# Correlation of Bone Textural Parameters with Age in the Context of Orthopedic X-ray Studies
## 4 Discussion  
The objective of the current investigation was to establish a relationship between alterations observed in X-ray scans of bones and the age of the individual. Such changes may not be perceptible to the imaging specialist. The utilization of mathematical algorithms to analyze the surrounding pixel environment affords an avenue for examining modifications in the bone microstructure that exceed the capabilities of human vision [24]. Our study focused on establishing correlations between bone structure in varied regions of interest within the proximal femur. X-ray appraisal is a firmly established method for assessing the skeletal system [25]. The high mineral matrix content adjacent to collagen fibrils resists X-ray propagation, which is the basis for determining the bone shape and clinical changes [26]. Bone is a dynamic organ that interacts with the endocrine system to maintain ion equilibrium and acid-base balance. This interaction relies on the action of osteoblasts and osteoclasts, which are differentiated and activated from osteogenic cells (stem cells) progenitors [12]. The lifespan of both cells is relatively short, with osteoblasts and osteoclasts surviving for three months and one month, respectively [27]. The actions of osteoblasts and osteoclasts are necessary for normal bone metabolism, including bone formation and depletion, and for remodeling bone to provide skeletal support, which varies in different locations depending on the load [28]. Although bone remodeling is a continuous process that involves the complete exchange of bone matrix every ten years, the overall bone mass is not significantly decreased [29]. However, advancing age and menopause are significant factors in reducing bone mass [30]. The gradual decrease in osteons and lamellae, as well as the organic and inorganic matrix associated with functional imbalances between osteoclast and osteoblasts, functions that favor osteoclast function, results in a gradual decline in the volume of osteons and overall bone [31]. The decrease in interconnections between bone trabeculae that form lamellae weakens the bone and makes it fragile and susceptible to pathological fractures [32]. This process of bone deterioration is ongoing in both cancellous and compact bone, which is crucial for load transmission [33]. In this study, two regions of interest (ROIs) were analyzed based on correlations of visual-based textural features. One ROI was located in the metaphysis region, where spongy osteocyte-containing bone with complex architecture is present, directed toward withstanding compression and extension forces concentrated along the main axes (lines) of support [34]. The second ROI was located in the peri-trochanter region, where the compact bone is prevalent. The peak of bone mass is typically reached after puberty (around 20 years) and gradually declines over one's lifetime [35]. This process, although it can be slowed by physical activity and good dietary habits, is inevitable and cannot be stopped. As trabeculae are overall of lower mass, the effect of the gradual reduction of bone mass is higher in locations with initially smaller bony mass, which is consistent with previous studies on the phenomenon of gradual depletion of bony mass [36]. Such changes are visible on traditional X-rays very late--only a loss of about 30% of the bone mass is visible on X-ray. Dual-energy X-ray absorptiometry (DEXA) is much more sensitive, but it is a less thorough examination and is performed in groups of patients at a certain risk of osteoporosis. The reduction in bone mass in the region of the trochanter is significant due to the influence of estrogen cessation [37]. Estrogens are known to be the most powerful stimuli for inhibiting the action of osteoclasts, which are known for their strong remodeling action on bone [38].