Osteoporosis is increasingly prevalent, and the societal impact of age-related bone loss is becoming progressively greater. It is estimated that 4-6 million U.S. women have osteoporosis, and that 13-17 million have osteopenia (Looker et al 1997). The gold standard for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) using dual-energy x ray absorptiometry (DXA) for trabecular/cancellous bone and high resolution peripheral quantitative computed tomography (HR-pQCT) for cortical bone. However, measuring bone density alone does not reflect the changes in bone microstructure associated with osteopenia. Women with osteopenia account for the highest number of fragility fractures, although they remain untreated because of their relatively high areal BMD (Bala et al 2014). In fact, over half of the patients with insufficiency fractures exhibit normal BMD scores (Schuit et al 2004, Sornay-Rendu et al 2005. For a given solid volume fraction or density, two structures with different micro-architectures can have very different mechanical competences. The information provided by BMD is only part of the picture, because it only reflects changes in overall bone mass, and does not account for changes in the micro-architecture. However, osteoporosis and osteopenia affect the micro-structure of cortical bone, through changes in average pore diameter and pore density (Schaffler and Burr 1988, McCalden et al 1993, Yerramshetty and Akkus 2012, Chen et al 2013. The definition of osteoporosis was updated in 2001, and includes both low bone mass and micro-architectural deterioration of bone tissue (NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy 2001). Bio-mechanical and morphometry testing have revealed strong correlations between cortical bone material properties and intracortical porosity (Augat and Schorlemmer 2006). The mechanical competence of cortical bone strongly depends on these two parameters (Osterhoff et al 2016). The size and number of pores determine intracortical porosity, which accounts for almost 55% of yield stress and 70% of elastic modulus (Neil Dong and Edward Guo 2004). Fracture toughness also decreases significantly with increasing porosity, possibly by diminishing the net loading area (Yeni et al 1997). All of these results lead to the conclusion that combining micro-structural with bone mass assessment in cortical bone improves the screening for osteoporosis and the prediction of