Effects of osteoporosis drug treatments on cortical and trabecular bone in the femur using DXA-based 3D modeling

Osteoporos Int. 2018 Oct;29(10):2323-2333. doi: 10.1007/s00198-018-4624-4. Epub 2018 Jul 4.


Effects of osteoporosis drugs on proximal femur cortical and trabecular bone were studied using dual-energy x-ray absorptiometry (DXA)-based 3D modeling method. Changes observed in this head-to-head study were consistent with those obtained using computed tomography in the literature.

Introduction: The aim of the present study was to assess the effects of osteoporosis drugs on cortical and trabecular bone at the proximal femur using DXA-based 3D modeling.

Methods: We retrospectively analyzed 155 patients stratified by treatments: naive of treatment (NAIVE), alendronate (AL), denosumab (DMAB), and teriparatide (TPTD). DXA scans were performed at baseline and after treatment, and areal bone mineral density at spine and femur were measured. A software algorithm (3D-SHAPER) was used to derive 3D models from hip DXA scans and compute: trabecular and cortical volumetric BMD (vBMD), cortical thickness (Cth), and cortical surface BMD (cortical sBMD). Changes from baseline were normalized at 24 months and evaluated in terms or percentage.

Results: After 24 months, a non-significant decrease was observed for trabecular vBMD, Cortical sBMD, Cth, and cortical vBMD (- 2.3, - 0.8, - 0.3, and - 0.5%) in the NAIVE group. Under AL and DMAB, significant increases were observed in trabecular vBMD (3.8 and 7.3%), cortical vBMD (1.4 and 2.0%), and cortical sBMD (1.5 and 3.6%). An increase in Cth was observed in patients under DMAB (1.8%). Under TPTD, a significant increase in Trabecular vBMD was observed (5.9%) associated with a non-significant increase of Cth (+ 1%) concomitant with a decrease in cortical vBMD (- 1.1%).

Conclusion: Results obtained in this head-to-head study are consistent with those obtained using computed tomography in the literature. DXA-based modeling techniques could complement standard DXA examination to monitor treatment effects on trabecular and cortical compartments.

Keywords: 3D modeling; Cortical and trabecular bones; DXA; Femur; Osteoporosis treatments.

MeSH terms

  • Absorptiometry, Photon / methods
  • Adult
  • Aged
  • Alendronate / pharmacology
  • Alendronate / therapeutic use
  • Bone Density / drug effects
  • Bone Density Conservation Agents / pharmacology*
  • Bone Density Conservation Agents / therapeutic use
  • Cancellous Bone / drug effects
  • Denosumab / pharmacology
  • Denosumab / therapeutic use
  • Female
  • Femur / drug effects*
  • Femur / physiopathology
  • Humans
  • Imaging, Three-Dimensional / methods
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Osteoporosis / drug therapy*
  • Osteoporosis / physiopathology
  • Retrospective Studies
  • Teriparatide / pharmacology
  • Teriparatide / therapeutic use


  • Bone Density Conservation Agents
  • Teriparatide
  • Denosumab
  • Alendronate