Bone Density VS. Bone Quality — Is there a difference?

Bone density and bone quality may initially sound like one-in-the-same. If a bone’s density is good, doesn’t it follow that the bone’s quality is therefore good?

Not necessarily!

Bone density and bone quality are actually quite different properties of the bone! The distinctions can make or break (pun intended) your osteoporosis treatment.


Currently, testing for bone density (or Bone Mineral Density — BMD) test has been the most common technique used to determine if someone has osteoporosis. BMD is the primary factor used in the DXA (Dual-energy X-ray Absorptiometry) method.

The current understanding is that bones with a higher BMD are healthier and stronger and less likely to fracture.

However, bone density doesn’t provide a whole picture of bone health.

A denser bone is not always a stronger bone. For instance, sodium fluoride was once thought to be a suitable treatment for osteoporosis. Although fluoride effectively boosted measured bone density (BMD), it actually made bones more brittle and prone to fracture.

Bone health also can suffer without becoming excessively “thin.” Certain illnesses and medications can affect a bone’s structure without a measurable decrease in density, making the bone more likely to fracture.

In both of these circumstances, the bone quality was affected.

Image showing the structure of a normal bone versus one damaged by osteoporosis.


Although there is no precise, quantifiable definition of bone quality at this time, many medical professionals understand it as the combination of all bone properties that impact a bone’s resistance to fracture.

The concept of bone quality extends beyond BMD to include aspects such as bone microarchitecture, accumulated microscopic microarchitecture damage, collagen structure, mineral crystal size and composition.


Bone strength describes a bone’s resistance to fragility fractures. The stronger your bones, the less likely they are to break!

Although some professionals in the field of bone health consider BMD the best (if not the only) way to assess bone strength, research from the last few decades reveals that this is not entirely true.

That means DXA technology, which only considers a bone density (BMD) measurement, has a limited ability to determine fracture risk.

Research shows that bone quality is important in determining a bone’s ability to keep from fracturing. Therefore, testing for bone quality is an important part of assessing someone’s bone health status and assessing the risk of sustaining a fracture.

To get a full picture of bone strength, it’s best to consult with a medical professional who uses technology, like the innovative Echolight EchoS technology, that can assess BMD as well as other aspects of bone quality.


Looking for accurate, complete bone strength testing? Go no further!

The Central Carolina Orthopaedic Associates team uses Echolight EchoS technology and their expansive bone health expertise to provide comprehensive bone density AND quality testing and osteoporosis assessments.

Schedule your bone health assessment today!

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