Cheung WH, Hung VWY, Cheuk KY, et al. - Osteoporosis is characterized by low bone mass and bone structural deterioration which may result in fragility fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT), a 3D imaging device to measure volumetric bone density and bone microarchitecture, is expected to have capability to yield adequate information for the diagnosis of osteoporosis and prediction of future fragility fractures.

• A systematic review and meta-analysis was conducted to determine the HR-pQCT parameters at the distal radius and/or distal tibia that could aid in making best prediction of fragility fractures.

• Embase, PubMed and Web of Science yielded 25 articles for inclusion in the systematic review, and 16 articles for meta-analysis.

• Cortical volumetric bone mineral density (Ct.vBMD), trabecular thickness (Tb.Th) and stiffness were identified as better predictors.

• Meanwhile, major osteoporotic fractures were better predicted than incident fractures using HR-pQCT parameters.

• Among the two standard measurement sites of HR-pQCT, the more preferable site was the non-weight bearing distal radius than distal tibia for fracture prediction.