Posts By :

Fabio García-Castro



World Osteoporosis Day (WOD) is here. This October 20th gives us an excellent opportunity to reflect on the millions of people affected by this disease, right? Well, yes and no.

Using WOD as a means of spreading the word and teaching about osteoporosis is a fantastic initiative of the International Osteoporosis Foundation (IOF). It will enlighten people who were previously oblivious to this disease and it will broaden the knowledge of those who knew about it, but thought it was just an unavoidable byproduct of aging. However, aging and osteoporosis are very serious multilayered matters. They should be focal concerns for all of us, not just during WOD, but each and every day.

Why? Well, for starters, let’s see what osteoporosis is and what are the effects of the disease in our bodies. Osteoporosis is a systemic bone disease characterized by the deterioration of the microarchitectural bone structure and by a low bone mass. This, of course, translates into brittle bones, which in turn greatly increase fracture risk. How great of an increase? More than 1.5 million fractures derived from osteoporosis are diagnosed annually. That means that in the minute it took you to read this section of the post, approximately 3 new fractures have been diagnosed. By the end of the day, more than 4,000 new fractures will have to be treated. Those patients with a severe degree of osteoporosis are risking a fracture just by sneezing. And I’m not making this up:

The IOF has launched a great website for World Osteoporosis Day, with this and lots of other resources that you’ll be able to share on social media to increase awareness about the disease and its consequences. Also, the World Health Organization (WHO) is hoping that 2020-2030 will be the decade of healthy aging and has launched the “Aging and Life Course” initiative, where osteoporosis is one of the main concerns.

We, and by we I’m referring to scientists, bioengineers, biotech companies, pharma companies, etc., should be doing our best not just to promote World Osteoporosis Day, but to use it as inspiration to create new technologies and drugs for diagnostic aid and treatment. For QUIBIM, musculoskeletal has been one of our main product lines since our beginnings, especially the trabecular bone characterization through magnetic resonance (MR) and computed tomography (CT). You can find a previous post describing the advantages of QUIBIM tools and how to use them here.

According to the IOF, more than 200 million people worldwide suffer from osteoporosis. That’s 200 million reasons to try to tackle this disease every day.

Image source:


Assessing the bone quality of your patients is just a few clicks away

QUIBIM is proud to introduce its new advanced methodology to assess bone quality and fracture risk: QTS (Quality of Trabecular Structure). The need for a reliable approach for the characterization of trabecular microarchitecture is evident, as conditions and diseases related to trabecular bone quality and structure are becoming a focal point of precision medicine. Millions of dollars are spent on bone fracture care and prevention, which in many cases represents a grave danger to the patient health. In this scenario, can we rely upon available methods to predict bone fractures? Regrettably, the answer is no. Or so it was. Before we introduce QTS in detail, let’s first review some of the available methods to evaluate fracture risk.

DEXA Bone Mineral Density (BMD) limitations as a fracture predictor are widely known. However, despite its glaring shortcomings, it’s still considered as the gold standard in clinical practice. The WHO developed the FRAX tool hoping to improve the low ratio of success of BMD as a predictor, and, while it improves sensibility and specificity in assessing fracture risk, it’s still not satisfactory enough for it to be used as a stand-alone predictor in clinical practice or clinical trials.

In an attempt to fill this void in the search for a reliable predictor, new imaging biomarkers that guarantee to provide the needed sensibility and specificity have been developed. Trabecular Bone Score (TBS®) by Medimaps is a fracture risk predictor using DEXA as a source. TBS® performs a gray level analysis (textures) on the DEXA images to determine bone integrity. But, is DEXA adequate for this task? Unlike regular XR, in which it’s possible to assess the trabecular structure, DEXA’s low radiation is not enough for trabeculae differentiation. In addition, DEXA (like XR) represents a 3D structure as a projection onto a plane, losing spatial information.

Other medical imaging modalities are much more adequate for bone analysis and the subsequent fracture risk evaluation. Thanks to advanced computing models, Quibim has developed a new imaging biomarker that uses either magnetic resonance (MR), computerized tomography (CT) or X-ray imaging for a detailed characterization of the trabecular structure. QTS (Quality of Trabecular Structure) by QUIBIM introduces several advantages over other analysis methods:

  • Real extraction of the trabecular bone microarchitecture: bone volume, trabecular thickness, trabecular separation…
  • Information of the complexity of the structure: fractal analysis
  • 3D spatial information, not only in plane (only CT and MR)
  • 3D reconstruction of the trabecular bone (only CT and MR)
  • Optional mechanical analysis (only CT and MR, with QTS+)
  • QTS Score comprises all this information in a single score for a rapid and accurate characterization of the bone structure.

This groundbreaking analysis method is already available at our cloud web platform: QUIBIM Precision®. Below we detail how to analyze your study in a few simple steps.

QUIBIM Precision® allows the upload of studies in Dicom format. The upload process is easy, intuitive and 100% secure, guaranteeing the patient confidentiality thanks to QUIBIM ’s anonymization and encryption system. The whole process is performed without the need of installing any additional software. To start, click on the green “Upload Study” button to the right of the website.


The platform will then ask for Dicom studies selection. With Google Chrome, we can drag and drop the study folder directly to the dotted box. With any other browser, we need to select the Dicom files to be uploaded.


Once the Dicom folders have been selected, QUIBIM Precision® allows the pre-visualization of the study to choose which sequences we wish to upload. In this case, we need a CT, an X-ray or a 3D T1 MR.

After the selection, the files will be anonymized and encrypted. QUIBIM Precision® will ask for an encryption password before the upload process starts. The user needs to preserve this password, as it’s needed for patient traceability.


After the upload process is completed, we click on the “Analyze Study” button of the study we want to evaluate.


This will take us to the detailed view of the study, where we can perform all actions related to it. First of all, we will choose among all the available sequences the one to be analyzed and its Quibim standard name. In this case, the name of the sequence is “Linear Attenuation [1/cm] (3035)”, which corresponds to the standard name “High Resolution CT”.


Next, we open the embedded Dicom viewer by clicking on “View”. Thanks to this viewer we can draw the ROI that will be used for the analysis. The viewer allows drawing 3D ROIs, first drawing a 2D rectangular ROI, and then selecting the slices on which it should be replicated. Clicking on “Apply” and “Save and go back” will store the ROI and it will be used for the analysis.


Finally, we should choose which analysis method we’ll use among all the available apps in QUIBIM Precision®. In this case we’ll click on the “Start Analysis” button of the “3D Bone microarchitecture – QTS Score” app. The analysis process will then start, and the user doesn’t need to perform any other action than checking the results.


The results of the analysis are available on the view of the study. Once the analysis is completed we can check them by clicking on the “View Study” button on the “Processed Biomarkers” section.


We can examine the 3D reconstruction images and the numeric results of the extracted imaging biomarkers on the results view. Furthermore, we can download them and the structured report in pdf format, which includes all the generated data in a compact, easy to read way.




All the benefits of QTS are just a few clicks away. Create an account on QUIBIM Precision® and start offering a real added value with your imaging studies.

Try us for free!