Hip Structural Analysis and Bone Strain Index in Clinical Practice: Their Utility Beyond BMD.

Previous studies have demonstrated that in certain medical conditions, fragility fractures tend to occur even at bone mineral density (BMD) levels that are in the nonosteoporotic range. This warrants the assessment of other factors beyond BMD that might confer an increased propensity to fracture. Hip structural analysis (HSA) is also performed by the DXA scanner and evaluates different variables pertaining to proximal hip geometry. Bone Strain Index (BSI) is another novel DXA-based tool that was recently developed to further assess bone health. This has been based on a finite element analysis of grey scale images of density distribution of the femoral and lumbar spine scans obtained from a DXA scanner. Preliminary studies assessing the utility of BSI in predicting fragility fractures have been promising. This review will focus on the technical details and utility of the HSA and BSI beyond conventional BMD assessment.