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19), one-third radius (p?=?0.47), and ultradistal radius (p?=?0.90). Postmenopausal women with normal or osteopenic BMD who had a history of low-energy fracture had significantly different (p? http://www.selleckchem.com/products/Adriamycin.html than an age, race, and ultradistal radius BMD-matched control group of postmenopausal women with no history of fracture. Our study suggests that ?MRI can be used to identify individuals without a DXA-based diagnosis of osteoporosis who have impaired trabecular microarchitecture and thus a heretofore-unappreciated elevated fracture risk. ? 2012 American Society for Bone and Mineral Research. Osteoporosis is a multifactorial disease of low bone mass and impaired bone microarchitecture that results in decreased bone strength and increased fracture risk.1 The disease becomes extremely common with advancing age with 40% to 50% of women and 25% of men sustaining an osteoporosis-related fracture during their lifetime.2, 3 Currently an estimated 1.5 million fractures occur annually in the United States,4 which produce high morbidity and mortality and cause substantial health-care expenditures.5�C9 Whereas the current disability and economic burden associated with osteoporosis is enormous, the future burden will be considerably higher with the increasing age of the population worldwide.10 As such, http://www.selleckchem.com/PD-1-PD-L1.html a pressing need exists to optimally identify those individuals at elevated fracture risk. The clinical standard for osteoporosis diagnosis is bone mineral density (BMD) measurements obtained using dual-energy X-ray absorptiometry (DXA).11 In fact, the World Health Organization (WHO) T-score-based system classifying individuals as normal, osteopenic, or osteoporotic12 directly applies only to BMD as measured by DXA.11 DXA has proven to be a valuable clinical tool, because it identifies individuals at elevated fracture risk, and subsequent treatment of men and women with low BMD reduces http://www.selleck.cn/products/MK-1775.html fracture risk.13�C17 However, BMD accounts for only 50% to 65% of variations in the mechanical strength of bone.18, 19 Furthermore, large prospective studies have found that fewer than 50% of individuals who sustain low-energy fractures have a diagnosis of osteoporosis based on BMD measurements.20�C22 Thus, clinical need exists to identify factors other than BMD that influence bone strength and fracture risk. Bone strength is the result of bone density and ��bone quality,�� a complex amalgamation including macroarchitecture and microarchitecture, mineralization, turnover, and damage accumulation. Bone remodeling is a component of normal human physiology that prevents fatigue damage accumulation and contributes to mineral homeostasis.23, 24 Remodeling is carried out by a coupled team of cells, osteoclasts that excavate remodeling lacunae and osteoblasts that produce and mineralize osteoid.25, 26 Ideally, osteoblasts precisely replace the amount of bone resorbed by osteoclasts via a complex coupling process.