Semin Musculoskelet Radiol 2022; 26(04): 478-490
DOI: 10.1055/s-0042-1754340
Review Article

Imaging of Metabolic Bone Diseases: The Spine View, Part I

Alberto Bazzocchi
1   Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Amanda Isaac
2   School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
Danoob Dalili
3   Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Epsom, London, United Kingdom
4   Department of Diagnostic and Interventional Radiology, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
Anastasia Fotiadou
5   Royal National Orthopaedic Hospital, Stanmore, United Kingdom
Eleni P. Kariki
6   Manchester University NHS Foundation Trust, Manchester, United Kingdom
7   Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
Jan S. Kirschke
8   Interventional und Diagnostic Neuroradiology, School of Medicine, Technical University Munich, Munich, Germany
Christian R. Krestan
9   Department of Radiology, Favoriten Hospital, Vienna, Austria
Carmelo Messina
10   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Edwin H.G. Oei
11   Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Catherine M. Phan
12   Service de Radiologie Ostéo-Articulaire, APHP, Nord-Université de Paris, Hôpital Lariboisière, Paris, France
Mahesh Prakash
13   Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India
Nuran Sabir
14   Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
Alberto Tagliafico
15   DISSAL, University of Genova, Genoa, Italy
16   Ospedale Policlinico San Martino, Genova, Italy
Francisco Aparisi
17   Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
Thomas Baum
18   Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
Thomas M. Link
19   Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California
Giuseppe Guglielmi
20   Department of Radiology, University of Foggia, Foggia, Italy
Maria Pilar Aparisi Gómez
21   Department of Radiology, Auckland City Hospital, Auckland, New Zealand
22   Department of Radiology, IMSKE, Valencia, Spain
› Author Affiliations


Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).

This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.

We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.

Publication History

Article published online:
14 September 2022

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