Longevity, in the context of healthy aging, is the ultimate goal of health care. It also represents the rationale for some of the most significant endpoints in research. Aging is commonly associated with frailty. However, it is questionable whether the concept of so-called normal regarding frailty exists, which is the threshold for pathology. A strategy is needed to integrate assessment and management of frailty, with the dual aim of both increasing life expectancy and quality of life.

A good insight into metabolism is fundamental to the understanding of pathophysiologic processes. Imaging of metabolism runs the gamut from advanced nuclear medicine and magnetic resonance imaging (MRI) techniques targeted to assess specific metabolic imaging biomarkers to the clinical diagnosis of a wide spectrum of metabolic bone diseases (MBDs). Theoretically, all diseases have a metabolic anima to understand, defined not only by physiology but also the need to be considered in the context of biomechanics and genetics. This is very apparent for metabolic diseases with effects on the musculoskeletal (MSK) system. Muscles, bones, and fat deposits are the components that make up most of our body weight.

The MSK system is central to understand, prevent, and manage metabolic conditions and frailty. The role of clinical radiologists is crucial for the benefit of the community, from screening to monitoring the effects of treatments. The ultimate problem of MBDs is represented by fractures and the consequences of frailty. For instance, the effects of osteoporosis and sarcopenia have an unparalleled impact on health care systems, in addition to severely impacting a patient's quality of life. Despite metabolic changes that occur at a molecular level, understanding MBDs relies increasingly on imaging. This is true in both research and clinical practice. Imaging is capable of assessing (and sometimes discovering) different in vivo biomarkers of metabolism and frailty, aside from detecting fractures (that also sometimes poses a challenge). Imaging is now making visible what was invisible or impossible to assess only a few years ago, with new techniques and tools in clinical practice.

This issue of Seminars explores the added value of imaging in the diagnosis and management of MBDs, with the invaluable contributions of several internationally acclaimed and credited authors. Twelve articles describe updates on both older and newer techniques in the radiologic management of MBDs, such as dual-energy X-ray absorptiometry (DXA), Trabecular Bone Score (TBS), radiofrequency echographic multi spectrometry (REMS), quantitative computed tomography (QCT), high-resolution peripheral quantitative computed tomography (HRpQCT), and MR imaging, after introducing insights into the latest research on bone marrow. Specific focused articles address hot topics such as body composition, artificial intelligence, opportunistic screening, vertebral fractures, and interventional radiology. As per tradition, the History Page reminds us of the beauty of our discipline.

We hope you will enjoy this issue and that it helps you translate science into practice in the field of MBD diagnosis and management, in the light of the research on the most recent imaging.

Article published online:
15 October 2024

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