Osteoporosis remains underdiagnosed and undertreated. Current clinical standards have low sensitivity because half of all fracturesoccur in individuals without osteoporosis based on bone density testing and/or with few clinical risk factors. Photon-counting computed tomography (PCCT) is an emerging advanced imaging technique that shows promise in improving this by offering resolutions similar to high resolution peripheral quantitative computed tomography (HR-pQCT). HR-pQCT studies indicate that bone microarchitecture measurements improve fracture risk prediction beyond the clinical standard. HR-pQCT, however, is limited by accessibility and field of view, restricting measurements to peripheral sites. Our studies involve optimizing scanning and segmentation protocols to evaluate bone density and microarchitecture of the axial skeleton.
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