention of the biochemistry of collagen health and type, and ways that may be assessed in the future.
It’s hard to pick one overall take away point from this presentation to discuss: the investigations range from trabecular assessments tacked on to routine densitometry, to tetracycline-labelled bone biopsy and everything in between.
There is a somewhat frustrating lack of detail – no indication is given to the sensitivity and specificity of any of these studies. Newer technologies are mentioned, but again, no data presented. I suspect that this is not due to any lack of diligence on Dr Tanner’s part, but rather reflects a lack of available and reliable material.
What we are left with is an orchestral cacophony of instruments warming up – full of potential but lacking the precision required to make a symphony.
13M103 Gluck Memorial Lecture: The Quest for Fracture Risk Prediction & Bone Strength Measurement
