Evaluation of the structural quality of bone in a case of progressive osteoporosis complicating a Complex Regional Pain Syndrome (CRPS) of the upper limb

Densitometry is considered to be the gold standard in bone quality assessment. However, since its introduction, the medical community has been aware that mineral density is only one of the factors that influence the bone risk of fracture, which also depends on the bone's trabecular arrangement and, in particular, on the trabecular architecture's load bearing capabilities. At the University of Trieste, in recent years, a test has been developed that simulates the application of compressive loads on trabecular architecture's reconstructions extracted from digital radiographs. In this work, the test is described, and the results obtained by applying the appraisal in a particular case of severe osteoporosis of the hand, complicating a Complex Regional Pain Syndrome (CRPS) type II, are presented. The test was able to quantify the pathological alterations of bone micro-architecture by means of a Structural Index (SI), which was absolutely significant and relevant to the clinical situation. Important research and clinical opportunities of application of the test include accurate evaluation of osteoporotic bone diseases, careful clinical follow-up and monitoring of responses to therapeutic approaches, and, prospectively, reliable quantification of biological damage (forensic field).