Purpose of Review <p>Osteoporosis remains a pressing worldwide health concern. Understanding disease progression and evaluating treatment responses requires comprehensive skeletal assessment. This review presents a novel skeletal assessment – time-lapse high-resolution peripheral quantitative computed tomography (time-lapse HR-pQCT) – and highlights its capability in assessing bone formation and resorption.</p> Recent Findings <p>Time-lapse analysis was validated for in vivo bone remodeling assessment in micro-CT-based preclinical studies two decades ago. Recently, clinical time-lapse HR-pQCT research has demonstrated its feasibility in assessing bone turnover in patients with chronic kidney disease, and in characterizing the spatial distribution of long-term bone gain and loss in response to medications, mechanical loading, disease, and injury. Moving forward, time-lapse HR-pQCT requires validation against the gold standard bone biopsy with quantitative histomorphometry.</p> Summary <p>Time-lapse HR-pQCT is a skeletal assessment capable of evaluating and longitudinally monitoring changes in bone density, microarchitecture, and remodeling dynamics. Rigorous validation and application to clinical imaging modalities will enable its broader implementation.</p>