Revelation of bone loss

What does healthy bone and osteoporotic bone look like?

Normal adult bone has a dense, thick (several millimetres) envelope (cortex). The interior (spongy bone) is evenly distributed, with trabeculae oriented in the form of an arch. The cellular aspect is homogeneous. The envelope is very strong. It can withstand a force of one tonne per cm². This is the force borne by the femur when a footballer shoots a goal. The content is responsible for most of the bone's elasticity. A goalkeeper can dive and fall on his hip several times during a football match without fracturing the bone. A skier can travel at more than 100 kph – both femurs bend and straighten, because of their elasticity, without breaking – up to a certain point.

An osteoporotic bone has a thinner envelope. The more serious the osteoporosis, the more fragile the cortex. The content loses its trabeculae and those remaining fracture easily. They may consolidate and form micro-calluses. "Holes" of different sizes form in different areas. The more serious the osteoporosis the more fragile the walls and inside of the bones. It is easy to understand how even a minimal trauma – such as a fall from your own height – can break a bone.

Can bone loss be detected on standard X-rays?

When there is major bone loss, this can be seen in the form of a "bony void". It can be located via the missing trabeculae which form an arch-shape in healthy bone.

Void detected in a non-fractured bone	Void detected in a fractured bone
The "hole" in the bone is shown by the white arrows in both cases

Is it possible to "materialise", to "see" directly inside a bone?

When it is a healthy adult bone, it is impossible to see inside it because of its compactness. A hole can be drilled and a camera inserted to record "something", but this "something" would not give a picture of what really goes on inside the bone because the manipulation itself creates iatrogenic lesions – which means lesions created by external intervention – in this case the drilling process and camera insertion. This examination would lose all its scientific value.
On the other hand, if there are already holes, notably due to osteoporotic disease, a camera can be inserted to examine the walls and explore the various cavities, their site and size, and describe what can be seen.

This is a bone endoscopy. This examination is equivalent to an arthroscopy in which the camera penetrates a joint cavity, or a coelioscopy in which the camera penetrates the abdominal cavity.

One question: Isn't it possible for the camera to create lesions?

The camera only records what it is in front of it, during its progress into deeper regions. The neck of a femur is four or five centimetres long. When a solid obstacle is present, the operator does not go past it. If he can get round it he does so.
Otherwise he points the lens in another direction and continues recording what can be seen in front of it.

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