Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography



The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems.


A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document.


An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems.


This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.

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Correspondence to M.L. Bouxsein.

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Dr. Boyd is a co-founder and co-owner of Numerics88 Solutions Inc., creator of finite element package FAIM. Dr. Ghasem-Zadeh is one of the inventors of the StrAx algorithm and consults for Strax Corp. Dr. Burghardt is a consultant and served on an Advisory Board to Mereo BioPharma.

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Whittier, D., Boyd, S., Burghardt, A. et al. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 31, 1607–1627 (2020).

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  • Bone microarchitecture
  • Guidelines
  • High-resolution peripheral quantitative computed tomography
  • Imaging protocol